When Hell Freezes Over

Earlier this year I was reading an article entitled, “The Death of Expertise”(https://thefederalist.com/2014/01/17/the-death-of-expertise/?fbclid=IwAR0PTqplHQQSRifprtAOjY7u9dDYyTGyKFBGcaBwTwbQNF_PlxamhF8RVZs). It was a brilliantly written piece of work expounding on the current cultural phenomenon of individuals possessing a particular aptitude for a particular skill or specialty being challenged by those who have no proficiency in said skills. The fact that the demand for proof of prowess has no real basis in fact is irrelevant. To the challenger, it seems perfectly logical. Any pre-existing, well-founded evidence is dismissed and replaced by whimsical thought and baseless opinion.

I too have been baffled by this same assertive attitude in medicine. Non-physician practitioners(NPPs), particularly nurse practitioners(NPs), with no medical training, insisting physicians demonstrate that their healthcare outcomes “are better” than those of NPs. Legislators, whose knowledge of medicine is damn near non-existent, demand the same. To make such a claim, one must presume that medicine and nursing are equivalent. How can they be? Nursing is nursing, medicine is medicine, and neither the twain shall meet. The training models are completely different, as are the licensing boards and the licenses themselves. That I have to clarify this is ludicrous. One cannot compare apples and potatoes, they are incomparable. Yet, that is exactly what is occurring in this scenario. So then one must ask how is it possible to compare outcomes between the two? It isn’t. But the so called data exists stating that their outcomes are equivalent, right? Balderdash. If one legislator with a degree of sense and research experience would review one study, the lack of quality of the study would become apparent. Most, if not all of the studies, utilize SUPERVISED NPs. One must again ask, how does one compare outcomes for UNSUPERVISED NPs using data for SUPERVISED NPs? That alone should indicate that the study is irrational. Nevertheless, attempting to convey this to those who have a vested interest in maintaining such illogical thinking is an exercise in futility…Let’s just say it would be much easier to move the Rock of Gibraltar. What we are witnessing is fiction becoming fact as a result of persistent rhetoric. Imbecilic.

No one would demand that attorneys prove that their outcomes in criminal cases are better than those of  paralegals. It is safe to assume that the attorneys would have a higher success rate because they have more extensive training and expertise. I submit that if a defendant was standing before a judge and jury awaiting the decision on a life or death sentence, he would most likely take his chances with an attorney. Yet, in medicine, not only is our expertise questioned, nurse practitioners have the unmitigated gall to suggest that they are actually equivalent to physicians. And for legislators to expect us to prove they are not is beyond insulting.

There are some things that do not require evidence because, by their very nature, the answer is apparent. So allow me to school you. Teachers do not have to demonstrate they are more qualified than student aides to teach students, it is presumed based on training and education. Attorneys are not expected to prove mastery of their craft for the reasons stated above. The same applies to physicians…or it should.

Our medical educational system is modeled after Johns Hopkins, an undoubtedly premier medical and academic institution. It is a result of the Flexner Report which mandated the standards of medical instruction which continues to be followed to this day. This model ensured that medicine would be safer, more consistent and of higher quality for the public to receive optimum care. THAT WAS ITS PURPOSE AND THAT PURPOSE HAS NOT CHANGED. Nursing has no such standard. Not today.

The practice of medicine has never guaranteed perfect outcomes. Ever. How can it when those practicing it are imperfect human beings and fallible? However, one can be assured that there will be less chances of errors(compared to NPPs)based on training and aptitude. Practice makes damn near perfect. There is an assumption, culturally, that when a physician’s services are required, it is the highest level of competency that is expected. And that is with good reason. Because of the extensive training and education that is REQUIRED to understand and practice medicine. The human body and its ills ain’t no joke. 

I can absolutely say, WITHOUT COMPUNCTION, that medicine is safer when practiced by those licensed and trained in it. That would be physicians. Does that indicate all physicians are safe? That would be silly and I need not qualify that further other than to say dangerous physicians are why medical boards exist. The high standards of medical training have endured hundreds of years since the Flexner Report. Thus, by extension, so have the standards in the practice of medicine. Cannot say the same about nursing. Education matters. Standardized, quality education matters even more. Lives depend on it.

Legislation cannot make nurses into physicians. Sham doctorates obtained online in less than 2 years does not create physicians. Hijacking medical terms typically used in the medical lexicon does not a physician make. Long white coats and a “white coat ceremony” makes no one a physician, an expert in medicine nor anything else for that matter. Medical school and residency. That’s it. That is the path to physicianhood…and mastery of the practice of medicine.

“The practice of medicine is the gold standard by which all other disciplines of health provision are measured. The onus is on them to prove, with VALID evidence of sound quality and unquestionable standards and methodology, that their discipline measures up.”

Lesson over.

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