A Question of Medical Integrity

I entered medicine not because I loved people but as a result of my love of anatomy and physiology. While in high school, I took anatomy and physiology (A&P) and was instantly smitten. And I was good at it–straight A’s. We dissected pigs, cats, worms, and oysters. I was amazed at the organization of organ systems and how they worked in conjunction with each other. At that time, I had aspirations of being a nurse. In my last year of high school, while my friends were taking fun electives, I enrolled in our Regional Occupational Program (ROP). The ROP program allowed me to earn high school credits while working or volunteering off-campus. I worked as a sort of glorified candy striper in the emergency department of my local medical center. I wanted to be a nurse. I thought. There I met the most amazing charge nurse. She ran the ER like a champ. I recognized that she was the one in control of that organized chaos and had to have a pulse (pardon the pun) of what was occurring at all times. I knew I wanted to work in the ER, but at that point, I began to doubt that I would be in the right role as a nurse. When I was in college, I again enrolled in an anatomy and physiology course;  then subsequently worked at the local medical school-associated hospital in the pathology department slicing and storing tissue specimens for the pathologists. Eventually, I would also work as a pathology assistant at the county coroner’s office. One of the best jobs I ever had; it helped solidify that medicine was where I belonged. However, I had no desire to continue to work with dead people. To make a long story short, I loved A&P and decided the best way to see it in all its glory would be in the human body. In vivo. And the emergency department would be where I would see it.

Fast forward to medical school where I was assigned my first patient in the middle of my first year, as part of a patient-based program. I managed the care of a pregnant patient under the supportive and watchful eye of my supervising physician. I followed this individual through her delivery and late into my second year. I was present when she delivered and was involved in the care of her baby. We became so close that I attended her wedding. When I began my clinical rotations, the hard work began. And so it continued and became more challenging through residency. But I survived and subsequently became a board-certified emergency physician. However, a funny thing happened on the way through my journey. A major transformation occurred…in me. The patients, who initially had been interesting objects in which to learn more about A&P, became visible. I was humbled by the fact that these strangers granted me permission to lay hands on them. So I could learn. So I could become the physician I am. They did not know me from Adam; yet they would hand, to me, their most valued “possession”– their child. Inherently believing that I could be trusted because of my oath. I began to view their faith in me as an honor. A privilege. And I had to do right by them. They deserved no less. My actions were recognized when I was nominated by the dean of my medical school, and won, the Marjorie M. and Henry F. Saunders award “for her compassionate care of patients within the family structure”. I was determined that I could not, would not, violate that trust. Ever. Little did I realize at the time the trials and tribulations I would encounter throughout my career to keep that promise. 

I will never support the unsupervised practice of ANYONE not appropriately trained and licensed to practice medicine. Period. Because education matters and people matter. COVID-19 has exposed the best, and the worst, of this country. When I saw the multiple posts on Twitter and Facebook by the AANP, individual nurse practitioners (NPs) and a select few physician assistants (PAs), demanding to be granted “independent” practice throughout the nation so they could better assist in the response to the pandemic, I was both appalled and disappointed. There’s nothing preventing them from assisting now. Nothing. They are on the front lines currently. Their excuse is a smokescreen. It is my belief that their hope is that when this crisis ends, full practice authority (FPA) or optimal team practice (OTP) will not be rescinded. They will no longer be required to fight, state by state, to prove to legislators they can practice medicine without governance. Instead, they will be permitted to do so, carte blanche, with the blessing of unenlightened lawmakers.

The AANP and most NPs are well aware that the nurse practitioner educational system needs a  complete overhaul. It is non-standardized, poorly structured and inconsistent. They know that the majority of NPs graduating today do not attend competitive, high-quality programs. The NPs who “matriculate” at these sub-par degree mills are subsequently released, unqualified, to practice in the community. On people. Like guinea pigs. With no existent process to filter them out. THE AANP KNOWS THIS. But why allow this minuscule fact to interfere with an agenda, particularly during a pandemic? They can protect their families from these particular individuals even if the public can’t protect theirs because they don’t have access to this knowledge. Well….this deceit affects me. Profoundly. People are not Petri dishes upon which those untrained in medicine can practice unregulated. Unfortunately, this is not a new phenomenon. American medicine has a history of engaging in such deplorable acts. The Tuskegee experiment was not all that long ago…1932. Physicians and nurses, Black and White, knew penicillin had been discovered and was being utilized for the treatment of syphilis in 1943. However, the participants in the study were neither informed of nor provided treatment. The study only ended in 1972 because of a whistleblower with a conscience. Then there were the Mississippi Appendectomies (https://www.uvm.edu/~lkaelber/eugenics/MS/MS.html), the sterilization of Mexican women in southern California in the ‘60’s and ‘70’s(memorialized in the documentary, “No Más Bebés”) and the case of Henrietta Lacks (think HeLa cells in medical school). These regrettable events occurred within the U.S. medical environment and involved all disciplines of health care professionals. They continued because medical oversight was lax, laws were not stringent, the public didn’t know and legislators and health care professionals didn’t care enough to get involved or prevent it. It only took one or two people with principles to expose the wrongdoing. Currently, we have people practicing medicine without a medical license and without regulation. And legislators willingly turn a blind eye to any consequences that may occur as a result of their poor political decisions because they benefit from the votes they receive for a job well done. Welp, those who do not remember the past are condemned to repeat it.

Governors granting FPA to nurse practitioners and physician assistants without regard to their training and capabilities to practice unsupervised is immoral, irresponsible and indefensible at best and criminal at worst. THEY ARE AIDING AND ABETTING THE UNLICENSED PRACTICE OF MEDICINE. The fact that we are in a pandemic excuses nothing. Desperation excuses nothing. We must do right by the public who have placed their trust in us. Especially when they are at their most vulnerable. Poor care will occur in this crisis, including by physicians. It is inevitable. But certainly one must ask if physicians, who are the only health care professionals trained and licensed to practice medicine legally can commit errors, what is the likelihood those not trained in it can do the same? Perhaps worse or more frequently? Then what? What do we tell the families? Oops?

One does not learn medicine adequately by apprenticeship nor by working for decades in another profession that appears to mimic medicine. Were that the case, the Flexner Report would have been unwarranted. Legislators, do not allow individuals who have not been appropriately trained in an acceptable, appropriately accredited, nationally approved, competitive, standardized medical program, to practice medicine unsupervised. Regardless of the reason. Because it is wrong and you know it is wrong. It is this abdication of one’s integrity that frustrates me….because it is a choice. But mostly because it’s just….not….right. 

Education matters people. It matters.

https://www.aanp.org/news-feed/five-states-take-action-to-expand-access-to-care-during-covid-19-pandemic