In May 2020 I wrote an article on the absurdity of various health care disciplines being granted the right to practice some form of medicine without the appropriate training(https://authenticmedicine.com/2020/05/what-kind-of-fkery-is-this/). It was both satire and cynical. What was not clear was my sincere, underlying concern about the trajectory education is taking in the healthcare arena.
There was a time in America when education was at its best. I saw it, lived it and loved it. The U.S. was a leader in science, technology, engineering and math. I felt extremely fortunate to have received the excellent public education I did, much of it courtesy of the Department of Defense(DOD), when my Dad served in the Air Force. We traveled to various countries which also contributed to my social education and appreciation of other cultures. Upon settling in California, my parents began seeking a home located in an area where their children were ensured to receive a proper education. At that time, the community in which we would eventually reside generally avoided selling to Blacks. Nevertheless, my parents persisted and found a home. The year I graduated, my public high school was in the top 10% of the nation in both academics and sports. It was common for most of the graduates to go to college. I followed suit.
While I was in college, I began lecturing on the value of education. Beginning in childhood, my mother would take us children to the library weekly. There we would check out books and excitedly go home to read them. Then we would exchange with each other. It was not unusual for us to read 3-4 books in a week, in addition to our school books. Also, our mother encouraged us to enunciate clearly; she believed that when one is educated one should speak as if they are. She would ignore us if we used fabricated words or slang, we would have to find an appropriate alternative. When we would ask her to define or spell a word, she would simply advise us to look it up in the dictionary or encyclopedia. That forced us to sound out the word enough to know the letters, then we could search for it. Webster’s Dictionary was a well-used staple in our home. My favorite books to read were part of a series called Childcraft Encyclopedias. My maternal uncle bought it as a gift for his nieces and nephews. It was that series of books that sparked my interest in science. From that point I became engrossed. It was years before I understood that my mother’s dedication to our understanding and mastery of the English lexicon was done to improve our comprehension and empower us. Comprehension enables one to openly embrace more information; thereby absorbing a wealth of knowledge. Knowledge is power. That power is emancipating. Mom wanted us to recognize that there is no limit to our ability to be victorious in our goals, except the limitations we place on ourselves. This from a woman who never completed high school but read voraciously. She is the most inspiring person I have ever known.
Over the years and to my dismay, I have witnessed the decreasing importance of education in our nation and the proliferation of false achievements, manifested in “toilet paper” degrees. Easily obtained online degrees and certificates for any field one can imagine: healthcare, law, business, education, etc. Manipulation of words/titles give the impression to the unsuspecting that one possesses an aptitude that one, in fact, does not. In my opinion, most who seek these degrees have a sincere desire to advance their lot in life. Unfortunately, they do so by choosing the road most easily traveled. The less challenging journey. I recall when I came home one day from high school. Crying. I told my mother that I failed chemistry. Despite doing my best to understand it and receiving extra tutoring from my teacher after class the entire semester, I failed. She showed no anger. Her response, “You tried. You challenged yourself. I’m proud of you. I’m more worried about your sister who is not challenging herself.” I was speechless. My mother was proud of me. Not because I failed, because I tried my best. She had faith I would do better…the next time. Suddenly, I didn’t feel so much like a failure anymore, because I knew I could try again…and triumph. By the time I was in college, I was tutoring organic chemistry, a course in which I had received straight A’s.
It is mortifying to me to now be a disheartened observer of the devaluation of education…at a professional level. Health care professionals who have no desire to challenge themselves. Just an intense drive to reach the end-goal, by any means necessary, by the shortest route possible. Currently in Texas, optometrists wish to perform eye surgery; however, they have no interest in developing proficiency as opthalmologists have, by attending medical school and completing a residency. Nope. They have determined that the path of least resistance is more desirable; by legislation, not education. The same with nurse practitioners(NPs), certified nurse midwives(CNMs) and certified registered nurse anesthetists(CRNAs) seeking Full Practice Authority(aka practicing medicine without a medical license), physician assistants(PAs) seeking Optimal Team Practice(aka practicing medicine without a medical license), psychologists seeking prescription writing rights(aka practicing medicine without a medical license), dental hygienists seeking the ability to provide anesthesia services(aka practicing medicine without a medical license) and chiropractors seeking to treat neurological conditions(aka practicing medicine without a medical license). The theme is obvious. Everyone wants to play doctor; however, no one wants to do the actual work it takes to become one–that journey is just too damn long and laborious. One significant difference between all of the aforementioned disciplines and medicine is physicians learn how to manage the complications that may occur as a result of their practice and/or procedures. There may be times when they have to refer to another colleague. When it is appropriate. Those determined to practice medicine without a medical license don’t learn how to manage the serious complications of their actions. Thus, when an optometrist punctures an eye, who is supposed to repair the damage? Not the optometrist, but the opthalmologist. When the psychologist f**ks up the pharmacologic management of a patient because he/she has no appreciable understanding of the marked dangers of anti-psychotics, who is expected to address that complication? The psychiatrist or in the case of imminent death(ie: neuroleptic malignant syndrome), the emergency physician. A dental hygienist will most certainly have no ability to manage any complications arising from the administration of anesthesia. These charlatans expect to enjoy the “fun” aspects of practicing medicine without the responsibility of treating the complications or accepting the inherent liabilities. The legislator proposing ALL of these bills, who is a registered nurse, has no concerns regarding these issues whatsoever. None.
What exactly are these legislators thinking? Medical expertise seems to have become an amorphous, indistinct entity that is no longer recognized as requiring focused, formal, structured training. Some non-physician practitioners(NPPs) have arbitrarily decided that the mastery of medicine is nothing but hype and is not as difficult or complex as it is made out to be. Benighted legislators apparently agree. The fact that we are in the middle of a pandemic, caused by a virus that was identified by physicians who recognized something was different about this particular presentation of SARS, still does not register as anything that requires erudition. Perhaps, in their mind, the virus’s discovery was an educated guess. The clinical presentation of SARS-CoV-2 wasn’t identified by NPs. It wasn’t identified by PAs. It wasn’t identified by dental hygienists. It was identified by physicians. As was AIDS. The discovery of various diseases, vaccines, medications, etc. are generally made by physicians and scientists, not those who perpetrate them.
Education provides knowledge and knowledge is power. That power is beneficial to us as individuals and our society. When that education is adulterated to effectuate a means to an end, it earns contempt, in my opinion. The individuals willingly participating in these acts ultimately dishonor themselves. One cannot demand respect for sub-standard, non-challenging, contrived “achievements”. One commands respect when success is attained the proper way, the honorable way. Sometimes that “way” is grueling. So be it. Nothing worth having ever comes easy. It’s not supposed to. If it did, one could never have true appreciation for one’s success.
“Real education must ultimately be limited to men who insist on knowing, the rest is mere sheep-herding.”–Ezra Pound