Wither medicine?

LuckyLisfranc · Dec 13, 2010

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An interesting piece reported in the Australian Doctor and other media outlets today, where the outgoing editor of the Medical Journal of Australia has taken a swipe at nurses and other health professionals (such as podiatrists) taking over the traditional roles of medical practitioners;

Some 60 years ago, Lord “Tommy” Horder, the doyen of British physicians of that time, addressed a meeting on the theme “Whither medicine?”.1 He suggested that a visitor from Mars would have found such a question incomprehensible and would have responded, “Why, whither else than straight ahead ...” It was a time when the role of doctors was unambiguous: to care for patients and draw upon their scientific and clinical training to promote the “forging [of] still more weapons with which to conquer disease ...”Now move forward to present times and ask the same question. Sadly, the Martian will be confused. The central tenet of medicine has not changed, but the role of doctors certainly has. This has become blurred by the significant influx of other professionals into clinical practice, often usurping doctors’ roles through task substitution.2 We now have nurse practitioners and physician assistants in general practice, emergency medicine, rural and remote medicine, obstetrics, surgery and other areas of clinical practice.Nowhere is doctor displacement more evident than in general practice. Nurse practitioners now have access to autonomous practice, in which they enjoy Pharmaceutical Benefits Schedule prescribing rights and Medicare Benefits Schedule arrangements for which remuneration is not all that different to that of non-vocationally registered general practitioners.3 To further compound this sudden elevation of their role, nurse practitioners’ earnings will soon exceed the current reimbursements for non-vocationally registered practitioners, through indexation (J F O’Dea, Manager, Medical Practice Department, Australian Medical Association, Canberra, personal communication). Nurse practitioners operate within the framework of recent federal legislation that requires loosely formulated “cooperative agreements” with GPs — an arrangement that is ripe for entrepreneurial exploitation.One may well ask how we have come to this turn of events. Firstly, the powerful Australian Nursing Federation has been without peer in influencing an ideologically driven federal Minister for Health and Ageing and promoting the cause of its members. Secondly, there is the federal government’s implicit agenda of fostering competition through levelling financial rewards and downgrading comparative professional intellectual standards. Underpinning this ongoing absurdity is the fallacious assumption that equivalence (between doctors and nurse practitioners) exists, where there is none.Paradoxically, coverage and critique of these policy developments have mostly been confined to the medical tabloids — exemplified by recent letters in Australian Doctor (Box).We must ask ourselves: what can be done at this late stage?The role-substitution campaign has been based on a blurring of what defines a doctor and what a doctor does. These questions of identity have occupied overseas institutions such as the Royal College of Physicians and Surgeons of Canada, in its CanMEDS project,6 and the medical colleges and British Medical Association in the United Kingdom, with similar projects.7 But it remains an inescapable and uncomfortable fact that the respective university selection processes for medicine and nursing, and their subsequent training, are poles apart — in content, depth of learning, and intellectual rigour. These inherent differences have been specifically designed to meet the needs of distinct and differing roles — valuable roles, which work best in a symbiotic relationship.Unfortunately, we have no accepted definition of a doctor in Australian medicine. It is long overdue! For too long there has been a tendency to devalue excellence and achievement. Furthermore, it could be claimed that organised medicine might be more affirming of the skill and expertise of doctors and less appeasing and accommodating of clinical practice by non-doctors. In short, doctors need to affirm their expertise, as currently the only practitioners whose skills and talents are extolled, especially by the Minister, are nurse practitioners. It is time for the profession to stand up.
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Yet, in the very same edition of the MJA, we see research pointing to the decline in medical student training in Anatomy, such that optional courses are now being offered. As The Australian reports;

Anatomy stumps medical students

Adam Cresswell, Health editor
From: The Australian December 13, 2010

ANATOMY teaching has been cut back so much that medical students have been unable to identify important body parts.

In some cases, students who volunteered for a catch-up crash course in anatomy could not answer when asked to identify specific anatomical structures, such as major blood vessels, in partially dissected human specimens.

In a few cases, students responded with fictitious names of body parts that did not exist.

The seven-week course in full-body dissection, run earlier this year at the University of Sydney, proved wildly popular with the students who completed it -- and had a dramatic effect on their anatomical knowledge.

The students were tested again halfway through and at the conclusion of the course, and both times the 29 students achieved almost perfect scores.

The findings, by a team led by George Ramsey-Stewart, professor of surgical anatomy at the University of Sydney, promise to rekindle controversy over the scaling back of anatomy tuition nationwide.

Detailing the results in today's edition of the Medical Journal of Australia, Professor Ramsey-Stewart called for a standard national curriculum for anatomy -- something resisted by most medical school deans -- that included dissection.

He also called for "barrier" assessments, requiring students to gain a pass mark before being able to progress in their degree course.

Structures some students failed to identify correctly included the abdominal aorta -- the biggest artery in the abdomen -- and the sciatic nerve, the longest and widest nerve in humans that runs from the lower back into the leg.

Professor Ramsey-Stewart said while it would be wrong to make too much of the students' poor results in the first tests, it was nevertheless "of concern" that one-quarter of all the answers given by the students betrayed worrying gaps in their knowledge.

"It's a problem for most universities . . . I hear from my anatomical and surgical colleagues that it's across the board," he said.

However, he said the students involved were too advanced in their course to have benefited from curriculum changes introduced by the University of Sydney in 2007, when anatomy teaching hours were trebled.

Doctor and researcher Steven Craig, who in March published a study that found teaching hours for anatomy varied from as few as 56 hours in one medical school to 560 hours -- said improvements in anatomy teaching to date were mostly "a patch-up job".

"These sorts of (voluntary dissection) courses are fantastic -- for the students who get to do them," Dr Craig said. "But if they can only accept 30 of the 250 students (it needs expanding)."

Australian Medical Students Association president Robert Marshall rejected the call for a national curriculum, and said such studies ignored the fact that much anatomy tuition was incorporated into other activities.
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So, let's try and get this straight. The medical profession should be mobilising its (not inconsiderable) forces to attack non-medical groups because they are usurping the role of medical practitioners, yet new doctors don't know how to identify the largest artery in the human body.

A case of having it both ways? :dizzy:

LL

NewsBot · Dec 13, 2010

LuckyLisfranc said: ↑

Yet, in the very same edition of the MJA, we see research pointing to the decline in medical student training in Anatomy, such that optional courses are now being offered.
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Here is the ABC's take on that story:
Medical students struggle to name body parts

Only nine out of 26 students in the survey managed to answer half of 20 questions correctly.....

Almost a quarter of the total answers were "of concern", indicating a perfunctory knowledge of human anatomy.......

All participants were considering surgery as an option.
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Boots n all · Dec 13, 2010

So is this the incentive we need to write on our self before surgery.

"No not this leg, the other one" "Cut along dotted line"

"Please turn over"

Definitely not something to read the night before you have surgery:empathy:

Paul Bowles · Dec 14, 2010

I once had the pleasure of meeting a patient who was meant to have a sural nerve biopsy taken by a surgeon, and ended up with posterior tibial nerve damage. The funny thing the puncture site was on the lateral side of the ankle! Go figure!

Wither medicine?

LuckyLisfranc Well-Known Member

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Wither medicine?

LuckyLisfranc Well-Known Member

NewsBot The Admin that posts the news.

Boots n all Well-Known Member

Paul Bowles Well-Known Member

AQP will it wither on the vine

Continuing professional development opportunities for endorsed for scheduled medicines podiatrists

LECOM Opens New School of Podiatric Medicine

Toenail Dust as a Potential Occupational Hazard in Podiatric Medicine

Establishment of Japan’s First “Podiatry Medicine Center” in a University Hospital

Australian podiatrists scheduled medicine prescribing practices

Acoustic medicine for the treatment of musculoskeletal injuries

Share This Page

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