Have you heard of Seth Godin's free education manifesto Stop Stealing Dreams?
In this manifesto, he discusses the history of education in America. How it was tailored to create "cogs in an industrial machine" rather than the much-needed linchpin's necessary to drive future innovations.
"School has become an industrialized system, working on a huge scale, that has significant byproducts, including the destruction of many of the attitudes and emotions we’d like to build our culture around."
"In order to efficiently jam as much testable data into a generation of kids, we push to make those children compliant, competitive zombies."
At times I fear the education of doctors and PAs has headed in a similar direction.
While attending conferences or reading through required CME I fear we have become cogs in a pharmaceutical machine.
One trick ponies taught to think pill first, everything else a distant second.
If we want to create great PAs of the future it starts with giving our current generation of students the tools they need to overcome the cognitive dissonance that resonates in today's medical field.
The one that sees an obese, diabetic patient with hypertension as the perfect candidate for Metformin and a new script for Lipitor. Rather than a perfect case for the intense lifestyle interventions and hard work necessary to actually improve long term health.
I am afraid many in today's generation have allowed themselves to be limited by fear.
Industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination.
A Physician Assistant Education of the Future:
Now students have access to more than just the medical textbooks and the best advertising big pharma has to offer.
We can break the cycle of prescriptions and compliance.
With this comes empowerment and better health care for our patients.
Also, a greater responsibility.
To be advocates for our patients, pioneers of new innovations that offer integrated approaches to health care solutions.
Not passive observers to a health care industry plagued by misinformation, a pharmaceutical focused approach to patient health at a cost to our patients that is truly non-sustainable.
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Jaclyn says
February 23, 2014 at 5:24 pmI’m exploring making a career change to become a PA, and feel lucky to have stumbled across your blog! Great article.
Stephen says
February 26, 2014 at 11:38 pmThank’s Jaclyn!
Christi says
October 12, 2012 at 4:29 pmStephen,
I’m with you. I’ve been a PA for ten years and agree that healthcare is a social issue the free market can not fix. I’m not gonna bother arguing my point, even though you two have been polite about your differences. Ana seems to be paraphrasing a website she relates to rather than forming an objective opinion only years in the field can form. She seems passionate about what she believes in which can translate into a passion to take care of her patients in the future!
Christi
P.S. stumbled on yr website looking for resume advise 🙂 and I enjoyed having universal healthcare as a young adult in Canada so I’m a little biased.
Ana says
June 27, 2012 at 1:35 pmGreat article. You articulated a very serious problem with our current healthcare model. I am particularly interested in preventive medicine. How much did your PA training focus on nutrition, exercise, and other lifestyle interventions? Are you ever pressured,by either the supervising physician or patients, to prescribe medications when you know that lifestyle interventions are what is truly needed? With the growing problems of diabetes, Alzheimers, and obesity in this country, it is disheartening to see the focus on pharmaceuticals.
Stephen says
June 28, 2012 at 12:12 amHi Ana,
I had very little training on nutrition, exercise, and other lifestyle interventions. Something that didn’t really occur to me until about year 6 into my practice.
I am sure you have heard Einsteins definition of insanity:
“Doing the same thing over and over again and expecting different results.”
After many years of countless prescriptions for Zocor or Paxil and complaints of “non compliant patients” I realized something critical. It wasn’t the patients, but it was my approach. Thus began a paradigm shift, one that was focused on intense lifestyle changes first, with medicines a distant second. 2 years later I found most of my patients were achieving their A1C goals, off most of their meds, feeling better, and many had lost a significant amount of weight (if necessary).
My approach towards diet and exercise was mostly self taught and revolves around my own obsession with such topics.
It is a shame that this is not the focus in medical school, and I have become more suspect over the years… many conferences later, and believe that much of med school education and what we learn afterwards is dominated by a pharmaceutical “incentivised” health system.
As medical professionals I believe we want what is best for our patients, if we understood such topics more thoroughly we would implement them better, regardless of it’s time intensiveness, Every good practitioner I know wants what is best for their patients.
Doctors have never pressured me to prescribe, although many doctors I know appear to be unaware of an alternative.
Ana says
June 28, 2012 at 11:19 amThank you for your insight. I’ve read two books that address how the ‘official’ guidelines and treatment plans for diabetes and obesity, major health problems facing our country, have been largely determined by big pharma to the detriment of patients. I think that these books should be required reading for every healthcare professional (every American for that matter).
Why We Get Fat: And What to Do About It by Gary Taubes
Sugar Nation: The Hidden Truth Behind America’s Deadliest Habit and the Simple Way to Beat It by Jeff O’Connell
I will be applying to PA school next year and this information has really changed how I hope to practice medicine. With the new healthcare act, I am concerned that we are moving even further away from quality care for patients.
Stephen says
June 29, 2012 at 8:02 amIt’s funny you say that, as both “Why we get fat” and “Good calories bad calories” are also on my “must read list”. I read both books last year after finishing Atkins Diabetic solution…. Also a wonderful book!
I am curious why you think the new health care act is a step away from progress. I am aware of it’s many flaws but I feel this is just the progression toward universal healthcare. I guess time will tell.
Thanks for your thoughtful comments
Ana says
June 29, 2012 at 10:03 amYou are right about this being a progression toward a universal healthcare system, but I do not see that as a good thing for Americans as far as patient care and access are concerned. Obamacare will only increase third-party interference in the doctor-patient relationship, increase costs, and reduce the quality of care. Insurance is not the solution but rather the root of the problem.
The healthcare crisis has been a 100 years in the making and we certainly are reaching a tipping point. We need reform, but the changes being pushed now are only going to make matters worse for all Americans.
These are some of the articles that have informed my understanding of the healthcare crisis and its origins. I hope you will be able to read a few of them and let me know what you think.
“Government Medical ‘Insurance'” by Murray Rothbard
http://mises.org/daily/6099/Government-Medical-Insurance
What Soviet Medicine Teaches Us
http://mises.org/daily/3650
“What’s Really Wrong with the Healthcare Industry” by Vijay Boyapati
http://mises.org/daily/4434
For more on the subject, here is a really extensive reading list.
http://mises.org/daily/3737#IDComment391571204
Stephen says
June 30, 2012 at 7:44 amI am confused then as to what you think is the solution… Universal healthcare to me is as much about policy as it is about morality. I agree fully that healthcare insurance will continue to drive up costs. Medicine works best as a “Social Business” one that we have not seen in the United States. I have paid witness to good families demolished by illness and cost, to me there is no excuse for this and there never will be.
As it stands there is a bubble in America where a hardworking, law abiding citizen who falls victim to tragedy out of their control can lose the shirt off their back. Not to mention with the cost of health insurance premiums those who have access to care do not use it. This is something that the new health care policy fails to correct. Yet, we see to it that things like lifetime maximums have been abolished.. A Doctor I work with fell victim to this. Two years into her son’s treatment for Leukemia her insurance dried up (the same “insurance” I have)…. Good thing she was a Dr. For many of my other patients they are not so lucky, they go without treatment.
Doing nothing at all is not the solution.
I personally think there is a large need for pay for service medical clinics staffed by Physician Assistants. We could do day to day care and urgent care for a fixed price… say $60. The health insurance would be there to cover “the bad stuff”. And for this I am not sure how we would control price as we continue to make advancements. Part of it is controlling the lawsuits, and what companies are allowed to charge, also a focus on public health i.e. everyone should be made to read “Why we get fat”.
What is your idea of a good model for solving the American Healthcare Crisis? Do you think it would have been best that we voted out Romney care? It seems we as healthcare practitioners should be partially to blame as it is our great apathy that has led in part to the crisis don’t you think?
By the way, some thought provoking articles… Thank you for sharing them with me!
Stephen
Ana says
June 30, 2012 at 9:09 amI agree that no American deserves to lose everything due to a sudden illness. The only way to minimize this problem is to drive down costs and I believe a free market system can do this. The US once had a healthcare system that was the envy of the world, we had the finest doctors and hospitals, patients received high-quality, affordable medical care, and privately funded charities provided health services for the poor. This guy does a decent job explaining the exact steps we need to take to return to model of care. It’s really exciting once you imagine the possibilities. http://libertyfeed.tumblr.com/post/26114440069/the-freedom-solution-to-healthcare
The Affordable healthcare act has many flaws but there is one part that I am strongly opposed to: the Individual mandate. Say for instance, I wanted to provide potable water to everyone in the developing world that currently lacks access. Would a logical first step be for me to tax or fine the individuals that lack clean water? Of course not. That would be absurd, yet this is exactly what the individual mandate does. It levies a tax or penalty on those without life insurance. Not only will forcing people to buy health insurance not fix the current system, it is wrong and unconstitutional (under the commerce clause).
I know when I mention the free market, some of my friends imagine chaos and people dying in the streets but it would actually function something like what you suggested….costs would go down enough that most people could afford to pay for routine care out of pocket and only use insurance for the ‘bad stuff’. We have to introduce price mechanisms back into the healthcare system. Right now, both patients and doctors are blind to the real costs through no fault of their own. There is simply no incentive to drive down costs when a third party foots the bill. In reality, we all end up paying more. This news report shows how Whole Foods uses personal health savings accounts to drive costs down (http://www.youtube.com/watch?v=3WnS96NVlMI).
I do hope that the healthcare act is repealed. Americans know the system is broken, so any reform seems like good reform. Unfortunately, the healthcare act will have negative effects on the entire economy and only increase the number of poor and unemployed.
Thank you for taking the time to consider my perspective. I’m enjoying our discussion!
Stephen says
June 30, 2012 at 2:48 pmI don’t even know where to begin, which is a sign that I too am enjoying this conversation. You are working out parts of my brain that have needed to do some lifting.
Just to let you know I don’t agree with these aspects of the Liberty Feed article you sent me:
1. Eliminate all medical licensing: What next eliminate licensing commercial pilots? Because my airplane trip to the East Coast a few months ago was quite expensive.
2. Repeal all laws requiring healthcare to those who cannot pay. The savings will be passed onto patients… Yes dead ones!
3. Eliminate coverage for the elderly, poor and children because of staff and paperwork. Why not just eliminate the paperwork instead? Single payer eliminates 40% of the billing costs, most of which is incurred because of the fact there are so many payers.
What I do agree with:
1. Eliminate pain and suffering as a way for LAWYERS to extract wealth from from another party in a civil lawsuit. But here the problem is often not the patient.
A lot of this seems to be more a social problem then a healthcare problem. What we need to do is eliminate poverty and then I agree your plan may work.
I grew up in Stockton California (you may have heard about us on the news recently) 19% of families there are unemployed, and what kind of job prospects are out there for them? Many people right now don’t have enough money to pay for groceries not to mention housing, electricity, or a tank of gas. How are they going to afford treatment for their 2 year old who is born with Cerebral Palsy? I ask you to look at this family and tell them to ask their friends for money or go to a local church so they can afford a wheelchair. And again the rich get the most benefits, the best medical devices and the best care. I have never had a patient who has had Lasix, or braces for that matter.
What kind of society is this?
Again the healthcare problem is in part a social problem.
Also you seem to assume that the “free market” actually cares about people… Repeal the laws requiring healthcare providers to provide healthcare to those who cannot pay…? The fact that this law even “needs” to exist is proof positive that the free market is actually the “ME” market.
Just look at the current state of affairs we are in. This is what happens when free markets are left to run without checks and balances… Greed.
If we create cash for service clinics that compete with an insurance market costs will come down. Technology allows me to do things for a quarter of the price I could just 3 years ago and it will continue to get better. But again medicine should be a Social Business, traded on a Social Market, that is not allowed to make profit of of peoples suffering.
We cannot eliminate protections, people will die and people will get hurt. We are just too far down the rabbit hole to do what you are suggesting. I understand it, in part I agree with it. But the human cost goes beyond what I am comfortable with. To deny a human cost with the plan you are suggesting is living in an alternative reality.
I assume that you care about people that is why you are going into the healthcare field, so I know you are a good person.
You and I essentially want the same thing. So why don’t we work to create the kind of system we want to see?
Complaining about government and repealing laws won’t help. If you want a free market system create it, there is nothing stopping you. As you said the system under insurance is way overpriced and this leaves a big opening for those like yourself and I who have the skills to step up, create a cheap health solution and make the world a better place along the way!
Stephen
Ana says
June 30, 2012 at 5:53 pmPhew, this is getting tiring. First some clarifications on where I stand on the three points.
1) There are many ways to demonstrate competency. I am arguing against the AMA’s essential monopoly on licensing. There could be other mechanisms that could protect patients. Licensing does not protect patients. It hurts them by limiting the supply of doctors and raising costs.
“A recent example of the AMA’s use of licensure was their attempt — ostensibly for “patient safety,” — to regulate Walmart’s creation of low-cost retail clinics by preventing the clinics from operating using only nurse practioners.[10] The practioners would have only been providing very basic medical services, such as administering needles and prescribing drugs, which Van Ruth et al. conclude carries no extra risk to patients.[11]
It is precisely the sort of clinics operated by Walmart that allow consumers — and especially the poorest in society — access to basic, affordable healthcare. By regulating these clinics and reducing the supply of doctors and providers, the AMA has caused higher prices for American consumers of healthcare.”
2) Many hospitals would choose to provide care regardless of ability to pay and I believe this should be voluntary, not done by force.
3) With so many dependents, government provided healthcare would have to be phased out over time. I am not for destroying these programs overnight.
Stephen, as you said, this is truly a social problem as much as it is a healthcare problem. What do you see as the role of government in healthcare? What do you think the role of government is in general? I’ve pretty much exposed my views as libertarian with all my links to the Mises Institute 🙂
The reason I am critical of some government policies is because they have real and long term consequences on all of us, from the safety of the cars we drive to the purchasing power of the dollar. Poor families cannot afford food, housing, or fuel, much less healthcare. Monetary policy and increasing inflation are decided by the Federal reserve and our government. These policies directly effect the growing numbers of impoverished in this country. We cannot ignore this if we seek to change things for the better. More people need to understand the causes of our nation’s problems as our economic circumstances worsen, so that we don’t offer more of the same as the solution.
The free market has been wrongly blamed for all of our ills. Unfortunately, we do not have nor have we had a truly free market. A free market consists of free people making decisions that allows them to better their lives by providing services or goods to others. Force and coercion are not part of a free market system.
If I wanted to go out now and feed the homeless, did you know I could be fined several hundred dollars in several US cities for not having applied for a costly permit? Is that compassion? Does that protect homeless people? Regulations and laws only protect those with the money and power to lobby for them in the first place. Rewarding greed through government has gotten us into this mess. Only a free market can maximize creative energies, reward those that provide services, punish those that harm consumers, and ultimately, increase the living standards for ALL people. Consumers choose the winners in a free market system. Right now, we have a corporate-fascists system whereby a small elite leach off the public through the government.