Monday, January 30, 2012

In Response to Shaun Johnson's Blog: "What if We Treat Doctors the Way We Treat Teachers"

The central argument of the blog: can be summed up in the following statement from the writer, who predicts the doctors' retort to being treated with the same accountability measures as teachers: "We can't control what our patients do or eat outside of our offices to maintain minimum levels of health. Also, these variables -- BMI, cholesterol, blood pressure -- are limited and don't adequately measure a healthy person. And one other thing, you can't expect us to be evaluated based on all patients equally, regardless of family history, poverty, and other complications." I have one basic response to this article, and it involves a deeper look at the comparison between the teaching and medical profession.
Although I am no expert on this matter, I believe that if you made automobiles a metaphor for the two professions (teaching / physician); one profession would be closer to a Model T Ford (teaching) and the other – by comparison – a Lexus (physician). To be clear, I am not talking about the people in the profession, I am talking about the profession itself.  There was a time when the medical profession and those who graduated from medical schools were held to very low standards. However in 1910, Abraham Flexner, an educator by trade, published a report that shared his findings on the medical profession. His conclusion? The medical profession (in large part due to low standards in medical schools) was operating in the dark ages, and lives were being lost as a result. Here is a summary of Flexner’s five findings in exact wording (yes, I tracked down and read portions of the 1910 report).
1.       For twenty-five years past there has been an enormous over-production of uneducated and ill trained medical practitioners. This has been an absolute disregard of the public welfare and without any serious thought of the interests of the public….
2.       Over-production of ill-trained men is due in the main to the existence of a very large number of commercial schools, sustained in many cases by advertising methods through which a mass of unprepared youth is drawn out of industrial occupations into the study of medicine.
3.       Until recently the conduct of a medical school was a profitable business, for the methods of instruction where mainly didactic….
4.       The existence of many of the unnecessary and inadequate medical schools has been defended by the argument that a poo medical school is justified in the interest of the poor boy. It is clear that the poor boy has no right to go into any profession for which he is not willing to obtain adequate preparation; but the facts set forth in this report make it evident that this argument is insincere, and that the excuse which has hitherto been put forward in the name of the poor boy is in reality an argument in behalf of the poor medical school.
5.       A hospital under the complete educational control is as necessary to a medical school as is a laboratory of chemistry is to pathology. High grade teaching within a hospital introduces a most wholesome and beneficial influence into its routine.
At the time of the report (1910), I can imagine that there was a range of responses from those within the medical profession. In one camp you probably heard the following responses:
            The nerve of that Flexner guy! What does he know; he’s not even a physician.
How does he expect us to produce better results with the terrible conditions that
people are subject to in 1910? The economy is tanking, living conditions are atrocious, and I can hardly feed my family on what I make.
In another camp you might have heard something like this:
Finally! Someone is talking about creating some unified standards for what it means to be an effective physician.
At last, someone is exposing the complexity of this job! Not just anyone can be a physician; I have been saying this for years!
Wow!! It’s exciting to hear someone talk about elevating this profession to the place where I believe it should be. Perhaps one day I will encourage my own children to become a physician and stop discouraging them as I currently do.
In response to the Flexner report, major changes were made to the medical profession over time. At that time, the medical profession was like that Model T. However, the profession underwent a major overhaul, and it’s never been the same again.
One hundred years later, the same type of overhaul is being called for with the teaching profession. Yes, we’re hearing voices from both camps. In one camp there are those saying things like, Finally! Someone is talking about creating unified standards for what it means to be an effective teacher. Others, in a different camp are saying things like, What If We Treated Physicians the Way We Treat Teachers?”  My answer to that question is that 100 years ago, physicians did get similar treatment. And their profession has not been the same since. We can only hope for the same with the teaching profession.

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