oh my, we have such different takes on all of this it's like we don't speak the same language...
UCLA2000 said:
In essence you're running/volunteering in a free clinic that dispenses meds, diagnoses and treats patients with little/no supervision from docs. You practice protocol based medicine (which requires you to evaluate, and asses a patient prior to determining which protocol to follow.
yes. we have many founding principles, amongst them that we believe in the demystification of medical care and the empowerment of everyone to learn how to take care of themselves and each other.
that said, we do not see anything immediately life-threatening (nothing requiring an ambulance), no "real" surgery (we take off warts, drain boils, etc., but nothing requiring more than local lidocaine/marcaine), and we do not have ongoing care, except for syphillis tx and follow up vaccinations (hep). we see people getting HIV tested, hep tested, STD screened, people who need td boosters, hep vaccinations, seasonal flu shots, and people with things like URI's, UTI's, strep throat (we have in house lab workers), basic dermatology needs, etc. again, nothing on-going, and nothing immediately life-threatening.
and yeah, we have to assess to know the protocol. but really, how hard is that? people know what is wrong with them, at least in general, and they know their body better than a provider ever could, so it's about listening and translating what they say into an identified problem with a name. plus, our trainings are really comprehensive, moreso than the state trainings where there are state trainings for things (like HIV counseling, phlebotomy, etc.)
UCLA2000 said:
So now lets say that someone decides to give you medical training. I suspect that one day you'd be able to open a group of these lay healthcare provider free clinics.
well, i would, but i doubt i could get legal dispensation most places in this country.
UCLA2000 said:
The effect that you could have on the medical profession could be somewhat similar to what Walmart does to the local economy. If you were to open 10 or 15 of these lay person clinics and allow them to "borrow your license", then you could potentially put actual docs out of business. Look at the effect that the NP model is already having on FP and Med docs in the field with their cheap labor etc. Currently 1 doc can oversee the operation of numerous NP's. It is a much cheaper model for HMO's, but does patient care suffer?
LMAO. first, who do you think comes to us? 70% of our clients are either a.) homeless, b.) jobless, and/or c.) uninsured working poor. these are people that the medical system complains about having to deal with. these are the people who have to use the public ER for care for strep throat, and all at taxpayer/insurance payer expense. the other 30% of our clients, who come for the STD screens, HIV tests, etc., come to see us for care that is stigmatized in the system. these people come to us for what they will not ask their doc for, because of either judgement of behavior and/or not wanting the test, no matter a potential poz result, on their medical record, lest they ever have to find new insurance and it be listed as pre-existing and not covered.
UCLA2000 said:
What impact do you think that lay person free clinics would have on local FP and IM docs?
little to none. it would, though, lower the ER crowding with non-emergency patients, and provide empathetic care to populations that are marginalized. health care is a right, not a privaledge, after all.
UCLA2000 said:
Plus, I haven't even begun to get into the ethical/legal questions raised by such a clinic. Where is the quality control? What if you misdiagnose someone? What if someone dies or has life-long sequelae from a disease process because it was not diagnosed/dealt with in the proper manner.
like i said, we consult each other. and we don't deal with much (sure, syphillis could, but that test is pretty fool proof, and we do send that off to a commercial lab) that could go all that bad. and, 'real" dr's misdiagnose from time to time, even with all that training, no (i had a doc at my HMO misdiagnose the early stages of pneumonia as croup on me just last year)? human beings are imperfect. and we have been open for 37 years, and have never had a malpractice claim.
UCLA2000 said:
It's like the difference between in n out burger and mc donald's. The end result is the same (i.e. you're full) but there is arguably a huge difference in the quality of the product.
wow. ouch. you know, if you're ever in my part of the country, i invite you to come see what we do. i think you'll see that an HMO is mcdonalds, and we are more like your local non-chain hamburger stand. we look a little shabby on the outside, but the product is wonderful and unique.
UCLA2000 said:
Keep in mind that these thoughts are coming from someone who has volunteered thousands of hours performing medical relief work in inner cities both in the US and internationally. I went to school for 10 years in order to earn the privilege of caring for people in their time of need, and even I have serious questions regarding the ethics behind what you're doing.
see, i see the care as a right, and the ability to care as a moral obligation, not a privilege. we take care of the people most see as useless, or who's illness is seen as their own fault, and we do it with empathy and individualized non-judging care. we do it seeing them as who we, or someone we love, could end up as, not as some other species. and i see how a lot of docs treat these people. and i hear how they are beaten down emotionally or mistreated physically when they ask for care. and it makes me so angry. and i want to be able to pay the rent and take care of them full time, instead of having to work the full day career thing and only have 20-30 hours a week for it.
the ethics of it? how about the ethics of an ER doc not giving local before lancing an abscess because it might "teach the junkie a lesson" or the gyn doc acting morally repulsed and then giving a lecture about having too many partners to a sex worker or the student health clinic doctor insisting that a gay student with a kidney stone "probably has chlamydia, because you have had a lot of sex, haven't you"? i could list stories for pages...
UCLA2000 said:
Now imagine how a senior physician who has never volunteered in the community, has kids to support, 10 years worth of student loans to repay, a house payment to make, and has been in the profession for 20 years or more may view what you are doing.
like i said before, if this person can't handle it, then i don't really want to go to their school. if i have to do this another way, i will. there are many roads to the same end, and i will take another one if i have to. my prinicples and respecting my ideals without compromise are more important to me than what letters i end up with after my name or how much i end up getting paid.
UCLA2000 said:
You stated that you think that they have you on hold because they don't know what to do with you. I think that they know exactly what to do with you. Keep you out of medicine! You're too much of a threat.
It's like any other profession in the world. If we were all plumbers and you were doing all the "basic plumbing" in the city for free, do you think that anyone in the city would want to give you a crash course on "advanced plumbing"?
first, if you're right, i would already be rejected from everywhere, or most everywhere. i have 16 schools that have me on hold, and i got non-automatic secondaries to three schools, so it can't be that extreme a reaction.
and personally, i would teach them advanced plumbing. they clearly have an aptitude for the work, and a deep enough love of it to do it for free. who am i to stop them?
but that's me.
Those "conservative, bitter old doctors" have the power to open or close the door to your medical career. If you ever hope of being accepted, then you better tone it down.
