Re: IUD and PID
From: Steven Crawford (scrawfmd@zoomnet.net)
Sat May 29 14:12:33 1999
Dear List,
After reading Woolley's thoughts on what non physicians are capable of doing, I
realize that I am arguing with someone who clearly does not know what they are
talking about. A PA performing a vaginal hysterectomy?? What's next!!!!?? I will
cease responding to such rhetoric and wasting everyone's time. I am sorry I debated
Woolley on this forum.
--
Steven Crawford, MD
"Robert J. Woolley" wrote:
> In message <v03007801b375769a1697@[208.2.63.42]> writes:
> Is it
> > at all possible that the public good is better served by insuring that
> > those who care for the health of our population have been adequately
> > trained?
>
> Sure, and as the saying goes, it is *possible* that monkeys will fly out of my
> butt.
>
> The question is whether you can demonstrate that (1) restrictive practice laws
> and licensure actually do improve the health of the citizens generally, and (2)
> whether the increase in costs and decreases in availability of providers that
> inevitably result from such laws are justified by the alleged benefits. I do not
> know that anybody has managed to do either of these things.
>
> >
> > I think everyone would agree that a NP can easily perform a pap smear and
> > counsel on contraception. I think we are all equally convinced that the NP
> > should not be performing a vaginal hysterectomy.
>
> Ahem. Count me out of the latter consensus. This is a technical skill that could
> be learned by anybody willing to invest the time--NP, PA, chiropractor, Army
> medic, etc. Naturally, it will take more time to adequately learn the necessary
> skills for one who has not had the broader and deeper general background of med
> school. But nothing conceptually stands in the way of their gaining the
> necessary knowledge and skill outside of a formal medical school/residency. I,
> for one, have worked with surgical assistants who have been doing their job for
> so long and with so many surgeons that they could easily perform singlehandedly
> most of the routine cases on which they now merely assist.
>
> The problem is that in
> > between are the grey areas. This is the battlefield. Interested parties
> > have financial stake, no doubt. However, my personal view is that some
> > societal protection needs to be provided.
>
> It seems inevitable that your reason for this is that you think you know what is
> better for your neighbor than he does. I find this attitude condescending and
> demeaning, no matter how well-intentioned. If you genuinely trusted your fellow
> citizens to be capable of figuring out who is best qualified to care for them,
> and genuinely thought that you have superior training and skills, such that
> rational people would voluntarily choose to see you and your peers rather than
> non-MDs, then you wouldn't feel the need to *force* that choice on them by law.
> Your insecurity is showing.
>
> I choose to believe that most people will most of the time continue to choose
> voluntarily to seek care from appropriate providers. I, for one, am not worried
> about the competition, and don't feel a need to enforce a medical monopoly, as
> you apparently do.
>
> >
> > We can see the consequences of cost cutting efforts in place already.
> > Rather than using RNs in the office and hospital, some of their functions
> > have been delegated to MA's. Doesn't everyone remember the uproar from the
> > nurses on this issue? I recall their argument was based solely on patient
> > care issues. Sure there was a job security issue, but I for one did not
> > doubt the sincerity of their argument.
>
> Then you are naive. *Everybody* who seeks to force people to choose *their*
> services (1) claims only to be working in the public interest, and (2) is
> actually working in self-interest. This occurs with, e.g., carpenter's unions
> that try to make it illegal or impossible to hire non-union members to build
> your deck, or day-care businesses that want to require state licensure to nudge
> out of the market those who provide such care in their homes casually.
>
> Do we really want to go down that
> > path? Would it not be possible one day, due to cost cutting measures, that
> > the person doing the vaginal hysterectomy was a technologist with 1 year of
> > training?
>
> I do not believe that an insurer, which has to worry about liability for
> contracting with incompetents, would knowingly allow that.
>
> Do we not owe it to the greater good to fight these battles
> > rather than succumb to the harsh Woollian rhetoric? Do we benefit from the
> > fight, hell yes we do! We went to college, med school, and trained in
> > residency for the right to practice medicine. No one is better trained to
> > do what we do than we are.
>
> Then why are you so afraid that, when genuinely given alternatives, people will
> flock away from you?
>
> To passively sit back and let our realm be
> > invaded by less qualified alternatives is derelict.
>
> I'll patiently await your empirical evidence that the current system's benefits
> outweigh its costs.
>
> ---------------------------------------------------------------------------
>
> ---------------------------------------------------------------------------
> Bob Woolley
> ---------------------------------------------------------------------------
> St. Paul, Minnesota
>
> "A free society is most threatened not by uses of government
> that are obviously bad, but by uses of government that seem
> obviously good."
>
> -- Charles Murray
