Think about the medical knowledge base we have today and how was it formed, who suffered to get it, and who can legally use it? I am trying to show that we really do have a logical and ethical obligation to provide basic, meaningful healthcare to all, and if we as a society choose to delegate or restrict the provision of such healthcare to a certain profession, well then that profession assumes this social obligation. First answers to the above questions.
— the medical knowledge base we have today was formed by trial and error experiments on people and animals in the existing world of the past.
–who suffered to get it?– All our relatives for the past hundreds of years.
–who can legally use it?–In the US, certain professions such as Medicine and Dentistry have been granted the sole privilege of using this knowledge hopefully for the good of mankind. It is illegal for others to use this knowledge in a business relationship without the indirect/direct certification of the profession and the direct certification of the state (licensure and scope of practice laws)!
Given this analysis, how is it that many of our citizens lack access to these chosen, privileged providers. Is this situation proper, whose obligation is it to try and fix the problem, and is anything happening.
Access to care problems seem to center on two main issues, finding a provider and paying that provider. As I said above, only providers certified by these privileged professions and the State can give the care. Paying for the care, which is often too expensive for many/most individuals to afford directly is through third party payers. However about 20% of Americans (>40 million people) have no third party payer.
As for finding a provider, many poor people in especially rural areas are blocked out of access to good care by a combination of not enough certified providers, and the refusal of many of these certified providers to see the poor, who may or may not have safety net insurance (Medicaid). This problem is true in both Medicine and Dentistry, but it is and has been especially acute in Dentistry. There has been much talk in America about health insurance reform and single payer versus consumer pay etc., but there has not been much talk about the supplier side issues that drive up cost and limit/prevent access. I want to deal with some of these issues in the rest of this diary using dentistry (which I am very familiar with) as my main example.
Medicine began using lesser trained auxiliaries as providers 30 or so years ago, and it may well be that change that has kept the lid on the system from failing at least for now. Dentistry in America has heretofore refused to allow real, independent midlevel providers claiming that it is a patient safety issue. However, midlevel medical providers have not proven to be dangerous, and mid-level independent dental therapists have been used successfully in Australia, New Zealand, and Canada for 50 or more years.
In rural Alaska, dental disease is rampant, and nobody in the dental profession seems to care much about leaving the disease alone. If dentists are not available to treat the disease (and they are not), then let the people suffer. I mean it is a patient safety issue isn’t it?? What about the disease dangers however? Well when some public health and tribal efforts try to do something about this chronic problem, namely to train midlevel therapist to treat these folks according to the New Zealand model, well here comes organized dentistry to claim foul. Where are they with real solution ideas when there is only suffering? Read the article below about organized dentistry’s attempt to stop the University of Washington from being the first University in America to offer a training program for mid-level dental therapists.
Here is a link and excerpt from the article
UW debates dental therapy program for Alaskans
What do New Zealand trained-dental health therapists and tooth decay in Alaska have to do with the University of Washington? Quite a mouthful, as it turns out.
In a guest column published by The Seattle Post-Intelligencer on June 29, Peter Milgrom, a UW faculty member in dental public health, accused the UW dental and medical schools of abandoning Native Alaskans and their oral health.
At issue is a pending application with the W.K. Kellogg Foundation, applied for by the UW School of Medicine’s MEDEX Northwest, a physician assistant program, and the Alaska Native Tribal Health Consortium (ANTHC) 18 months ago.
The $2.5-million grant would provide 24 months of Alaska-based training for eight to 10 dental health aide therapists (DHAT). Upon completion, the DHATs would be able to assume mid-level oral-health functions and treat Native Alaskans in their communities on a year-round basis. The program would be administered by the UW’s MEDEX Northwest campus in Bethel, Alaska.
Native Alaskans’ rate of tooth decay is at least two and a half times that of the general population. Dentists are scarce in rural Alaska where most Native Alaskans live — many villages are accessible only by plane or snowmobile.
“Because of ADA [American Dental Association] opposition, no therapist program has ever been mounted in a United States university,” Milgrom wrote.
If any profession is derelict in meeting its social access obligation, it should expect society to take its monopoly away! In the healthcare access crisis in America, both affordability issues and provider type issues will have to be addressed for any meaningful solutions to happen, and these issues are directly related, IMO. We will never be able to train and afford the number of doctors and dentists, as they are currently trained and paid, to do everything people will need. We must be less guild conscious and more outcomes conscious in our scope of practice definitions so that number of providers and future costs of care can be kept at a reasonable level with adequate access to care for all. It is all related, and some professional obligation to cooperate and even directly solve the problem should be demanded by the public. (See Poll)
interesting topic.
There was a time whem, as an Licensed RN, I was free to hang out my own shingle, and I did, back in the 70’s, in a small town that didn’t have many mental health resources. I made a decent living providing low cost counseling to people with emotional/mental health issues, as well as doing private medical home visits.
This has been over for a long time. Today in my state, a mere RN cannot see mental health clients in private practice at all, unless directly supervized by a psychiatrist. We cannot do home visits unless in the emply of a Certified Home Health care Agency, most of which are corporate owned big business now.
If I could ever have afforded to go back to college for a Nurse Practioner Certification. I may have been able to practice independently in some areas.I suspect to see Nurse Practioners being allowed to fill a much more important role in times to come..hopefully.
But as a former case manager, I can tell you locating dental services for the poor, and especially for the poor who also have potentially dangerous medical conditions ,is incredibly difficlt to impossible. I long ago lost count of how manhy people I’ve watch suffer greatly, and even get sicker and die, from untreated dental conditions.
There is NO greater national disgrace for a country as rich as this one, to allow so many of its own people to suffer needlessly for years and years, only to and die prematurely, from lack of access to adequate medical/dental care, housing asnd nutrition. For over 40 years, I have watch the disintegration of what once was a noble calling and an “art”, for so many of us, be reduced to a cold hearted profit making industry built solely on the backs of the sickest, poorest and most vulnerable among us.
For me, this is a much greater reason for me to feel ashmame of my coutnry that any foreign policy decisions that have been made. There simply is NO possible excuse for the scop[e of this hard reality.
Unfortunately, it is a reality that mostly visible to those of us who spend whole careers trying to keep poorer people alive and as well as possiblle, given the class structure in this country.Now I am getting a close up gander at how it feels to experience this from the “lower class” as well
Is America “exceptional?” Depends on who you ask and what window they are looking out of.
From my view in this one lifetime, as a woman born in 1940, who has spent a half century working with the “lower classes”, well, while I am quite away of the good things accomplished by my country, no way in HELL can I see America as very “excpetional” at all.
I see her as a nation run by people (that we have elected) , who is selling her soul forthe profit, power and gain of the upper classes.
You do get the feeling that most of the folks on these blogs have no clue as to what you have just said. Good rant, and right on. The me first and me only mentality you talk about in America must be changed for any meaningful universal health system to take root here! I doubt it will happen in my lifetime however!
Too bad that we as a nation can not see the experience that ppl like you and I have in all the years we have practiced our profession and the benefit we have to offer to our society. We have knowledge that is way long gone out the window and it is simple common sense practices, for the most part. Someone who could connect the poor to the system that needs that connection and then do the minor care for those who can not afford the advanced care of medicine and dentistry. I hear ya there my nurse friend. It has come down to the laws of constraint for all of us that have been the bruiser for society, I think.
Found this article just rummaging around on the Internet highway of fun today. Just for your read only, but to ppl like scribe and me this might mean something to ponder over….:o) This is the end of my glorious career[ I am the cat]. Nursing in my life was/is a life of working for nothing to just get by and raise my kids on. But the happiness I found in doing my job and the feeling of being unselfish as to giving back to others. In my day, to earn a living was just that. We had nothing, at the end of the pay period, to save. It was all spent ahead of time, for the kids needed things to carry on their lives. We tried hard to make ends meet…and then maybe squeeze a little out for a small vacation once a year that probably meant to stay home and work, cleaning better and more. Just to sleep in and not have the alarm clock to get us up with, for even on days off, cause the kids had school or something they had to attend to/for. My life then and such as it is now is always for my kids and their offspring. I can not tell you enough, though, as to the satisfaction I have had in my life with doing the things that my chosen career has brought to me and my mind of learning and reacting upon. The best wings that took me under for their teaching and carving out a speciality to make me, with them, the best that I could possibly dream of. I still do not earn much, but now, I do not have the kids to worry with on a daily basis. So when it comes to giving back to my community, I do as much as I can, in simple and small ways. I am always there for the next door neighbor that can’t afford an ER visit, to check and see, if that is really what they need to be doing or otherwise. It is called taking on some of their worries. It is dangerous in a way, for the laws that have developed over the course of time, have made that kind of neighboring, called “practicing medicine”. We can not be just neighbors anymore. I have to say to most, that I am not here to diagnosis or practice medicine, just as someone who does know some of that you are asking for in the line of help. Above and beyond that, I have to refuse to help, for fear of being sued. So please understand, I tell them. Anyhow just thought I would throw that in for thought. To get a degree in a thing such as nurse practitioner or the same equivalent in dentistry would be great, but then again, sometimes, I wonder about the common sense factor of some that I see failing to demonstrate. When talking to new nurses, I try to warn them about the things that have been hurdles for me. I ask them to really care about human being, not the money they think will make them rich, for it will not be there, for most. To go through reality shock, then go on to doing that which they were taught to do and do it to the best of their ability and always strive to do better and to learn more than yesterday’s sense of knowledge. Maybe I am preaching to the choir, but if someone does not have the heart to help others, there will be no help—only robotic actions of the daily living. Hugs to all. I am that cat walking and eating.
some pureed food for thought
All so true. It also didn’t take the “profit makers” long at all to see how easily this kind of true dedication and committment of (mostly female) nurses and health care workings could be exploited, big time. The fact we can’t walk away from suffering means big bucks to them, cuz we tend to give care first, go punch out on time, (no overtime allowed without prior approva; and “you really could get it all done in 8 hours if you had better time management skills ” or so they say) then stay on and “donate” the time it takes to do all the required paperwork.
Ack. I am so glad I am DONE.