When it comes to information on healthcare, it pays to maintain a healthy skepticism. Our Healthy Skepticism show made true believers out of you, judging by your many emails. Hit the jump to get a healthy sample of your reaction.
My interview with social scientist Laura Servage about the implications of creeping 'credentialization' among health care professionals generated by far the most emails. Some of you took issue with Ms. Servage's point of view.
"I was shocked and actually disappointed that a woman who is pursuing higher education herself in order to be classified an "expert" in her field of education, is tramping on nurses and physicians who are also attempting to gain higher credentials in order to provide better patient care. Does her pursuit as a PhD candidate outweigh my pursuit of higher credentials in order to be a better nurse? It seems that she is walking a slippery slope of presumed authority about a profession in which she knows nothing. I would love to enlighten Ms. Servage about the differences of higher learning vs. apprentice knowledge that she believes would serve the nursing profession and in turn the general public.
"I have been a registered nurse for over ten years with a degree in nursing and presently pursuing a Masters of Education. I have had the privilege to work within an adult intensive care unit/coronary care unit for more than ten years, and as a cardiovascular research nurse, diabetes research nurse and instructor at the University of Calgary and Mount Royal University working with nursing students. I hold several post-graduate certificates because of my chosen area of specialty and continue to pursue higher education as a demonstration of accountability to my profession. It is not, as Ms. Servage puts it, to increase my status as a nurse, because if she was really aware what nurses do for her and the public, she would know that a nurse doesn't do her job for status but to make a difference.
"Ms. Servage has never held the hand of a dying patient, nor been present when family members receive devastating news that their loved one will not make the night. She has never been present to see true miracles of the human body and the tenacity of the human spirit to fight for life, or the overwhelming support of family and at times faith to heal.
"Ms. Servage is unaware that the credentials of an oncology nurse are different from those of an orthopaedic nurse. For, as the nurse hangs the bag of medication that will completely destroy living cells, just may save the life of a cancer patient, and with that knowledge is aware that the nurse's role is not just an understanding of the pathophysiology of that medication, but also for the emotional support that will be required later, as the nurse holds the basin hours while the patient has severe emesis, This is not about status. Nor does she know that when I hold the syringe prior to performing a wedge on a Swan Ganz catheter, I must completely be aware of the potential risks, the underlying pathophysiology of the seemingly simple task, the benefits of this knowledge and how to interpret this information so that I can communicate effectively these results to an intensivist, for the overall well being of my patient. This is not status but a requirement of my job and not for everyone. This small glimpse of a brief moment in the life of a nurse requires credentials and with those credentials, applied knowledge. Despite individual credentials, nurses respect each other for their knowledge. It's too bad, that Ms. Servage doesn't have that same respect for nurses.
"It is with sadness that even you, Dr. Goldman has encountered nurses who pursue credentials as a means to elevate their social status within a profession. I am honoured and proud to be a nurse every day, and I love what I do. Why should my passion for my career and continuation of learning to serve not only my patients but also my students, be looked upon so negatively by Ms. Servage? I take pride in my career and with that the knowledge and credentials that I gain along the way.
"I would love to hear your feedback on my comments and to even discuss the nursing profession further. Nursing is a career of diversification that includes more than just bedside nursing. Maybe one day, Ms. Servage will be aware that a nurse is more than the credentials behind the name.
From: Kara Sealock RN, BN, CNCC(C), Calgary
However, many of you found Servage's arguments refreshingly different.
"As a nurse I'm with Laura. Your show took me back to the fifties and the opening of Mount Sinai Hospital in Toronto. Most of the nurses had been recruited abroad from Commonwealth countries. Because of this, we had to wait a while to get our registration in Ontario, so did not wear a black band on our caps. Patients were amazed at our knowledge since we were NOT registered nurses, i.e. not wearing the black band. We of course played along saying that we had considered training but for various reasons did not finish (ouch)! Word spread of the patients' extreme upset at all these 'unqualified' nurses looking after them. That led to an announcement from the nursing office that all overseas nurses were to apply the black band to their caps forthwith. The patients relaxed and life at the hospital continued. All of this proved an important lesson to me. Don't be fooled by appearances. Weren't we all wearing our graduation medals? Love the show and the topics you raise. There's been no one like you since (the late) Dr. Morton Shulman."
From: Cara Worthington, North York, Ontario
"Laura Servage presented her case brilliantly and I would like to know more about her. The medical profession is an excellent example, but it is only the tip of the iceberg.
I think this (pursuit of credentials) is costing our country billions and keeping many people out of professions that they may have a greater aptitude for than the ones that are able to jump the hurdles that exist. As a Doctor, how much of the education that you were forced to take, do you feel was not essential or irrelevant?"
From: Gary Ridsdale, Kamloops, British Columbia
"The Canadian healthcare system was and is still based on the existence of the GP, the general practitioner, something which has not been graduated from Canadian medical schools for some 15 years. These days, all medical students are required to specialize so that there is no GP, only FPs or Family Practitioners. Gone are the days when a young doctor could serve rural areas until they had repaid school debts and reflected upon what (if anything) to specialize in. Gone are the days when GPs were the backbone of rural healthcare. I recommend a movement to reintroduce the GP to Canadian medical schools so that the original Canadian healthcare model can function properly again."
From: Vicki Jenssen, Cape Breton, Nova Scotia
"The post-war growth in the economy created a shortage of people for jobs not just in medicine but in all walks of life. In the 60's and early 70's, training was fast-tracked and a person could be working within months of choosing a career. A person could graduate from high school in the spring, go to school that summer, and be teaching that fall. Licensed practical nurses (LPNs) could be working in hospitals in less than a year. As the job market became tighter, education became a tool to slow down entry into jobs. Four-year degrees replaced three-year programs and masters programs became commonplace, which kept people out of the market those extra years waiting for positions to open up. Now that the boomers are retiring, there is a need to get people into jobs faster. The discussions in medicine around such topics as nurse practitioners, increasing the role of registered nurses as well as midwives and finding ways to encourage people to become general practitioners and family doctors all have a common theme: finding ways to ease the current shortage in medicine. All of these jobs require less training than specialist doctor. Some people stay in their chosen area and do a great job: others continue training as they work and go on to other fields. As you pointed out, it is not just the theoretical education that makes a good doctor."
From: Ken Weatherill, Delta, British Columbia
Some of you took notice of my interview with Gary Schwitzer, Publisher of HealthNewsReview.org.
"Regarding your program on medical research papers that report incorrect results, I fear the public may misunderstand your comments to mean that medical papers are just as accurate or inaccurate as papers and claims from other groups and disciplines, such as homeopathy, astrology, and the like. While some research papers may be just as mistaken in their conclusions, on the whole, the scale of error in the medical literature as a whole is quite different."
From: A. MacGregor
Finally, one of you had something to say about a comment I made regarding the names we give to diseases.
"Dr. Goldman made a comparison between shyness and social anxiety disorder as though they are the same thing. They are not. Someone who is shy can still function in society albeit sometimes with difficulty especially if they have to talk to someone, but someone who has social anxiety disorder cannot. My son has social anxiety disorder and has come a long way but at times it has been a battle. He has been in places and moments where he has been overcome by anxiety and has "frozen" and been unable to even respond or function. At those moments, he can't just snap out of it and get over his "shyness." Neither is he being defiant. Anxiety can be overwhelming and should be taken seriously."
From: Steve Burk, Timmins, Ontario
Steve, the point you raise was the focus of my interview with Meredith Young on what happened when impotence was renamed erectile dysfunction or ED. Thanks for pointing that out. And thanks to all of you for your many emails.