Prepare to Defend Yourself ... How to Navigate the Healthcare System and Escape with Your Life

Chapter 2. Medical Professionals: You Can't Tell the Players without a Program

C H A P T E R 2 MEDICAL PROFESSIONALS YOU CAN’T TELL THE PLAYERS WITHOUT A PROGRAM MEDICAL PROFESSIONALS 27 I t has been famously said that “there is no place you can’t go with a clipboard and a confident wave.” If someone is wearing a uniform or carrying the accoutrements of authority, we tend to accept that the person is in authority. Put that in the hospital setting, and factor in that you are in pain or ill and far from at your best. Someone in scrubs and a lab coat becomes what you need her to be, your healthcare expert and proxy. The question is, who is this person and how qualified is she to do that? What are her credentials and qualifications? What does getting to that level of credential really mean? What is her experience? In the course of treatment you will potentially interact with medics, nurses, practitioners, assistants, and specialists of varying stripes. It can be really confusing as to who is authorized and properly trained to determine and perform different tasks, and that is even before you get a sedative! The fact is that we trust this person in uniform, often without knowing her backstory. 28 CHAPTER 2 The compartmentalization of medicine has been mentioned previously, so it helps for you to have an idea of who you are talking to and what that person’s role is in the healthcare system. Physicians I intentionally use the term “physician” here, because it distinguishes a medical doctor (a graduate of a medical school) from other “doctors” (doctors of philosophy). The term “doctor” can be quite broad, and a doctor in the healthcare setting may be a doctor of education, nursing, physics , or English literature. Imagine your English teacher holding a scalpel, and you see the importance of this concept. A licensed physician is a graduate of a medical school or osteopathic medical school who has met certain postgraduate requirements for licensure and the privilege to practice medicine. What makes a medical education distinct from a nursing education, or technical medical training, is the method, content, and structure of the training. Technically, a graduate of a medical or osteopathic medical school is a physician, but until that individual has completed an internship and passed certain examinations, he cannot obtain a license. Until those postgraduate requirements are met, an individual is a medical or osteopathic doctor, but not a licensed physician. For most American-educated physicians, the training progression is as follows. They graduate from high school or obtain a GED, and then they graduate from college with a requirement to take certain classes in mathematics, physics, chemistry, organic chemistry, and biology, with a grade-point average that generally must be above a minimum of 3.5 out of 4.0. They then undergo a competitive process (including a competitive entry examination known as the Medical College Admissions Test or MCAT) in order to get into medical school. They must then graduate from medical school, during which time they must take certain qualifying examinations (boards) to progress to clinical (patient care) training and then compete for entrance to an internship or residency. Internship and residency placement are also competitive processes, with grade-point averages , exam scores, and subjective evaluations weighing heavily. Internship and residency are intense training periods that involve patient care—as a MEDICAL PROFESSIONALS 29 30 CHAPTER 2 practicing physician—and continuing book study within a supervised setting . The oversight is provided by autonomous, licensed, board-certified physicians known as attendings. Internship lasts one year. Residency is specialized training (family medicine, emergency medicine, dermatology, surgery, etc.) that may last, depending on the specialty, three to five years. Beyond that some physicians will engage in additional formal training known as a fellowship that generally lasts a year. In order to advance year to year, certain success measures (testing and evaluations) must be met. Internal medicine physicians, or “internists,” are not to be confused with “interns.” Interns are first-year postgraduates, but internists are specialists , although a doctor can be an intern in internal medicine; so you do need a program to know the players, and that is just the physicians. Some residencies are listed as “competitive,” meaning they eliminate or whittle down the number of residents each year. This is pretty stressful in that a resident may be eliminated even though the individual has done a good job. He or she...