Posted by: notdeaddinosaur | November 28, 2008

"Being a Doctor"

Once again, I seem to have started a bit of a dust-up with this post. Comments have ranged from “right on” to “you hypersensitive twit” and other, less printable versions thereof. In this case, not only do I stand by my original take, but I feel the need to clarify precisely how the dissenters are being jerks.

A recurring comment was something along the lines of “just because I’m a specialist doesn’t mean I stop being a doctor.” [emphasis mine] What exactly is meant by that oh-so-innocent-sounding phrase?

It seems to imply that there is some basic skill set learned in medical school; certain things that one is capable of doing just by virtue of being awarded that magical MD degree. Gee; what might that skill set contain?

We all dissected a cadaver and did a surgical rotation during medical school, so we all ought to be able to do surgery.

Didn’t most of us rotate through oncology as part of our medicine rotations? What’s the big deal about writing for chemo?

We all did orthopedics, too. I can look at an x-ray and prescribe an air cast and rehab for a sprained ankle.

How about ophthalmology? I can look in a patient’s eyes and prescribe drops. What’s the big deal?

I know, I know: all of those things, and many more, represent skills we learned in our post-graduate training and honed over years of practice. So here’s my point: Why do you think that dietary counseling and lifestyle intervention requires any less training, skill and experience to do (well) than any other medical procedure? What you specialist commenters are actually saying — in code that is so insidious you may not even realize it — is that primary care is so easy, any “doctor” can do it. You are disrespecting my special skill set in a way that is deeply offensive. (Far more than just consulting behind your back, HH. Next time you ask for respect from your colleagues, maybe you can start by giving it.)

What we all take from medical school is the knowledge base to learn how to become whatever kind of “doctor” we end up becoming. Without special training and experience to become a surgeon, we’re just assaulting people. Without special training in oncology, we’re just poisoning them. Without ophthalmology training, we’re just poking them in the eye. And without the special training and experience that comes from years of practicing primary care, you are just rudely telling people that they are fat.

PS: Smoking cessation is different. I agree that any doctor ought to have the knowledge and expertise to understand why smoking is bad. Then again, any fifth grader who has attended a Tar Wars presentation has the knowledge and expertise to understand why smoking is bad. Don’t exactly need an advanced edumacation to figure that one out. Interestingly, though, providing effective smoking cessation counseling is also harder than it looks.


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