When Moliere prepared his notes for the satirical "Le Medecin Malgre Lui," he was moved to include a sheepish apology. "Doctors," he suggested, "are both our plague and our promise. They nag us for their bills but in return stand firmly and uniquely between us and our ultimate meeting with a far more fearsome Collector."
Although I doubt that any of today's new allied health practitioners were among the original viewers of Moliere's play, I perceive that certain of these practitioner groups are now trying to compromise the ability of physicians to stand between patients and that fearsome Collector of whom Moliere spoke. In support of these groups, D.C. Council member Polly Shackleton has introduced a bill that would unravel every effort made since Moliere's time to guarantee uniformly high standards of treatment for hospital patients.
While the primary purpose of Bill 5-166 is to amalgamate the hospital licensure and hospital accreditation processes--a laudable goal--the bill includes provisions that mandate hospital access for five specific allied health practitioner groups. Independent access is authorized for one group, and the bill is silent on this issue for the other four groups. The bill also establishes certain questionable standards for evaluating applicant practitioners, thus undermining the traditional authority of the hospital governing board.
The measure, by interfering with the ability of hospitals to protect patient interests-- how else to describe the anarchy in the ranks of hospital admitting personnel that the bill provides for?--would pose tangible and unnecessary risks to patients, produce varying degrees of chaos in hospitals and contribute absolutely to escalation of health- care costs.
There is simply no shortcut to the seven-plus years of medical training physicians now receive, nor any expedient detour around the specialty training many physicans undertake to perform delicate, difficult and often dangerous procedures that help save human lives.
None of this is to say that there is no place in the health-care establishment for a variety of complementary health-care team members. Nurse-midwives, psychologists, nurse practitioners and others are invaluable satellites in the health-care galaxy. But does the council truly believe that these individuals should be permitted to admit acutely ill patients to hospitals and supervise their care? For that matter, do the council members believe that untrained and inexperienced physicians ought to be given the privilege to perform highly specialized medical procedures? I do not believe that council member Shackleton supports such license as beneficial, but the bill reflects otherwise.
In view of the general and spreading concern that exists across the country about health care and its costs, the bill may contain some superficially attractive aspects. After all, if legislation alone could will that psychologists and nurse-midwives could provide the same spectrum and quality of care as physicians, why not next do away with medical schools?
This bill, the most sweeping of its kind in the country, represents a clumsy effort to treat a multifaceted problem with an overdose. We look forward to working with allied health professionals in and out of hospital settings with the same confidence we have always had in their commitment and competence. We simply ask that the council recognize that in the war on disease, as with all other wars, there must by definition be soldiers and generals. There is an absolute need for expert command in the battle against illness. And, for all the triumphs as well as all the heartbreak, it falls to the physician to guide, and to serve with all of his legions in offering comfort.