continued A somewhat humorous example of against F.M.G.s was related to me by a friend. In the 1980s his son walked in for an interview with the chief of the department at a prestigious University residency training program. Seeing him the chief exclaimed, without looking at his applications, "Who asked you for this interview? We don't accept F.M.G.s! The young man replied that he had graduated from Cornell Medical College, to the chagrin of the Professor. The young man was of Indian (Asian) heritage.
The gradual change and decline in the power and prestige of physicians started as medicine developed and progressed and became a trade. Changes started out in the training programs- Specially surgical. There was a tragic death of a young patient due to the fault of an Intern on call, who used disorientation due to fatigue from overwork as defense. Did started another campaign the rules change restricting the duty hours of medical trainees because of sleep deprivation and 'burn out. Disregarded was the fact that for decades medical training consisted of close follow-up of the patient who came first, without any detriment to them from on call physicians fatigue. Papers and studies came out supporting loss of function due to sleep depravation. Yes- if it is acute. That was part of the training. Human beings can be trained for a lot of things which are seemingly impossible in daily life. The military trains soldiers with all kinds of stress and demand and they remain healthy. People have two jobs, at times. The human body adapts. Besides, during training we had learned how to catch up on sleep and handle medical stress and hopefully became better physicians putting the welfare and care of the patient first and even before us. Old fashioned now? I venture to say not. As this change spawned a cascade of problems.
Physician's training suffered, specially surgical. The crucible of training became a warm fizzy bath. Now papers are out saying that a significant percentage of general surgery trainees come out with lack of confidence to be able to do certain procedures.
Part of medical training like starting intravenous or drawing blood became "scut work', given to med. students or nurses. Nurses began to take on more 'hands-on' work like cleaning and dressing wounds placing catheters and other work hitherto done by a physician. Not that there was anything wrong in their doing it, but it distanced the training physicians from the fundamentals of care. More work and responsibility was given and ceded to the nurses like using the stethoscope for other than taking the blood pressure.
As physicians ceded responsibility others were happy to fill in. Pharmacists started to advise patients and suggest medications. Optometrists wanted to prescribe medicine and even do surgery. Podiatrists started doing all kinds of foot surgery done by the orthopedic surgeon. Physiotherapists who did the prescribed therapy now started to prescribe and order x-rays. Nurses advanced to 'nurse-practioners' and 'advanced practiceoners and 'nurse assistants and anesthetists. ( to be cntd)
