Today us medical students had a chance to sit down and talk with healthcare professionals outside of the strictly "MD" field, and I have to say that it was quite enlightening. There is, though, one thing I noticed that I find intriguing, the rise of doctoral students in the healthcare team on the wards other than MDs. Two professionals gave me two very different pictures of how this could impact a patient care.
The first encounter I had was with a doctor of pharmacy, known as a PharmD. From the minute we sat down with him, he made it very clear what his role is, to monitor, adjust, and suggest medications for patients. He stated that with the ever-growing complexity of meds on the market, he was there to ensure that side effects are avoided and the best drugs possible are being used. He also made it very clear that it was not his job to diagnose or come up with a differential on a patient. He gave the example of a patient with a cough; in his mind a cough=possible drug side effect while in a doctor’s mind cough=tens of physiologic derangements.
The second Dr. we saw was from the physical therapy department. She presented a very different case for the role of the doctoral physical therapist. She envisioned being the front line for patients with any ache/pain complaints. She also had a mouthful to say about when it was and wasn’t acceptable to bother the PT in the hospital (“my time cost 700 dollars an hour” she kept repeating).
Unlike the PharmD, who had a clear purpose and limits on what he was and wasn’t capable of, the PT seemed to want to be a doctor. And to some extent, what are you to expect from someone with a doctoral level of education? They have acquired a vast amount of knowledge that they feel is being underutilized. But herein lies the problem; she learned mountains about PT, but not as much on clinical pathophysiology, as she would have in a medical program. I think its clear that her role isn’t to compete with the physician for who will make that primary diagnosis, but rather to complement the physician’s work as a primary caregivers. I mean, after all, if she wanted to diagnose and treat, why didn’t she get an MD?
Now I know that this probably comes off as a really snobby sounding post, but I swear it’s not meant to be. I just want to draw attention to what I see as a potential conflict that could lead to negative outcomes for patients. The idea of a healthcare team is not one where egos and degrees clash over the diagnosis of a patient, rather, where each brilliant mind complements one another given their respective training. Like the PharmD, it seems that the PT needs to define their role and then best apply their skills in that role, just as a pharmacist focuses on drugs, a doctor on diagnosis, a dentist on oral hygiene, etc. etc. No doubt, however, that physicians need to also step down from the podium and define their limits and bolster their weaknesses with those that choose to go into PT, pharm, nutrition, occupational therapy…food for thought, I suppose.
