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Correspondence |

In Defense of Medical EducationIn Defense of Medical Education FREE TO VIEW

Paul J. Failla, MD, FCCP
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From the Department of Medicine, Pulmonary/Critical Care, School of Medicine, LSU Health Sciences Center Baton Rouge.

CORRESPONDENCE TO: Paul J. Failla, MD, FCCP, Department of Medicine, Pulmonary/Critical Care, School of Medicine, LSU Health Sciences Center Baton Rouge, 5246 Brittany Dr, Baton Rouge, LA 70808; e-mail: pfaill@lsuhsc.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(2):e59. doi:10.1378/chest.15-0716
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Published online
To the Editor:

I read with great interest the recent Point/Counterpoint editorials by Blumenthal1,2 and Pastis and Strange3,4 in a recent issue of CHEST (March 2015) debating whether nurse practitioners should perform transbronchial biopsies. In making the case for her “yes” stance, Blumenthal1,2 finds the use of the term “nonphysician” egocentric. What is not egocentric is the belief that medical education, including medical school and years of postmedical school training, is a necessity to the proper delivery of high-level medical care.

The desire to perform bronchoscopy with transbronchial biopsies is illustrative of one of the most troubling aspects of the nurse practitioner advancement, which is the impression that most medical care can be delivered after a period of technical training. This fails to acknowledge the vast amount of time required to develop a fund of knowledge and the intense training necessary to add judgement to that knowledge base. This is a process that entails up to 10 postgraduate years for many physicians. A physician performing a procedure is not simply supplying a technical skill based on algorithmic decision-making, but drawing on years of integrative thinking. Medical education was not conceived as an arduous obstacle course designed to reduce competition but as a necessary path to the attainment of that thoughtful approach. This process cannot be distilled down to 2 to 3 years of postgraduate education. Access concerns should be addressed by markedly increasing opportunity to this path for those who wish to provide patient care without bypassing the intensity and style of it. This would be welcome and reassuring.

The ideals of quality and access referred to are unfortunately not balanced in our present health-care environment as the former is often secondary to the latter. As well, the attempt to perform a procedure that is generally performed by pulmonary physicians with 9 to 10 years of postgraduate training is revealing not only for its concerning boldness but also as proof that access concerns can no longer be used as the default rationale for the ever-widening advancement of nurse practitioners’ scope of practice. Claims of cost savings are also questionable as increased resource utilization (referrals, testing) may ultimately counter any upfront savings. Additionally, Blumenthal’s1 comment that nurse practitioners and physicians view clinical dilemmas from a different perspective is a critical understatement. She states that our different academic paradigms are immaterial. They are actually the core of the debate.

Nurse practitioners have not hesitated in their drive to independently practice medicine. It is time for physicians to defend medical education as a prerequisite for that practice. It is our duty to patients and certainly not an egocentric one.

References

Blumenthal NP. Point: should nurse practitioners perform transbronchial biopsies? Yes. Chest. 2015;147(3):594-595. [CrossRef] [PubMed]
 
Blumenthal NP. Rebuttal from Ms Blumenthal. Chest. 2015;147(3):597-598. [CrossRef] [PubMed]
 
Pastis NJ Jr, Strange CB. Counterpoint: should nurse practitioners perform transbronchial biopsies? No. Chest. 2015;147(3):596-597. [CrossRef] [PubMed]
 
Pastis NJ Jr, Strange CB. Rebuttal from Drs Pastis and Strange. Chest. 2015;147(3):598-599. [CrossRef] [PubMed]
 

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References

Blumenthal NP. Point: should nurse practitioners perform transbronchial biopsies? Yes. Chest. 2015;147(3):594-595. [CrossRef] [PubMed]
 
Blumenthal NP. Rebuttal from Ms Blumenthal. Chest. 2015;147(3):597-598. [CrossRef] [PubMed]
 
Pastis NJ Jr, Strange CB. Counterpoint: should nurse practitioners perform transbronchial biopsies? No. Chest. 2015;147(3):596-597. [CrossRef] [PubMed]
 
Pastis NJ Jr, Strange CB. Rebuttal from Drs Pastis and Strange. Chest. 2015;147(3):598-599. [CrossRef] [PubMed]
 
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