Louisville Medicine Volume 67, Issue 9 - Page 30

DOCTORS' LOUNGE (continued from page 27) What students of medicine – and primary care students, the APRNs and the PA students need – are not just teachers, but patients to learn from. Doctors learn from seeing sick and injured people, and we remember them individually, by the lessons they have taught us. We have patients in our offices, and we need to teach students there. According to the Association of American Medical Colleges (AAMC), there is not one medical school in the country that teaches the history and physical exam online. Lots of research has focused on the standardized patient and lots on the use of the simulation lab, working with faculty and small groups of students in the medical school setting. But the real patient has the edge on all of them: real findings, real emotions, real distractions, real questions. Currently, of the schools I could contact directly (school holidays in force at the time of this writing), the University of Kentucky doc- toral nursing program, the Northern Kentucky University and the Bellarmine University Masters’ degree programs for Family Nurse Practitioner: all have their physical exam courses online only. The same holds for the University of Cincinnati. However, the University of Louisville still – thanks be – has classroom-only teaching for their students for physical assessment, as well as for pathophysiology and pharmacology. Dedra Hayden runs the clinical assessment course and she is a terrific teacher. I could not find online any detailed written curriculum standards by any national accrediting agency for APRN programs. All of the online-only university programs above, however, are fully accredited by either the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing. To get that accreditation, their curricula must meet the standards of the state’s Board of Nursing. What I would like to know is, who decided this was adequate? Who felt that APRN students, who are expected to do the same jobs as the internist/med-peds and family practice doctors in primary care offices, will be at all prepared? Why did graduate nursing faculty members around the country agree to abdicate their re- sponsibility to teach? Was it just for the convenience and revenue from online programs? How carefully does our Kentucky Board of Nursing examine the candidates for graduation? Why is there no mechanism for a licensing clinical practical exam (not a paper test) by a state certifier? We need more doctors to serve as preceptors for APRN and PA students. We need to help with “nurse residency” programs that have sprung up in response to the stark reality of the short, superficial and rushed NP programs. We are responsible to protect the public and we need to help our nursing colleagues. After all: you can learn a lot online, but not how to take a pulse. Dr. Barry began a part time “float/fill-in” only position at various Norton CMA offices in February. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine. MEDICAL DEBT AND BANKRUPTCY: AN AMERICAN DISGRACE F 28 AUTHOR Michael Flynn, MD inding data and information about medical bankruptcy in developed/ first-world countries other than the US is not very productive. The simple explanation is that medical bankrupt- cy is not an issue in other first-world countries. In 2017 there were zero medical bankruptcies in France (1). France’s single payor system provides medical care for all citizens. for as long as a decade. There were just under 800,000 bankruptcy filings in the US in 2015. In any given year, around 60% of US bankruptcies are related to illness and medical costs (2,3) . This effects primarily low and middle income families, including the 75% who have health insurance. The consequences include loss of assets, including the family home, and any savings or inheritance. Ruinously, one’s credit rating is degraded In 2014, 64 million Americans carried medical debt, the leading cause for bankruptcy in the US (4) . Massachusetts is the only state where medical debt is not the number one cause of bankruptcy because of a law retaining the individual mandate which requires health insurance (5) . The 2017 GOP tax bill eliminated the individual mandate from the Affordable Care Act. LOUISVILLE MEDICINE When a patient has a medical event like MI, cancer, trauma with limited health insurance (short-term coverage) followed by the financial ravages of the current health insurance marketplace which include deductibles, copayments, surprise medical bills and uncovered services: these lead to financial ruin. After a few rounds of chemotherapy or a hospitalization and post-op rehabilitation, the disability leads to loss of employment and income. The end result is 500,000 American families suffering bankruptcy each year (3) .