Doctor is a title that elicits a variety of emotions. Depending on who you are talking with, it could command respect and honor...or it could trigger suspicion and fear. While "physician" is still considered as one of the most esteemed professions, it suffers a great deal of flak. Some of this scrutiny is unwarranted, but much of it is deserved. The current state of the American healthcare crisis is in no small part connected to the failings of the medical profession as a whole.
The world of medicine has changed a lot over the course of the last few millennia. During earlier times, medicine was relegated to the domain of the shaman or folk healer. These people had specialized, traditional knowledge of herbs and techniques (some efficacious, some not) that, when combined with spiritual ritual, helped to heal patients. It is important to note that no distinction was made between the healing intervention and the spiritual one. The two were the same.
As humanity entered the classical period, when city-states and organized governments began to take form, a more didactic approach to medicine was developed. The ancient Greek and Asian civilizations began to codify previously oral-only knowledge and thus the schools of Hippocrates, Ayurvedic, and Chinese medicine were born. This produced a traceable lineage of thought development and created the profession of medicine. While institutionalization of ideas by no means eliminated the spirituality of the healing arts, it introduced a layer of secularism that would continue to grow over the coming centuries.
The word "doctor" first entered the lexicon during the Middle Ages and was derived from the Latin, "to teach." Originally applied to doctorate level professors of divinity schools, doctor was universally applied for anyone holding the highest degree in a given discipline of study. In these times medicine was often practiced by the learned monks of the church. The title didn't become commonly applied to physicians in English speaking countries until the early-1800s and led to a variety of issues. The chief problem was standardization.
Many folk healers began to call themselves doctors, whether or not they were qualified to do so. Chiropractic medicine, founded in 1895, became a major point of controversy in the United States, concerning the use of the title. Ultimately culminating in a law suit in which the American Medical Association (AMA) was found responsible for wrongfully boycotting chiropractors despite the fact that they were licensed medical providers in every state. Even today there is still tension between the two professions.
In the US, medical schools train and educate M.D.s (medical doctors) and D.O.s (osteopathic doctors). These two are the sole providers of allopathic medicine, which allows them to prescribe drugs and perform surgery, without direct supervision (which is necessary for nurse practitioners and physician assistants). No other doctor can legally provide these things, except in some states (like New Mexico, Colorado, and Oregon) where chiropractors and naturopathic doctors have a limited scope of practice on those functions.
The driving force behind these changes seems to be the major lack of primary care providers in the United States. Thanks to the efforts of the AMA to restrict the number of students who graduate from medical school, a quarter of physicians today in the USA are trained abroad. Furthermore, more physicians are pursuing specialization in their careers which has produced a falling number of primary care and family doctors. As a result, there is a national trend to educate more N.P.s and P.A.s to bridge the gaps in the healthcare industry, but it is far from efficacious. More and more people in the US are using emergency rooms as their primary health care choice due the both the lack of affordable health insurance and paucity of general care clinics.
Perhaps some readers remember the days of the family practitioner who used to do house calls where they would get to know the patient. Now most doctor's visits are conducted in hospitals or multi-practice settings, where physicians spend less than 15 minutes on average with their patients, have little time to discuss lifestyle, and have almost no contact with the myriad of other doctors that the patient is seeing. Over-medication resulting in drug interactions is the third leading cause of death in the US behind heart disease and cancer. Sadly, most M.D.s and D.O.s don't like to practice this way either but are shoehorned into it by an industry that can't seem to accept its own failings. Add several hundreds of thousands of dollars of student debt and an expectation to earn five times the national average income, and you have a recipe for compliance.
If we are to untangle this knot, we must shift our focus back to the true meaning of medicine. The allopathic branch has taken the physicalism of medicine to its extreme and we have gotten a system that treats people more like cattle than humans. The faith healers have taken the spiritualism of medicine to its extreme and we have gotten the denial of disease and modern intervention. It is now time to embrace the holism of medicine. Time to see the body and spirit as a unified and synergistic organism in the context of all other organisms. Time for a return to the hometown doctor. Time for us all to invest our money and time into ourselves and not systems that make their money by keeping us sick. Doctor means "to teach." True doctors share their knowledge. They don't guard it.
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