WI: 1970s counterculture — successfully! — de-professionalizes both medicine and law

Very nice post, thanks! I agree that society is going to push for increased "quality assurance" in the professions - the history of medicine in the US shows that. GeographyDude mentioned the Flexner Report, which lead to implementation of actual standards in medical education and an oversight/licensing organization (AAMC).

I'm loathe to say that medicine is more important that another career or field. As you point out, programming errors can have serious and life-threatening consequences. However, in medicine the duty of care and responsibility for mistakes is much clearer and direct than say, programming. A physician practices independently and directly interacts with the patient. If I, for example, am taking care of your family member with a brain bleed and operate on the wrong side it is obvious who breached their duty to the patient (me) and who caused harm to the patient (me, again!). In programming, for example, the F35 code is probably a produced by a team which diffuses the individual responsibility, especially from the legal standpoint.

Rather than say one is more important than another, you can view it purely from an ethical viewpoint RE whether you can try again with minimal consequences. For medicine and law, "trying again" is either impossible or obscene (double jeopardy, human experimentation, etc.). By the way, this is the reason why environmental regulations and environmental laws are so important. The real world and nature gets in the way of laws of man -- we can't just unpollute or sue our way to clean air or clean water. Once it's dirty, it's dirty and it either takes extreme effort or worse is impossible to reverse.

Therefore any profession where you only get "one shot" else someone's life is ruined or lost or the effect of a mistake cannot be easily reversed, should be at a minimum restricted from amateurs. The more serious the mistake the more regulation and control and government interference there should be, to the point where if someone's life is directly affected by the skill of a single individual the entire profession should be highly regulated and its title protected by law (physicians, engineers, lawyers).

As an aside lack of "one shot" and regulation is the reason why the IT field is unique and attractive for entrepreneurs... low barrier to entry (assuming you are a top-notch programmer that is) and no regulation means you can try and try again to make that website or app or enterprise software with little consequence to human life and limb. Try that with other fields and you will either go bankrupt or kill someone.
 
I'm not talking about unregulated. I'm talking about where professional associations consciously adopt multi-path. For example, where only, say, 45% of doctors have been to any kind of formal medical school.

So, more formal training, less apprentice time required.

Another example, an army medic can learn some solidly useful information in a relatively short amount of time.

Then you have to consider the relative difficulty of the professions themselves, eg how "hard" it is to be a doctor or lawyer. Over time there will be more case law and history, and medicine and law grows more and more sophisticated, to the point that "multi-path" isn't a realistic option. The larger the body of knowledge and the more difficult the goals, the more formal education becomes a necessity not only because of the field's volume but the actual problems to solve become more difficult. I am reminded of a science fiction story where human beings lived to multi-hundreds of years, and the doctors each year would send a letter to the patient asking if they wanted to die; the answer was almost always no, so the doctors became extremely specialized and knowledgeable at solving extremely esoteric problems which occurred once in a lifetime.

For my profession (computer programming) multi-path is possible because every few years, the entire industry is upended and renewed with new technology and new "cool" programming languages. So self-taught and multi-path is a true option, because every few years the entry point into programming changes and the body of knowledge is arguably static at least at the entry level -- basic computer science will always be computer science. Even then it is only barely possible (I would definitely NOT recommend anyone try without a computer science degree). Compare this to law where the body of knowledge will increase forever, and medicine where no amount of human life or human life quality is enough, and you get a different picture. The more you have to "know everything before" the less multi-path is viable. The more mature the field the more there should be one path and one way.
 
You're talking about what it ideally should be like. But what about the previous '97 study which showed the high percentage of physicians who have problems identifying common heart sounds?

this was the last post on the previous page. The study's main authors are Salvatore Magione and Linda Nieman, both of whom are doctors (well, at least PhDs, it wasn't clear about this part).
 
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I'll also pull in the concept of system accident. The more separate administrative steps . . . well, it makes a certain type of accident more likely. Following is an engineer's summary of the 1996 ValuJet (now AirTran) crash in the Florida Everglades.

http://web.archive.org/web/20070927004115/http://www.cns-snc.ca/branches/manitoba/valujet.html

Step 3. Continental Airlines, a potential SabreTech customer, was planning an inspection of the facility, so a SabreTech shipping clerk was instructed to clean up the work place.** He decided to send the oxygen generators to ValuJet's headquarters in Atlanta and labelled the boxes "aircraft parts".** He had shipped ValuJet material to Atlanta before without formal approval.** Furthermore, he misunderstood the green tags to indicate "unserviceable" or "out of service" and jumped to the conclusion that the generators were empty.
So, no huge mistakes. Rather a series of small and medium mistakes.

complexity --> accident
 
Healing

I think it might actually work. I had a mentor one of the first physical therapists. People thought it was faith healing or acupuncture. He used a lot of modalities the newer generation rejected as unprofessional. I think less rigid orthodoxy would give people more choice and flexiiblty
 
or a Methodist, Baptist, or Presbyterian minister, who wants to help people with their Christian walk, who wants to be there with people in both good times and bad. So, now we're going to make this person study church history, ancient Greek language, etc., etc.???

Well---we want to keep the door open in case the person ever decides to become a theologian or professor.

Perhaps just give a smattering of church history and ancient Greek and that will keep the door open, and if the person wants to dive into it, then more power to them. He or she might even find studying the New Testament in the original Greek to be a centering activity. Again, more power to them.

But of course, not everyone is good at language. What you're actually doing is setting up a generalized intelligence test on the assumption that this wil automatically translate to helping skills. Whereas in fact, actual helping skills often involve underdoing. For example, if someone has lost a family member, I think it's usually best just to say a few words and offer a heartfelt hug. Don't lay a bunch of philosophy on them.

and we're more and more realizing, there is no such thing as generalized intelligence.

I'm a good-natured agnostic, just to lay my cards on the table. I'd invite people who are more traditionally religious to address this question, as well as persons of other faiths.
 
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Another way to advance medical knowledge is to silo down on particular topics. For example, there's the whole international effort to eradicate guinea worm, most popularized by former President Jimmy Carter. Of course Carter is not a doctor, nor are many of the other people. Arguably it's led by doctors, but with a lot of back-and-forth and arguably real insistence on addressing practical issues.

Another example of this is Dr. Atul Gawande talking about efforts to educate people on oral rehydration therapy in Bangladesh.

http://www.newyorker.com/magazine/2013/07/29/slow-ideas

. . . . . They recruited teams of fourteen young women, a cook, and a male supervisor, figuring that the supervisor would protect them from others as they travelled, and the women’s numbers would protect them from the supervisor. They travelled on foot, pitched camp near each village, fanned out door to door, and stayed until they had talked to women in every hut. They worked long days, six days a week. Each night after dinner, they held a meeting to discuss what went well and what didn’t and to share ideas on how to do better. Leaders periodically debriefed them, as well.

The workers were only semi-literate, but they helped distill their sales script into seven easy-to-remember messages: . . . . .
 
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