Feb 18 2016

Practicing Medicine Without a License

fake-diploma1

After four years of rigorous study in medical school, which includes grueling class work and then clinical rotations in which you may work 80 hours a week, followed by killer exams to demonstrate you have mastered a vast body of knowledge, you are not yet competent to practice medicine. Those four years only prepare you for your real training as an intern and then resident, another three or more years.

Even then, newly minted attendings who are supposed to be able to practice independently may appreciate having access to more experienced colleagues.

Further, as you accrue invaluable experience over time your fund of knowledge can actual degrade, because the science of medicine is quickly advancing under your feet. It is a struggle to keep up, which is partly why so many physicians specialize.

This is why one of the most important lessons we teach medical students and doctors in training is to have a very good sense of your own limitations. You need to have some sense of how deep any particular specialty is, so that you can gauge your own relative ignorance. The bottom line is – don’t practice out of your depth.

The public recognizes all of this, at least to some extent, which is why licenses are granted to those who spend years in training and can prove they have mastered their discipline. This is a common and reasonable social contract.

Part of my many problems with so-called alternative medicine (or SCAM for short) is that practitioners often take the short cut. They want to practice medicine without medical training. This includes a broad spectrum.

On the one hand you have professions like naturopaths and chiropractors, who do undergo years of education, but the validity of that education is questionable. They essentially regulate themselves, and there is no burden to demonstrate that what they are teaching is scientifically valid. Further, both professions are constantly trying to expand their privileges beyond what their training prepares them for. Many of them want to be primary care doctors, but that is not what they are trained for.

At the other end of the spectrum are those who have essentially no training. What they have is a philosophy, or just a narrative. They have a story to sell, and they are free to make it up as they go along. That is alternative medicine in general – they’re really just making it up, which is a lot easier than careful scientific validation.

One of the disturbing trends in recent decades has been the increased tolerance for essentially practicing medicine without a license. States are just less willing to prosecute this. Also, the definition of “practicing medicine” is a bit flexible, allowing an increasing number of practices to occur without qualifying as “practicing medicine.”

A recent Florida case shows the extremes to which this trend has gone, and how far you have to go to get law enforcement interested in actually enforcing the law and protecting the public.

Florida resident 18-year-old Malachi A. Love-Robinson was recently arrested for practicing medicine without a license. He has no medical training. He has a certificate that he obtained through the mail from the American Association of Drugless Practitioners, after “reviewing copies of degrees and diplomas sent by mail.” No training or testing was required. He also claims to have a PhD from an undisclosed Christian university in an undisclosed discipline.

Love-Robinson was targeted by a sting operation after a public tip:

He said that the undercover agent who posed as a patient came in complaining of an itchy throat. Mr. Love-Robinson took her weight, checked her breathing and checked her temperature, then recommended she visit a local pharmacy for allergy medication.

“There were no scripts given,” he said, “no medical advice given.”

Taking a history, doing an exam, diagnosing allergy, and recommending allergy medication (even if over-the-counter) is practicing medicine.

He also said in his defense:

“I’m not trying to hurt people,” he said. “I’m just a young black guy who opened up a practice who is trying to do some good in the community. If that is a negative thing, we have a lot more work to do in the community than to single out me.”

and

“I value my practice skills which include great communication skills as well as timely and prompt care,” his biography on Healthgrades said. “I am a strong believer that patients in general are the strongest medical tools there is.”

So he’s a people person. That’s a substitute for 7 or more years of medical education. These excuses are representative of alternative medicine generally. They are just trying to help people. They have skills. Why are we bothering them?

Mr. Rosenthal, who issued the dubious certificate, is quoted as saying:

“We tell them that all they can do is consult and educate.”

And there is vagueness of what constitutes “practicing medicine” that alternative practitioners are successfully exploiting. “Consulting” is actually something that physicians do. You have a problem, you consult a physician. Part of that consultation is getting information from you (history and exam). Most of what we do is then educate the patient about their problem and what to do about it.

Real doctors can also order diagnostic tests, prescribe medication, and perform or refer for procedures. Alternative practitioners, however, can prescribe homeopathy, and perform acupuncture, cupping, manipulation, oxygen therapy – a long and growing list of dubious treatments and procedures. They now even have their quack labs to perform dubious diagnostic tests to confirm their bogus diagnoses.

All of this is somehow not “practicing medicine.”

It is practicing medicine. It’s practicing fake medicine based on pseudoscience and philosophy, without the burden of having to validate practice with actual scientific evidence, and without the burden of having to prove valid expertise. They get to just make it up as they go along, and optimize their practice for marketing and profit.

Reading the accounts it seems to me that the reason Love-Robinson was busted was because he was 18. That was apparently part of the original tip – an 18 year old was passing themselves off as a 25 year old. It is highly likely that when Love-Robinson gets a little older, he will be able to ply his alternative trade unmolested by pesky laws designed to protect the public by ensuring anyone passing themselves off as a medical practitioner has actual knowledge, skill, competence, and professionalism.

Like this post? Share it!

24 responses so far