Homeschooling lessons for emergency medicine (and medicine as a whole).  My column in May’s Emergency Medicine News.  The text follows the link.

I just finished looking over the ABEM Requirements for Assessment of Practice Performance. My mind reels as I consider how many meetings were required to come up with the practice performance requirements put forth by our esteemed Board. Looking over the explanations and descriptions of required activities, allowed activities, schedules, oversight processes and all the rest, my mind returned to the convention I just attended with my wife and children.

It was no medical meeting; rather, it was a convention in Cincinnati for home-schoolers. We home-school our four children (ages 15, 13, 11 and 9), and are winding up our fourth year of filling and forming their young minds outside the standard educational establishment.

Jan and I were terrified at first because we value education highly. So the prospect of taking it on as our own responsibility was no small decision. But here we are, and our children are thriving. Their knowledge of science, history, language (and math, depending on which child we’re discussing) is excellent. When we sit down to dinner, our conversations range from quantum mechanics to singularities, from cosmology to alternative history, and from theology to Monty Python. Each of them is taking Latin, one is independently working through an ancient Greek study.

Despite our lack of participation in complulsory public education, each child is at or above grade-level; the oldest three already have reading comprehension scores comparable to a college-level. Furthermore, we have had no violence (beyond standard brother stuff), no drugs, no ‘sexting,’ no distractions from flirtation, no bullying, no cruelty, no suspension, no expulsion and no weapons in the school. (Other than the ones that are normally stored here, that is).

Now, for those readers who have teachers in the family, and for those whose children attend public school, I’m not trying to detract from you or yours. I have great respect for teachers and I realize that many kids thrive in that environment. I know I did. But I do wonder, if I had had this sort of intimate attention, what would I have accomplished? Of course, that’s purely hypothetical.

More to the point, however, while I was at the home-school convention, in that huge, packed meeting hall, I was mingling with thousands of families who educate their children successfully, but without intense government oversight. Here in SC, we have a small amount of accountability within home-school associations, but generally we are free to pursue our own plan in our own way. The state is largely hands-off. The buck stops at home, as it were.

That’s the thing about home-schooling. It requires an accountability and responsibility that is intensely personal. It works because families love their children and want the best for them, and are willing to work exceptionally hard in order to help their children achieve. And it requires that someone in a position of authority simply trust individual families to do the right thing.

Where there are battles between the state and home-school families, I suspect it has to do, fundamentally, with distrust. Many in the educational establishment can’t imagine that regular people could do a good job teaching children, when there are schools in place designed to do that, on a lare scale, for all kids. In defense of education professionals, America is full of persons who would, in fact, do a lousy job teaching at home. That’s because many parents are too busy, unprepared, painfully under-educated or completely disinterested.

But let’s flip back to medicine for a moment. The ABEM ‘Requirements for Assessment of Practice Performance’ are devices designed to make sure we’re concerned about practicing well, staying up to date and being nice to our patients. At their heart, even if they are part of a larger mandate by the American Board of Medical Specialties,’ they constitute a fundamental belief. And that belief is that physicians can’t be trusted.

I don’t know how we arrived at this juncture in medicine. I mean, we all worked hard to graduate from college with very difficult prerequisites which led us to medical school. We worked hard in med school, then landed in residencies and worked harder. We then entered practice, where (particularly in emergency medicine) our continued willingness to do the right thing under the EMTALA mandate should serve as more than enough evidence of our professionalism.

Ironically, the more responsibilities we assume, the more oversight, rules and potential punishments hang over our heads like some Caduceus-shaped Sword of Damocles. We face background checks, we pay for memberships in state and national societies. We take board exams, yearly exams, recertification exams. We are subject to the often arbitrary and maddening actions of state medical boards which are populated by individuals who seldom understand the situations they are evaluating or the practitioners they are punishing. We face scrutiny by groups like JCAHO for providing inadequate analgesia, and criminal penalties by the DEA for proving too many.

And we face lawsuits, unrestrained by an administration in Washington whose genuflection before trial lawyers makes our relationship with drug companies look positively chaste. This, even as that administration tells us we know too little about the problem compared to the vast comprehension of health-care displayed by executives, senators and congressmen. Furthermore, the future holds claw-backs of money paid to physicians, under the guise of fighting, ‘fraud, waste and abuse.’

Oddly, distrust of our profession, perhaps disdain for our profession, seems to pervade the political and legal systems. And that same distrust, or a surrender to it, has surely fueled further efforts to supervise our practices.

There are bad home-school families; but they are a small minority. There are bad doctors, as well. But most are doing an excellent job, working in difficult and dangerous situations to do the right thing, day in and day out, often for free and frequently in the face of the derision and disrespect of the very individuals we treat gratis.

I’m always weary of hearing that tired old excuse for new programs, so often spoken by our national societies and medical boards, ‘but everyone else is doing it.’ What I’d like to hear is this: ‘Our physicians are among the best in the world. They need no further supervision, for they have already surmounted sufficient obstacles and continually endure enough struggles to prove their character. They have our seal of approval.’

Pity that we haven’t learned what home-school families already know. The best guarantee of success is passion and love. And no amount of higher oversight can cause, or guarantee, either one.

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