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Monday, October 27, 2014

The fifth period of respiratory therapy: will our profession survive?

The profession of respiratory therapy has traveled through four periods where there was a fear that our profession would disappear, and we survived them all.  We are at the current time amidst a fifth period where there is, once again, a raging fear that our profession will some day soon cease to exist. Will we survive this time around?

First of all, it must be noted here that respiratory therapists are an integral part of the patient care team.  Respiratory therapists exit college with a knowledge base unique to any other medical professional.  Even in the 4th edition of his book "Fundamentals of Respiratory Care, Dr. Donald F. Egan said:
"The techniques that have evolved for the treatment of (respiratory) patients required the supervision of highly educated and skilled professionals whose degree of specialization is beyond the scope of the average attending physician or nurse."
Based on my own experience I believe this to be true to this day.  Over the years I have read many peer reviewed articles, and have seen similar quotes by various well respected physicians, respiratory therapists and even nurses.  It didn't take long after the first orderlies started taking care of oxygen equipment and Iron Lungs during the 1940s for them to realize that they knew more about this equipment than the ordering physicians.  This is a truth that continues to this day, and it should not be -- although often is -- denied.

During the 1960s the first professional organizations were created in order to improve the relationship between physicians and the respiratory therapy profession.  While much progress has been made in this regard since then, there continues to be a disconnect between the two professions. Thus, while individual respiratory therapists may earn the respect of individual physicians,
the respiratory therapy "profession" continues to be seen as an ancillary service where doctors write the orders and we just do as we are told (of course we often know this results in respiratory therapy apathy syndrome).

Why would this be?  You'd think that they would be more than happy to delegate responsibility to trained respiratory therapists.  You'd think they'd be happy to allow trained therapists do what they were trained to do, as this would be to the benefit of the patient and the entire patient care team. And while some physicians do allow such, the majority continue to have a poor understanding of what we are capable of doing.  I honestly think it's not because they don't like us, I think it's because that's how they were trained.

Yet there remain those who say the reason is because we only have an associate's degree, while they have doctorates along with many years of training. So while our professional organizations have done wonders as far as preparing us for the world of respiratory therapy, they have failed to improve the image of our profession to the medical profession.  It is for this reason why much of what we do is a waste of time, such as giving breathing treatments to patients with pneumonia, or patients with heart failure, or just because they smoked in the past.  It's for this reason patients often stay on a ventilator three days, when they could have been extubated on the first day.

The reason could be that some physicians are too proud to bequeath some of their responsibility to people with associate's degrees, although, more than likely, it's that they are unaware of the qualifications and skill set that the average respiratory therapist has. This is in no way the fault of individual therapists, and, to be honest, no way the fault of individual physicians either.  The more likely cause is that we are still a relatively young profession in search of respect that has yet to be discovered on the grand scale.

Making light of the lack of respect for the profession (and not the individual therapist) are bills presently alive in the State of Michigan and in the State of Texas that would would deregulate the profession.  They will try to spin this off as an effort to improve healthcare, although we all know the effort is to cut healthcare costs.  As the government slowly takes over the healthcare industry, it will do whatever is in its power -- even at the expense of good patient care -- to cut costs.

Will the medical profession succeed in getting rid of the much needed respiratory therapy profession? Will we survive the fifth period of respiratory therapy?  Well, most people don't know this, but Congress once tried to end science and thankfully failed.  So, chances are, our profession will likely survive the fifth period of respiratory therapy too.

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