I'm not sure how effective an online respiratory therapy degree could be when you have to see the patient to believe the patient. In respiratory therapy, bedside evaluation means everything. This is one of those situations where critical labs are not critical in folks with advanced lung disease. A blood gas that looks horrible may not be clinically relevant at all.
Recently, I found myself in the midst of an interesting interaction between two respiratory therapists talking about two different patients. Both patients were short of breath, but for very different reasons. On first glance, the therapists appeared to have vastly different skills sets. That's not a bad thing. It's just a fact. I found myself wondering if one got an online respiratory therapy degree and forgot everything while the other quit medical school to become a respiratory therapist.
In both patients I requested an arterial blood gas to help me interpret the patient's clinical situation.
Scenario #1
Happy: The patient said they coughed up blood earlier. Even though they aren't hypoxemic, could you please get an ABG and calculate the A-a gradient for me?
Respiratory Therapist: Pause. Dramatic pause. Pause. More Pausing. Smile. What's an A-a gradient, or what ever you called it?
Happy: You don't know what an A-a gradient is?
Respiratory Therapist: No.
Happy: How long have you been out of training?
Respiratory Therapist: About twenty years.
Happy: Smiles. The A-a gradient helps to determine if the patient is experiencing any type of shunting when you evaluate hypoxemia.
Respiratory Therapist: How do I calculate it?
Happy: You can find an online A-a gradient calculator pretty easily these days. There are even medical iPhone applications you can download too.
For a moment there I thought to myself surely respiratory therapy schools teach blood gases as part of their respiratory therapy training. Then I thought to myself maybe he got an online respiratory therapy degree and wasn't expected to learn unimportant things like blood gas interpretation. Then I realized there probably weren't any online respiratory therapy schools twenty years ago and twenty years is a long time to remember unnecessary blood gas physiology.
Scenario #2
Respiratory Therapist: Dr Happy. I'm glad I found you. I'm worried about Mr Smith. He's on large amounts of oxygen and doesn't seem to be getting any better since yesterday, even though he's peeing a bunch from the lasix. What do you think about doing an ABG and calculating the A-a gradient to look for shunting?
Happy: I think that's a great idea. Let's get it done. Give me a call when you have the A-a gradient calculated.
Respiratory Therapist : Great. I have special interest in end tidal CO2 monitoring. Do you mind if I get one and calculate out his anatomical and structural dead space?
Happy: Wow. Them are some physiology terms I haven't heard thrown around since my residency days.
I found myself wondering, if this respiratory therapist quit medical school to become a respiratory therapist. It's amazing in this world of medicine, how does one really know the skill set of those taking care of you? Presumably, both respiratory therapists have gone through their required training, both have passed the necessary testing to get certified and licensed in their field of expertise. Both have been given hospital credentials to practice within their defined scope of practice. But their underlying chest of knowledge appears to be incomparable. What does that mean clinically?
I'm sure if you did a study comparing mortality outcomes in both respiratory therapists, they would be equivalent. What's important? Are some respiratory therapists over trained? Are some under trained? They are all certified. We have online respiratory therapy degrees competing with the structured setting of a University environment complete with the best educators and retirement funds our tax dollars can buy.
Perhaps online respiratory therapy degrees with limited patient experience are enough to get by. Maybe our world is moving toward an education system based less on a broad foundation of knowledge and more on a limited focus of practice. It seems like you can get an online health degree in just about everything these days, including online respiratory therapy degrees and online nursing degrees.
Everything except for a medical school education. And I just find myself wondering over and over again why is that? It's a question that doesn't need answering. Because the answer is obvious. There are no shortcuts to earning a medical education.
