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Education and Medicine: What Two Broken Systems Have in Common and How To Fix It

Medicine and K-12 education have a lot in common…and it’s not the good stuff.  


I arrived at this conclusion during an unexpected hospital stay with my child. I could not help but notice the striking similarities between two broken systems in desperate need of repair.  Let’s take a look at the common problems, and then, how we might begin improving them.


PROBLEM: There are numerous specialists, but no one takes collective ownership. 


During my daughter’s hospital stay, we had the unfortunate experience of dealing with a parade of medical “experts,” each one laser-focused on whatever mystery ailment might be associated with their discipline. Notes were typed into charts, inevitably concluding with recommendations for additional consults by other specialists.  At the end of this process, Specialist A signed off, assigning responsibility to Specialist B.  Specialist B quickly informed us that she didn’t have the same expertise as Specialist A so we should try Specialist C.  Specialist C recommended an outpatient clinic with a wait list of over a month. I finally asked in exasperation, “Who is in charge of my daughter?”


This type of scenario plays out daily in education…  


A student is struggling?  Send her to the interventionist!  

The interventionist isn’t successful?  Send her to the school psychologist for an evaluation! 

The psychologist finds the student eligible for special education? Send her down the hall to the special education teacher to “get what she needs.”


But what exactly does she need and who will make sure she gets it???


This “pass the buck” mentality operates under the assumption that someone else is more qualified or better equipped to handle the situation.  The lack of collective ownership results in a fragmented approach that addresses pieces of a problem, but fails to address issues in a systemic way with the whole person at its center.



PROBLEM: There are resources that no one tells you about.  


Throughout our hospital stay, we stumbled upon resources by luck…three days in, a friendly staff member saw me eating lunch in the hallway and directed me to a family lounge, equipped with a refrigerator, free coffee, and laundry machine.  Another day, a kind nurse suggested we check out the outdoor rooftop gardens…we didn’t know one garden existed, let alone two.  And most importantly, after struggling with the aforementioned lack of collective ownership, I reached out to “insiders” through my own network - friends whose family members worked at the hospital, colleagues with connections, and so on.  These personal connections advised me to request a family meeting where all doctors sit in the same room and discuss the patient together.  This meeting was crucial to my child’s care, but no one within the system notified me that it was a possibility.


Similarly, in special education, families turn to “education insiders” for support in navigating a maze of bureaucracy.  These insiders may include friends in the field, advocates, or lawyers.  With the support of education insiders,  resources are often suggested or provided that would not have otherwise been made available. Families who have connections, financial means, or knowledge, command the time and attention of professionals.  Families who lack these resources must trust that the system will work in their favor, whether or not that assumption turns out to be true.  



PROBLEM: People without any background in the discipline influence important decisions. 


No hospital visit would be complete without a harrowing insurance experience.  It doesn’t matter how many physicians indicate that a certain type of care is necessary, someone you can only speak to through an automated phone system has the final word.  The Wizard of Oz behind the insurance curtain will ultimately determine the type of medical care one receives, despite having limited to no knowledge of the patient, condition, and treatment recommendations.


While the stakes aren’t quite as high in education, that system is similarly run by people who lack experience in the field - the school board!  These individuals, who are not required to be educators, are elected officials who are generally called upon to set policy, approve budgets, and hire the superintendent.  The superintendent, in theory at least, manages the day to day operations of the district.  Things go wrong when school boards become overly involved in the daily management of districts and involve themselves in minutiae. Just like insurance companies should allow doctors to do their jobs, school boards need to let administrators and teachers do theirs.  



PROBLEM:  A reliance on “the way we do things” stifles creativity and thwarts change.


 “We don’t do that here.”  

“This is just the way we operate.”

“It’s not possible.”


These refrains can be heard frequently in hospitals and schools, both change-resistant institutions where individuals often assume that the way something has always been done is the best way to do it.  Ophthalmologist, Dr. Tara McCannel, notes, “There are parts of the practice of medicine [that are] based on traditions and habit, rather than actual evidence.”  McCannel cites the common practice of prescribing topical antibiotics after eye surgery as a treatment that is not evidence-based, but persists because it’s just what everyone does.  Even the simple act of doctors wearing white coats, which one might assume is grounded in either storied history or a hygienic purpose, was initiated by a professor who thought medical students were not dressing professionally (Peters, 2023).


Likewise, many education practices we engage in today are based upon a system that was designed for life in an industrial era over 100 years ago.  In the early to mid 1900s, schools sought to prepare children for work in factories.  As such, children marched from class to class at the sound of a bell, and worked simultaneously on the same tasks (Watters, 2015).  Uniformity and sameness were prized, and students who did not fit the mold were sent somewhere else. Today, most factory jobs are gone but the outdated educational practices remain.



HOW DO WE SAVE THESE BROKEN SYSTEMS?


While massive structural overhaul is needed in both education and medicine, there are things we can do until that day comes.


1 .  Set aside time for collaboration.


Medicine and education are both siloed professions.  People enter into the fields with distinct specializations and largely work in isolation from those who do not have that same specialty.  The problem with this approach is that humans are complex, made up of multiple systems, abilities, feelings, and responses.  When we look at an individual in narrow ways, focused only on one aspect of their being, we fail to recognize the intersecting dimensions that could be key to improving that person’s situation.  Providing time for professionals to collaborate with one another and determine the best course of action is necessary to both comprehensive patient care and successful education.



2.  Treat individuals like clients worthy of time and attention, rather than recipients of a service.


Successful businesses need to position client satisfaction as a priority.  Excellent customer service and the delivery of quality products or experiences generally contribute to client satisfaction.  What if we put that same goal of client satisfaction at the forefront of medical treatment and education?  We could consider how to deliver a product that is better suited to individual needs.  We could communicate freely and openly about the available resources we have to offer.  We could regularly solicit feedback and then, actually make changes based on what we learn!  In hospitals and schools, institutional compliance is often valued over individualization and satisfaction. Adjusting priorities could result in better systems overall.



3.  Prioritize creativity.


Hamstrung by either insurance companies, school boards, or legal regulations, professionals in both the medical and educational fields often feel powerless.  Many in both disciplines know that things aren’t working but feel limited in what they are able to do.  This situation could be improved through prioritizing creativity.  People in positions of power must encourage their staff to imagine the system as it could be, not simply how it is now.  Superiors need to create a “culture of yes” where ideas are genuinely considered and not dismissed due to the way things have always been done.  This will take time, due to the resistance to change that has been long evident in medicine and education.


There’s no silver bullet for fixing the education system or the field of medicine. Yet, we have to try.  Our hospitals and schools are not realizing their full potential of what is possible, and we must take steps towards improving these systems.  (Or, we could at least fire the insurance companies…)




References


McCannel, T. (2019, October 1).  How medicine kills creativity.  Op-Med. https://opmed.doximity.com/articles/how-medicine-kills-creativity


Peters, E.F. (2023). Artists remaking medicine: The practice of imagination and the power to create a better healthcare future.  Procedure Press. 



Watters, A. (2015, April 25). The invented history of the factory model of education.  Hack Education.  http://hackeducation.com/2015/04/25/factory-model


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With over 40 years of experience in both fields, I wholeheartedly agree with you. The system needs fixing. In public education, staff often feel discouraged from informing parents about all available options, deemed unprofessional for upholding their standards that necessitate speaking out against negative practices. Alongside PEAC (https://paedforall.org/) and PEAL, your agency, and various nonprofits, we should collaborate to address the considerable needs. In the 1990s, I raised concerns about a student client being tied to a chair, a practice that, hopefully, has ceased in all schools now. Numerous nonprofits, such as Healthy Community Lifespaces at www.hclwellness.org and PEAC, are dedicated to promoting inclusion and health. We are both open to collaborating on our shared missions.

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