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Once upon a time, Anesthesiologists put people under during surgery and made a nice living in the hospital. Over the past few decades, nurses began competing with doctors for surgical anesthesia and the reimbursement rates declined for this service. This prompted many Anesthesiologists to move from hospital based surgical assistance to “pain management.” As a pain manager, the same doctor can work in an office, perform more lucrative outpatient nerve blocks and procedures, and prescribe pain medication. Many traditional specialties don’t really want anything to do with treating chronic pain, so referring a patient that complains about persistent pain to pain management is a “win/win.”Once the specialty of pain management came into play, pain societies formed, and they encouraged the consideration of pain levels as a critical vital sign. The prevailing wisdom became that there was no clinical reason for permitting a patient to experience unnecessary pain, and various subjective pain scales were advocated along with evaluation for how well pain was controlled during treatment. Essentially, doctors and nurses were trained to ask the patient to describe their pain on a scale from 1–10, and if their pain was high on that scale, medication was appropriate.Now there is absolutely no objective science behind visual pain scales, or pain as a vital sign—it’s all completely subjective. My 10 on a pain scale might be your 2. Patients who complained about more pain on a visual analogue scale were given more pain medication because it was part of the evaluation of the service; and there was a tremendous amount of pressure on doctors and nurses to control pain in the hospital and during the course of any treatment.All of this new sentiment, backed by absolutely no evidence based research, because most of the outcomes were measured by reductions in a subjective pain scale, flew in the face of longstanding medical knowledge that acute pain was important in diagnosing the problem, and that treating the underlying disease or condition was the best way to alleviate the symptoms. Pain management encouraged “symptom based medicine” rather than diagnosis based medicine. The former is “how can we reduce the pain symptoms regardless of diagnosis;” the latter is “what are the symptoms telling us about the likely diagnosis.”So while this new trend was occurring, physicians specialized in pain management, pain societies formed to promote the idea of pain as a separate disease process (apart from the underlying diagnosis), health care providers were evaluated on whether their patients were voicing subjective pain complaints, and bad research stepped in and was promoted.Addiction Rare in Patients Treated with Narcotics | NEJMThe referenced editorial, appearing in the leading North American Peer Reviewed journal, the New England Journal of Medicine, aggravated the current current opioid epidemic. Before this reference, opioids were very cautiously prescribed, usually for late stage terminal cancer. There were other formulations that were largely NSAIDs: Tylenol, or aspirin with low-level opioids. Generally, because most physicians had come of age during the Vietnam-era Opioid crisis or had served in the service where opioid abuse was well recognized, they were very cautious in prescribing opioids outside the hospital and assumed that the pain was actually being voiced to further addiction.But this reference, characterized as a “study” in subsequent medical articles advocating opioids for Chronic Non Cancer Pain (CNCP) ignored the long history of evidence that opioids were highly addictive and not particularly effective for long-term chronic pain. Opiods were traditionally used for terminal cancer pain with the understanding that concerns over addiction were secondary to making a terminal patient comfortable.The NEJM article is not and never was a study. It was simply an editorial statement of a prominent Harvard doctor. Moreover, it discussed patients who received opiates in the hospital, not patients sent home with bottles of opioids for vague subjective pain complaints. Nonetheless, either intentionally or negligently, this editorial was widely mis-cited as supporting outpatient opioid use for CNCP. At the same time, the market for opioids for cancer pain is much smaller than the market for CNCP since virtually everyone develops some form of pain that can be characterized as chronic pain. As a result of these trends converging, pharmaceutical companies, pain societies, pain management, and other specialty physicians began massively increasing opiate prescriptions in the US nearly eight fold, most for CNCP for which opiates would not normally have been prescribed before these trends.But this is how rapidly opiate prescriptions grew in the US compared to the UK:Clearly, US citizens in 2002 didn’t suffer four times as much pain as they suffered in 1995 or need eight times as much pain medication as their British counterparts. But as the history of the Opiate Epidemic below discusses, by 2010, there was a recognition of the problem and physicians prescribed less opiates, which led to already addicted people seeking Heroin on the street and more recently the far more lethal Fentanyl, which causes overdoses.History of the Opioid Epidemic

The current/traditional system of higher education could well be described as an expensive, on-campus, classroom styled, cohort organised, professor centric, seat-time structured and curriculum based learning system. This system requires the student to learn and understand a specialised core canon of information from generally paper-based textbooks. Understanding must then be demonstrated via the production of mostly text-based assessments to a standard that satisfies the requirement of a particular educational institution. In meeting this standard, the student secures the institution's academic award.If we look at the impact that technology could play on each aspect of this definition, we may well discover an effective alternative. But first ...Let it be said right at the start, that the current/traditional system of higher education has served well the needs of an industrial age, where graduates acquired “know what" knowledge to carry out specialist roles and functions that were logical, controlled and cumulatively sequenced.So education institutions became the learning factories of the industrial age and synced their output to the specialised needs of that age. In doing so they also imbibed the industrial age's efficiency mantra and organised students into age-related cohorts where knowledge was taught to students collectively, following the same sequence and delivered from the same geographic place. This bureaucratic, one-size-fits-all industrial age product became primarily focused on the industrial age's 'efficiency of production' mantra, which generally took precedence over the individual student's needs.But the world has changed .... and it has changed fundamentally in a way that many describe as a new age.In today's age, 'change and innovation' rather than 'stability and structure' is the new norm, making many of our industrial age skills now redundant. This matrix below shows the progress of our changing human society and the significant change that is now taking place as our society transitions from the Industrial Age to the current Information/Conceptual age.In this ever-changing 21st century Knowledge/Conceptual age, students need far more than to ‘know what’ to do in specialist roles and functions. They need to be able to use knowledge as a resource to build something new, rather than see acquired knowledge/understanding as an end in itself. Students need to be able to create new knowledge with their 'know-what' knowledge and so be able to use higher-order thinking to apply, analyse, synthase, evaluate and create.In the Information/Conceptual age, students need to master the Internet/mobile technologies to then creatively use knowledge to build new knowledge that is shared and enhanced by their engagement with global/virtual networks.There is no doubt in my mind that the advent of the Internet, coupled with mobile technologies, has fundamentally changed the way we learn in the same way that microwave ovens changed the way we cooked, TVs changed the way we entertained ourselves, ATMs changed the way we engaged with banks and how MP3's playing digital recordings changed the way we listened to music.So looking once more at each of the aspects of the current/traditional system of higher education described previously, I will look at how technology could be used to create an effective alternative:Technology could provide an alternative to expensive learning with the conversion of on-campus learning into digital learning products. This would involve, video lectures, online tests, pdf's of text documents, digitizing presentations like Powerpoint and then scaffolding these digital learning products into an online Learner Management System. Classroom courses could be filmed with multiple cameras and a sound mixer and uploaded to allow students to review any topic from an online index that charts the content of the entire class. Web applications and freeware such as Google docs can improve efficiency and reduce costs. e.g. InklingTechnology could provide an alternative to on-campus learning by employing the mobility of smartphones and tablets coupled with mobile apps,[1] allowing students to carry a 24/7 access to learning “in their pockets” ... from anywhere, in any place.Technology could provide an alternative to classroom styled learning by leveraging the power of cloud computing to engage a online community of peer learners and provide access to the information they need. The connectivity of mobile devices with their ability to monitor our coordinates creates the potential for “learning locations”."Increasingly we’ll see location-based services utilised as a key learning tool in higher education. We’ll see the management student in a case-study location, the social worker in the community, the nurse in the hospital, the archaeologist in the field, still connected with university resources and a community of peer learners." Professor Gilly Salmon [2]Technology could provide an alternative to cohort organised learning with an online virtual community of practice that help participants in an informal way to address issues and become better at what they do. These communities help participants to deal with a world that is increasingly complex, uncertain, volatile and uncertain. It has proven to be effective in the digital world, particularly for lifelong learning market dedicated to self-learning via collaborative learning which included the sharing of knowledge and experience with crowd-sourcing new ideas and development. Students' sense of audience is completely different. Blogging, online platforms and social media will change our notion of audience from the teacher + cohort ... to the world. e.g. Learning Management System | LMS | SchoologyTechnology could provide an alternative to professor centric learning with learning from a cloud of currently practising professionals working a business model that exchanges knowledge and skills for a subscription or fee ro for free like it's done here on Quora. e.g. Custom Elearning Development | LearnkitTechnology could provide an alternative to seat-time structured learning with a change in focus on competency based learning that assesses success based on the ability to perform a task regardless of the time taken to learn it. Competency based assessment is ideal for online games and simulations coupled with audio/visual/text based tests.Technology could provide an alternative to curriculum based learning with 'just in time' learning delivered over mobile devices and activated in response to the student's pressing need to solve some problem given to them as a learning process.Technology could provide an alternative to a student knowing a specialised core canon of information with a focus instead on how to source, access, validate and attribute existing crowd-sourced library published on the Internet and accessed via mobile devises. Technology ensures that we wil spend far less time finding information, so we can invest a significantly more amount of time digesting, thinking, and learning about new information.Technology could provide an alternative to paper-based textbooks with real-time digitally published online texts maintaining validated currency via a system of online peer review. e.g. Free Online Textbooks, Flashcards, Practice, Real World Examples, Simulations“The rise of online peer review may mean that some texts exist exclusively in virtual form, where they can be updated and refined in real time,” says Linda O’Brien, CIOof the University of Melbourne in Australia.[3]Technology could provide an alternative to text-based assessments with the outcomes from online gaming and simulation software applications being used to demonstrate the student's ability to apply their knowledge to relevant problems. e.g. Simformer - business simulations for online training, business games and educationTechnology could provide an alternative to educational institution standards with industries, organisations and businesses developing their own online assessments as a demonstration of competency.Technology could provide an alternative to institution's academic awards with badges earned for short courses taken online as taught by industry experts or organisations will take it upon themselves to accredit and award potential employees with competency tests. e.g. Udemy (company)Footnotes[1] Digital Collections on DukeMobile iPhone App[2] Tech for teaching: five trends changing higher education[3] http://“The rise of online peer review may mean that some texts exist exclusively in virtual form, where they can be updated and refined in real time,” says Linda O’Brien, CIOof the University of Melbourne in Australia.

As Perneko Papi asks, alternative to what?I’ll first answer assuming that you want to, plan to, and are capable of going to medical school. The largest subset people who do this end up in some kind of family practice or internal medicine career. That’s great. We need those people. There are specialists, like radiology or surgery. Then there are people who go into administration. That’s about it for traditional career paths.However, there are three fundamentally different paths you can consider. The first is medical research, where it’s best to earn a joint MD/PhD, although some will earn the PhD separately, and some won’t earn a PhD. This career is demanding in terms of education (extra years in med school and in advanced fellowships), but you can work on cutting-edge research. It’s not the primary “I want to be actively helping people” option (although of course they do help people). Another option is in a form of public service medicine, which can overlap with research (e.g., epidemiology), or be front-line medicine in challenging places (e.g, Médecins Sans Frontières (MSF) International, known in the US as Doctors Without Borders). Finally, there’s the option of being a flight surgeon for one of the armed forces; your primary job is caring for and evaluating pilots and aircrew.These people live exciting lives. They’re often paid less than their peers (although many have any student loans forgiven). They make sacrifices and probably don’t live quite as easy a lifestyle as their peers, but those I’ve known in these areas wouldn’t trade their careers for the world. Also, many will end up in private practice later in life; for example, you might retire from the Air Force and still be 50 years old (or younger).However, there are options that don’t involve medical school. You don’t have to have an MD to care for people. There are careers at all levels, regardless of your educational stamina and ability. At the most basic level, there are certified nursing assistants (CNAs); they get stuck with some not-so-fun tasks and they aren’t paid very well, but they only need to complete some coursework and pass a certification process. There are licensed practical nurses (LPNs), who have gone through more education and preparation, but they still tend to have rudimentary jobs. Registered nurses (RNs) are some of the most professionally satisfied people I know; they are given a relatively high degree of license and responsibility to carry out their duties, but they still have a lot of direct work with patients, but the job requires a good deal of education, and most have bachelor’s degrees (although NOT necessarily a BSN). Physician’s assistants have some post-college education and work under the direction of a doctor, but are somewhere between a nurse and a doctor, doing some basic work to diagnose and manage issues. Finally, nurse practitioners have a master’s degree (and/or doctorate) and are supervised by doctors, but in some states they are largely independent and can diagnose and prescribe medication.That’s not comprehensive, but these roles make up the core medical staff. There are jobs like phlebotomist (they draw blood) and imaging technician (they run scanners, like x-ray machines and MRIs), among others. Oh, and pharmacists and pharmacy assistants.Some of these roles make good money, too. As far as I know, medical imaging tech is the best-paid commonly available opportunity that only requires a two-year degree. Generally speaking, though, pay goes up in proportion to educational attainment.