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Per TNG: Ethics, Galaxy-class starships had a physical therapy station in their sickbay, which implied that a physical therapist could be stationed onboard if necessary. However, beyond the occasional dentist, healthcare in Starfleet is dominated by doctors, counselors and nurses. There has been no mention whatsoever, in Star Trek canon, of several healthcare professions that are present in a real-world military.

If one were to believe the canon works, Starfleet faces a severe shortage of optometrists, audiologists, speech-language therapists, physical and occupational therapists, to name a few professions. Or they were at best confined to starbases.

Yet, Starfleet crewmen also need all the support healthcare professions civilians need. Why is there very few, if any, mention of allied healthcare professions in Star Trek canon?

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    There have been dedicated dentists on Star Trek? And even if so, your question sounds as if dentists weren't doctors. – O. R. Mapper Jul 5 '15 at 14:03
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    Perhaps over a couple of centuries, specialties have evolved. What we consider specialties today will become part of a GP's routine practice in TNG's world, replaced by new specialties like the "biomolecular physiologist" called for in "Samaritan Snare". – Anthony X Jul 5 '15 at 15:45
  • Dental exists, including hygenists i.stack.imgur.com/gcuEj.jpg – ThePopMachine Jul 20 '15 at 16:57
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Superior technology and drugs have replaced many healthcare professionals and specialists in the Star Trek universe. For instance, a musculo-skeletal injury that would require months of physiotherapy today can be fully resolved just by waving around one of the various devices available to Starfleet medical personnel.

The availability of advanced technology makes McCoy or Crusher or Bashir or the EMH your:

  • physiotherapist (O'Brien, do you need that kayaking injury taken care of?)
  • optometrist (Laforge, need your visor adjusted?)
  • cardiovascular surgeon (McCoy performed open heart surgery on Ambassador Sarek)
  • neurosurgeon (Bashir's Changeling double, who had Bashir's skills, performed complicated brain surgery on Sisko)

and so on. In short, there are allied health professionals and specialists on starships — they are the same as your primary care physician, thanks to the assistance of extremely advanced medical technologies, techniques, and drugs.

Of course, the knowledge that comes with further specialization is still required in some instances. For example, Dr. Pulaski's specialization in cardiovascular surgery made her the only physician who could save Picard's life when complications arose in the replacement of his artificial heart at a starbase. However, the idea here is that (a) such situations are unusual, and (b) most procedures and surgeries can be performed by a starship's Chief Medical Officer, regardless of his or her previous specialization, due to the common standard of training at Starfleet Medical and the assistance of technology.

As for why nursing and counselling are still separate professions from physicians, the role of "nurse" on a starship seems to be that of "general assistant" to the Chief Medical Officer. For instance, Nurse Ogawa will handle minor medical incidents when Crusher is away from Sickbay or dealing with critical conditions, and will bring hyposprays, tricorders, and other devices to Crusher when she is dealing with a critical condition. On the other hand, counselling is still separate because technology and drugs do not replace psychological evaluation and support (for the most part). In other words, new technologies have not allowed primary care physicians in Star Trek to assume the role of counsellor.

Finally, one might ask: why are nurses not full-fledged doctors when technology makes it so easy to treat complicated conditions? There are a number of reasons:

  • One must still train for a longer period of time to become a doctor. One might be interested in healthcare but wish to enter the profession more quickly than becoming a full doctor would allow.
  • More leisure time: there may be several nurses on a starship, meaning more shift rotations and more free time than the ship's Chief Medical Officer.
  • One might not want the responsibility of being a doctor. The 24th Century has superior technology but still has death, and someone might not wish to assume the overall responsibility for decisions and actions that could lead to a patient's demise.

These reasons are not so different from what happens in today's world.

  • @NSERCProtestor : I know you didn't ask about specialists per se, but I felt it made sense to include them in my answer anyway. – Praxis Jul 5 '15 at 4:34
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    The flip size of this answer, do we know if and how nurses and physicians specialize? Ogawa was a general assistant to Crusher, Chapel assisted McCoy and later became a physician herself. Does that mean all nurses receive such a broad training? That would make sense on a small ship going where no man has gone before. – o.m. Jul 5 '15 at 4:52
  • @o.m. : I agree. – Praxis Jul 5 '15 at 4:55
  • This fails to take in account why are counselors and nurses still separate professions in Star Trek... – NSERC Protester Jul 5 '15 at 13:10
  • @NSERCProtester : I have updated the answer. – Praxis Jul 5 '15 at 14:55
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I'm very late to the party with this post, but wanted to weigh in.

Why are the allied health professions not represented on Star Trek?

As a practicing physical therapist, I think these roles still are relevant in the world of the future. Here are my reasons why, from the point of view of my profession.

The first thing that everyone needs to keep in mind is that human mobility is way more complex than simple musculoskeletal injury. It's not just the musculoskeletal system, but also the central nervous system and the motor map in the brain, the endocrine system, the cardiovascular system, as well as the person's thoughts, beliefs and energetics around how they move that make movement happen. Therapy treats all of this!

With their current training, a general practitioner, or even most specialized MDs, can't do what a therapist does. In the hospital, if the person can't just pop up out of bed (and much of the time they can't), doctors don't know how to instruct them in the correct techniques. If the person's vital signs are unstable, doctors know what the safe range is for exercise, but they don't know the practical piece of how to actually do that during an exercise session. (I've seen them try and it never goes well. :) I also frequently got orders for patients that actually were not appropriate for exercise once I reviewed their lab profiles, and I spent a good amount of time educating the medical team on when the person could safely start activity. What I do is a completely different skill set than what they do.

This is also true in the outpatient orthopedic setting. When I get an order from a doctor, it contains a very generalized diagnosis, but it is up to me to figure out specifically what is going on and decide a plan of care. I've also seen that docs have no idea how to teach or progress an exercise program. They're great at what they do, but therapy is a different skill set.

In order for a general practitioner to be qualified to do what a therapist would do, they would need at minimum an additional three years of training beyond the current medical curriculum. This does not even account for the interspecies component that would be present in Starfleet! I think it would be highly unlikely that the doctors of the future would add this component on to their curriculum, especially since the therapy skill set is fairly different from what they do, and most GP s have enough on their plate without this. For technology, it could take over a part, but not all, of what therapists do. People tend to think that pain and acute injury is a large part of what physical therapists do, but in reality it's just the tip of the iceberg. Sure, a medical device can definitely handle the simple acute stuff- someone broke their hand/nose/etc. on the holodeck after tripping over loose gravel and falling onto it. However, the majority of patients that need therapy are in for more complex stuff.

Example: A patient comes in complaining of knee pain while running. You could run a tricorder scan and see that the person's kneecap and IT band are inflamed. A medical device can definitely fix the acute inflammation. But...did you fix the symptom, or the cause?

You fixed the symptom, of course! The person will feel better for a couple of weeks and then come back to you with the exact same problems. This is because you never fixed the cause.

If this same patient goes to a physical therapist, they will do a gait analysis of the person while running. They could notice any number of irregularities in the way the person runs. Some of these have causes in the musculoskeletal system (stiff feet, flat feet, torsion at the femur, weakness of muscles, and the list goes on...), some of the irregularities are due to other systems, and many, many more of these irregularities have causes in the motor patterns of the brain. Even after the physical therapist and the doctor collaborate to address all of the musculoskeletal and systemic things going on, not just the initial painful symptoms, those motor patterns still need to be retrained, because they often don't automatically straighten themselves out once the musculoskeletal items get fixed. This is still the job of therapy.

There doesn't seem to be a technological thingie in the 24th century that you can point at someone that will automatically retrain their motor patterns. If there was, people would have no need to actually learn a sport. Captain Janeway would not keep getting knots in her neck and upper trapezius muscles. (Voyager: Resolutions) And Ensign Nog would not have phantom limb pain after he lost his leg (DS9: It's Only a Paper Moon).

This is an example from the PT perspective, and I believe that other allied health professionals could offer similar ideas from their own point of view. There was a good argument made that our roles would change, such as being less involved in the management of acute injuries, which makes a lot of sense. However, I think that the needs of the crew would still be such that having onboard allied health professionals would make more sense than having to ship a crew member back to a starbase (and thus losing that person's contribution to the ship) every time they need therapy. After all, most people pursue their rehab program while still living their daily work and social lives.

So, why do the allied health professions never show up in the series?

I think it's for the same reason we never show up in any medical TV series. What allied health practitioners do takes patience and skill and perseverance, but it's not sexy, and doesn't make for good TV. :) Instead, we work quietly behind the scenes to help get people better.

  • One would think the EMH was programmed to do even what allied healthcare professionals do on a regular basis. But was I in the position of, say, Picard, I would rather have a few allied healthcare professionals onboard; I would assume that the ships with the largest crew complements would have had priority in Starfleet's pecking order for assigning such allied health practitioners, if there's any left after hospital ships are accounted for. – NSERC Protester Sep 25 '15 at 3:00
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Aside from @praxis answer above, most of the specialists you ask about are beyond what would typically be available on a ship. The Enterprise where most of the series takes place is a long haul ship where the main medical needs are immediate first response and emergency trauma. Secondary is routine care. And as we see in Whale movie, technology has advanced so far that 80s state of the art surgery is barbaric in comparison. McCoy had the cure for kidney failure in his away bag! Anything that needed long term care that couldn't be handled by the on board staff, would either send that crew member to a base or planet, or if they couldn't for whatever reason, have a specialist brought in, just like real life. This was shown when Worf had a severed spine.

As an aside, technology could aid in what used to require a specialist to being routine for a General Practice doctor. Computer aided or ran vision and hearing tests. Video conference speech therapy. Holo deck physical therapy. The EMH was programmed with everything imaginable, even delivery.

In real life, we are starting to see the rise of Tele - medicine over Skype and remote surgery via machines that copy surgeon movements.

In short, anything that technology hasn't minimized or made obsolete, is likely shipped out.

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Going by the BOOKS, if books are considered canon, specifically, Time for Yesterday of the ToS series, I think the ships of the ToS era at least DO have these various professionals or at least people trained in the skillsets of these professions/specialties... They simply are not mentioned frequently enough because they are otherwise irrelevant to most stories.

In Time for Yesterday, Spock's son, Zar, is brought onboard the Enterprise where - under the instructions of McCoy but executed by other healthcare professionals - he undergoes very rigorous therapies to rehabilitate the bad leg made better by McCoy.

On page 244 of the paperback, there is mention of suspension therapy and rehabilitation and on page 248, it is mentioned that the nurse Urgh'kesht would be supervising Zar's rehabilitation regime as set out by McCoy. Additionally, on page 251, an actual physical therapy room is mentioned.

In this case, though Urgh'Kesht is not a physical therapist in name, she is apparently well-qualified to ensure McCoy's patient follows and adheres to a strict rehabilitation plan.

This seems to support the discussion between @o.m and @praxis re: who specializes in what and if onboard 'nurses' are trained more broadly in various specialties.

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    Typically, the Star Trek books are not canon. – Jeff Jul 5 '15 at 16:17

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