Could an FPNP start an operate a "cash only" walk in... - page 4

by Roland 7,317 Views | 31 Comments

clinic without a doctor onsite? If I couldn't become a CRNA I think that this would be my secondary goal. When I was a Corpman in the Navy I dreamed of going to medical school and gaining a Family Practice specialty. With such... Read More


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    You may also note that it indicates that the use of these four drugs post MI is ALREADY a reccomendation of the American College of Cardiology AND the American Heart Association! This study was confirmatory rather than revolutionary it's just that the researchers were surprised to see how POWERFUL the four drug combination actually was in reducing mortality. The other "story" was that despite the ACC and AHA advising the use of these medications (based upon previous studies) that FEW patients who are eligable are actually RECEIVING ALL four medications. "Translational" medicine that is to say the translation of the latest scientific findings into clinical practice often lags years behind what it should! Consider, that we have had considerable evidence that elevated C-Reactive protein, and homocystein are AS predicative for CHD as elevated LDL cholesterol. However, many practitioners do not utlilize these relatively inexpensive tests (my FP told me that he had never even heard of c-reative protein).
    Last edit by Roland on Feb 25, '04
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    Quote from Tenesma
    zenman:

    you are confusing a lot of points in one paragraph

    1) my primary practice is "western" medicine, but as part of my pain practice i rely on "alternative" medicine: acupuncture, behavioral modification, etc..

    2) comparing length of existence is not a valid point: eastern medicine has been around for a long time, and it has a poor track record. Like you said, the biggest changes in global health have been public health issues (sanitation, urban reorganization, hospital hygiene, washing hands, smoking cessation) and those all stem from "western" culture. Just because people have been drinking chicken blood for abdominal cramps for thousands of years, doesn't lend more credibility to eastern medicine - superstition is a dangerous thing

    3) when you say that we are ranked behind CUBA - what statistic are you using??? that is just plain ridiculous - and I have been on a medical mission to CUBA - so i saw it first hand.

    4) western medicine has failed with chronic diseases... you gotta be kidding me!!! the reason why we have chronic diseases is because "western" medicine has allowed for people to live beyond 35 years of life!!!! how many chronic diseases would a 28 year old have??? now that we have extended their life expectancy of course there are going to be more chronic diseases
    a) life expectancy in 1900 in China was 25 while the life expectancy at the same time in the US was 48.
    b) life expectancy in 1950 in China was 35 while in the US it was 73
    c) 2/3 of deaths in China were due to infectious diseases - what did their alternative medicine do to help with that? again: sanitation and antibiotics

    5) jumping into the jungle - what? western medicine relies on medication and medical devices, therefore you could never compare western medicine and eastern medicine in that setting as you would be depriving the western practitioner of their devices. I would argue that if you and I jumped into the jungle and performed a double-blinded, randomized trial we would have the exact same mortality rate for our patients

    6) i am glad that you were able to cure/treat your elbows, your wife and orthopedic surgeons.... how can you use that as evidence that eastern medicine is better - especially since your first post was alluding to the higher death rate with western medicine... which brings me to my next point

    7) "how many people are killed by western practitioners?" - first of all that is an inflammatory statement, since the patients that you are alluding to died of medical errors and complications, and were not intentionally "killed".
    - and yes, there is a high number of patients who have died in hospitals due to negligence/errors/complications/device-malfunctions etc, but you would have to compare the general population mortality rate with AND without access to a hospital/"western" practitioner... and you will find that the deaths are a small price to pay for the number of lives saved by western practice. a good example of this would be vaccination, there are annual deaths due to side-effects of vaccines or reactions to the vectors/stabilizers in the vaccine, but that has to be compared to the number of deaths that would have occured without the vaccine

    So, in totum, I agree that an ideal practice of medicine would be the integration of western medicine with the best that eastern medicine has to offer (something i practice already), however, you can't be making generalizations that are erroneous, misleading and just ill-conceived.
    Well said and very to the point. I think the point of any practitioner's practice should be to incorporate the best evidence based interventions (including no intervention) with the needs of the patient. East/West-- it doesn't matter. In rural health care, I use a wide variety of interventions to help my patients. It is important to keep yourself informed of advances in all areas of healthcare. It is also important to remember that just because we can do something, doesn't mean that we should.
    I also get really frustrated by herbalists who suggest that an herb might be bettter, safer, etc. than a medication. The designation of a treatment as a medication only implies that it comes in a form that has been processed and perhaps tested and approved by the FDA (or not). Don't think for one second that "herbs" "homeopathic remedies" etc. don't possess active chemical metabolites just like "medicine". Foxglove grows in the garden... in pill form we call it digoxin. (I am pounding on the keyboard now!) Many of my patients come in asking if this or that interacts with their prescription meds. I have to answer (even with multiple herbal resources to consult) that I have no idea because they haven't been tested together. At any rate, if a patient would like to incorporate herbal remedies with their prescription meds, I always recommend one new product at a time to assess any side effects and measure improvement.
    Thanks for keeping my day very interesting!
    Jenfnp


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