Physician Hostility

zenman · Feb 26, 2004

See Randy, we have more in common than you thought. I was a corpsman with Marine infantry for 4 years and spent the entire GW campaign on the ground in a damn hole! can I say that here??

Great,we probably do have a lot in common. Let's drink to that!

I have also worked with Red Duke, and I know you know who he is.

Sure do; he's a famous guy from the Republic of Texas!

But I have to disagree with you on one point Randy. NP's cannot do manipulation and certainly cannot bill for it.

As a Zen Shiatsu therapist, I don't do that dreaded "manip" but do seem to get patients lined up with purposeful stretches. Remember, I'm not a NP...I'm Dr. (Hon) Feelgood!

Crazy enough though, you nurses are starting to grow on me. I do understand much of your animosity toward physicians in general, but there are plenty of us out there who are not condescending and do know who really runs the hospital

Yes, we're wearing you down and training you in the right way. Soon, grasshopper, it will be time for you to leave! Now, remember MDs do not run health care...it's the big business guys. All of us are merely small players. I really have no animosity towards MDs. They are like everyone else...good and bad ones...and I've chewed up a few bad ones...chewed up a few attorneys also...that damn contempt of court thing was expensive, your honor!

PA-C, DO · Feb 26, 2004

Fergus, you are out in left field. You do not learn pathophys as a resident. You learn it in medical school. You may get some clinical concepts related to path reinforced in residency, but pathophysiology is a basic science of medicine. As a resident, one has already proven that they have mastered the basic sciences by passing the USMLE steps one and two. No NP would be teaching a resident pathophys in residency. They might be teaching some via their vast clinical experience, but lets not try and make it sound like midlevels are routinely teaching residents on service. Don't take this wrong Fergus, but as an RN, you really wouldn't be sure if you were listening to a path lesson or not. You are describing an abnormal phenomenon when midlevels teach residents, and that is not to say it is wrong, because there are many midlevels who are good enough at what they do to teach like this. But this usually means they are not well rounded in the other areas of medicine that the resident has already had to master. That is what makes physicians unique. They have to be responsible for everything. Remember, you can teach a janitor to do a pap smear and have them teach residents to do them as well. But this is not teaching anything other than personal experience and technique, and this is where midlevels excel.

zenman · Feb 26, 2004

From MD Terminator: Please try to remember, that for the best care to be given to OUR patients... we have to work together. That's CNA's, LPN's, RN's, NP's, MD's and DO's. Everyone brings some amazing skills to the table, and we both need to recognize what they are.

That's basically it, MD Terminator! We need to look at the system cause it's not working. Medicine is based on newtonian physics which is 300 hundred years old and was proved totally inadequate 50 -60 years ago. Yet the foundation of our scientific training is based on this inadequate info. Nursing is screwed up also and nursing education needs to be re-worked.

Consider:

--Most illness are self-limiting, as with the common cold, yet we spend a big chunk of money and waste our time with advanced diagnostic techniques while waiting to heal.

--"The American health-care system is at once the most expensive and the most inadequate system in the developed world," according to the New England Journal of Medicine.

--Medical errors rank as the eighth leading cause of death in the United States - higher than motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516) - Agency for Healthcare Research and Quality, 2002

--One in five Americans (22%) report that they or a family member have experienced a medical error of some kind. This translates into an estimated 22.8 million people with at least one family member who experienced a mistake in a doctor's office or hospital. - The Commonwealth Fund, 2002

--If our healthcare system is so great, why are we ranked 37th of all countries studied (World Health Organization) as to the health of the population, cost of health care, allocation of public and private funds for healthcare and the ratio of our current state of healthcare compared to what we could be. Even Cuba was ahead of us! France ranks number one in case you want to pack your bags and move quickly!

Here's what I'm asking. All modalities of healthcare should look at each other's systems. They all have something that works. There is a reason that the western population is disenchanted with our current system and is demanding more. Figure out why.

Study the role of the brain and mind in healing because that's where the common theme between all systems of healthcare resides. Shamans were the first mind-body practitioners and "tricked" many patients into getting better, even when their patients knew they were being tricked! We sometimes do the same thing today with the placebo effect. Study it more!

Yes, there are frauds and quacks in all systems of healthcare. Weed them out. But don't knock another system because you think there is nothing to it. You're just being ignorant...that goes for people in any healthcare modality.

I'll wrap up with Serge Kahili King, Ph.D., psychologist (and shaman) and author of Instant Healing: "One very significant thing I have noted is that no matter which system is used, some people are healed through it, some people are not healed through it, some people are healed without it, and some people are healed in spite of it."

Required reading for everyone in health care:

Health Care Meltdown: Confronting The Myths And Fixing Our Failing System

Do We Still Need Doctors: A Physician's Personal Account of Practicing Medicine Today

Code Green: Money-Driven Hospitals and the Dismantling of Nursing

Wall of Silence: The Untold Story Of The Medical Mistakes That Kill And Injure Millions of Americans

Confessions of a Healer: The Truth From An Unconventional Family Doctor

The Future of Healing: Exploring the Parallels of Eastern and Western Medicine

Becoming a Doctor: A Journey of Initiation in Medical School

The Desire To Heal: A Doctor's Education in Empathy, Identity, and Poetry

The Lost Art of Healing: Practicing Compassion In Medicine

Complications: A Surgeon's Notes On An Imperfect Science

What Price Better Health: Hazards Of The Research Imperative

fergus51 · Feb 26, 2004

Actually, I do know they're teaching patho because the resident told me and there are postings all over the place. Even with my puny intellect as an RN, that seemed pretty clear to me. I have no reason to think he was lying to me and don't know why you would assume that you have a better idea at what teaching goes on in my unit. I never claimed this was the norm in residencies, because as I said, I haven't worked with many NPs.

They do of course learn patho in medical school, but most of them had very little in sick prems or the odd kind of congenital issues we see in the NICU, or they are good actors! This is a very specialized unit, and our NPs are certainly very specialized (as are our docs). Believe me, our poor residents do not come to us with a great understanding of either clinical skills or the patho for this unit (I feel terrible for the way they are thrown in and think it's scary). That's not because their training is bad, it's because this is a specialized area. They don't seem to have a problem with learning patho from either of our NPs and the staff docs and hospital feel they are educated enough to teach, so I don't see a problem.

gwenith, BSN, RN · Feb 26, 2004

please once again a reminder to debate the topic not the person. focus on the issues and not your fellow members. please also remember this is a public access board and information posted here is available to a wide range of people. please, please be very careful when posting names.

now i have to second fergus's point we have a terrible time trying to get medical personnel out to rural and remote areas despite big incentives from the goverment which is one reason why we are going to np's here. we do not have pa's at all. if a patient comes in with something beyond the scope of the rn/np we ship them out either by flying doctor or medivac.

zenman · Feb 26, 2004

Aloha gwenith! Fair-go, mate! She'll be apples! Don't send the divvy van after us! Well, got to go walkabout to Border's Books.

Hellllllo Nurse, BSN, RN · Feb 28, 2004

You're my HERO!
I hunted an hour for that article. Googling isn't my strong strength, ya know
:kiss YOU ROCK!
-Dave

Right back at ya', Dave! :kiss

Another point I'd like to make is that physician's assistants are just what the title indicates: assistants to physicians.

Nurse Practitioners are Nurses who "practice a learned profession."*

Nursing is a very seperate profession from medicine. Of course, Nursing and medicine do overlap in some areas. However, an NP is a practitioner:. A PA is an assistant.

*The noun "practitioner" has 1 sense in WordNet.

1. practitioner, practician -- (someone who practices a learned profession)

Tenesma · Feb 28, 2004

isn't this debate getting old for you guys??? PA vs NP... yawn...

what blows me away is this striving for complete autonomy!!! do i believe that most PAs/NPs can take care of most basic issues? SURE!!! and they are fantastic at it!!! and the patients love them... but when there is a problem who do they turn to?

I ran into such a situation tonight... There are several PAs/NPs, who are pushing for more autonomy, who got a patient in the cardiac step down unit with a dysfunctional LVAD --- the pts Systolic BP=55 and he was cold, clammy, diaphoretic. They were trying to tell me what to do (i was on card. anesth. call) and in the end they were just hoping I could fix everything for them, because that was the extent of their training. How can you ask for autonomy in the field you are specializing in, when you can't manage things that deviate from "norm"???

it still boggles my mind... i felt like saying: here is your opportunity to be autonomous!!! but i just did what i always end up doing... I took over the care...

PA-C, DO · Feb 28, 2004

We agree Tenesma

fergus51 · Feb 28, 2004

Well, congrats for you. I guess that one story shows that NPs should not be autonomous. Of course, when those stories come out about other docs, they're just individual stories right?

Roland · Feb 28, 2004

Were either of the NP's Acute care certified and had they had recent ACLS training?, Had they been trained with ventricular assist devices? In addition, you should consider that most of the arguments for greater autonomy are in the context of primary, ambulatory NOT acute care settings. I think it is also true that NP's would consider well meaning criticisms for increasing the length, and or nature of their training in order to facilitate a level of education that would make doctors more secure. However, short of medical school I don't think that most M.D.'s will have much advice to offer in this area. Finally, keep in mind my argument which argued that significant cost savings can in certain cases justify a lower level of competence (and greater morbidity and mortality rates as a result of that situation, not that I actually concede that this situation exists, rather I'm arguing that EVEN if it did there are circumstances where NP's would be the logical choice)

Another compromise might consist of "limited oversight and review" of NP's that practiced independently. Under this scenario NP's would be responsible to an organization made up of NP's and MD's who would "evaluate" their patient care on a quarterly or even annual basis. NP's would be responsible for defending the care that they provided, and their rates of success and failure to provide good care would be compared with other NP's and M.D.'s in their area (and who treated similar types of clinical presentations).

Dave ARNP · Feb 28, 2004

You bring up a very good point about extending NP training.

I think it merits another thread.

I'll be making it, stat!

-Dave

Were either of the NP's Acute care certified and had they had recent ACLS training?, Had they been trained with ventricular assist devices? In addition, you should consider that most of the arguments for greater autonomy are in the context of primary, ambulatory NOT acute care settings. I think it is also true that NP's would consider well meaning criticisms for increasing the length, and or nature of their training in order to facilitate a level of education that would make doctors more secure. However, short of medical school I don't think that most M.D.'s will have much advice to offer in this area. Finally, keep in mind my argument which argued that significant cost savings can in certain cases justify a lower level of competence (and greater morbidity and mortality rates as a result of that situation, not that I actually concede that this situation exists, rather I'm arguing that EVEN if it did there are circumstances where NP's would be the logical choice)
Another compromise might consist of "limited oversight and review" of NP's that practiced independently. Under this scenario NP's would be responsible to an organization made up of NP's and MD's who would "evaluate" their patient care on a quarterly or even annual basis. NP's would be responsible for defending the care that they provided, and their rates of success and failure to provide good care would be compared with other NP's and M.D.'s in their area (and who treated similar types of clinical presentations).