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Are we intervening too much?

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I'm currently an FNP student and as I'm progressing into my program, gaining that provider mentality, a conversation with my mother-in-law got me thinking...

She was telling me a few stories how her older relatives hardly received treatment for things; going to the doctor meant you had something beyond what a little salve could take care of (or, for fans of my My Big Fat Greek Wedding, a little Windex). I'm sure we've all encountered those people that say "ehhhh I'll just wait it out I'm not running to the doctor for every little thing" and they actually turn out to be fine.

One story in particular really got me thinking: an aunt of hers was born 8 weeks early in her home at a mere 4lbs. She was not in the NICU for weeks or hooked up to machines. I'm sure there was some intervention, but nothing compared to protocols we have today. Her aunt is completely fine.

I responded to my MIL by saying that there are individuals who do not survive and cannot live with some ailments like they can today. Such situations led to research and treatment development that make it possible to overcome sickness and live with disease. But I couldn't help but still ask myself the question: are we really intervening too much? Of course there are evidence based practices, but is the million dollar workup really implemented because of money or is it more to cover our butts, even for minor things? If you are presented with something minor, how much do you really intervene? Is there middle ground?

 

Sincerely,

A curious FNP student.

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29 Posts; 452 Profile Views

Yes. Definitely there is a middle ground. I come from a country where you have a national health service where there is no billing the patients and no charging insurance companies so people get what they need and nothing extra. In the US you can bill for a range of unnecessary things to cover yourself or it’s more profitable for the hospital/service. You compare the recommendations for cancer screenings in the US compared to Europe or Australia for example. When you allow advertising of prescription medications on TV too people think they need a medicine to solve everything and then go and demand this from their provider.

Take circumcision of newborns for example. Completely medically unnecessary and comes with a whole bunch of risks but because it’s profitable for people to do- it’s still done routinely. 

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

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Hmmm....I care for very ill patients for whom death would never be "unexpected." Yes, I do feel that sometimes we do "too much." That said, I also believe in self-determination. If, after I have very bluntly explained the risks, possible complications, degree of discomfort and/pain, they accept the proposed treatment/procedure, then I do my very best to provide them the best care possible. 

There are sometimes though, that I think we might offer "too many choices."

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

165 Articles; 21,045 Posts; 192,985 Profile Views

Merged both threads

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68 Posts; 743 Profile Views

3 hours ago, traumaRUs said:

Hmmm....I care for very ill patients for whom death would never be "unexpected." Yes, I do feel that sometimes we do "too much." That said, I also believe in self-determination. If, after I have very bluntly explained the risks, possible complications, degree of discomfort and/pain, they accept the proposed treatment/procedure, then I do my very best to provide them the best care possible. 

 There are sometimes though, that I think we might offer "too many choices."

Agreed. There was a study in the NEJM put out there about a decade or so back that palliative care patients with small cell lung ca tend to live about an average of 3 months longer than those getting aggressive treatment due to the complications with minimal benefit that aggressive treatment offers for advanced disease.

Edited by egg122 NP

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PollywogNP has 41 years experience as a ADN, BSN, MSN, LPN, NP and specializes in Med-Surg/Tele/ER/Urgent Care.

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On 7/26/2019 at 7:11 PM, NovaFNP2021 said:

 

One story in particular really got me thinking: an aunt of hers was born 8 weeks early in her home at a mere 4lbs. She was not in the NICU for weeks or hooked up to machines. I'm sure there was some intervention, but nothing compared to protocols we have today. Her aunt is completely fine.

 

 

What year was this aunt born? How accurate were the pregnancy dates? Ultrasound was invented in the mid 1980's or so, & home births/birthing clinics were the norm in the 1950;s in many cities. Did the aunt actually get weighed at birth? Technology has allowed us to "intervene" and many are alive today that might not be because of technology. 

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29 Posts; 452 Profile Views

3 hours ago, PollywogNP said:

What year was this aunt born? How accurate were the pregnancy dates? Ultrasound was invented in the mid 1980's or so, & home births/birthing clinics were the norm in the 1950;s in many cities. Did the aunt actually get weighed at birth? Technology has allowed us to "intervene" and many are alive today that might not be because of technology. 

It’s easy and fairly accurate to date a pregnancy using a woman’s last menstrual period date. Ultrasounds are also not perfect- estimated due dates have a margin of several days either side. 

Babies have been weighed at homes and in hospitals for a long time, definitely 1950s onwards. Everyone always wants to know the baby’s weight! 

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Undercat has 41 years experience as a BSN, MSN, CRNA and specializes in Retired.

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Hmmmm.  Did everyone in the rust belt need OxyContin for back pain and menstrual cramps?  Yes, yes and yes.  We intervene too much and let the patient become passive.  I think NP's who are already experienced nurses will buck this trend because they really understand what iatrogenesis is.

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37 Posts; 1,798 Profile Views

23 hours ago, PollywogNP said:

What year was this aunt born? How accurate were the pregnancy dates? Ultrasound was invented in the mid 1980's or so, & home births/birthing clinics were the norm in the 1950;s in many cities. Did the aunt actually get weighed at birth? Technology has allowed us to "intervene" and many are alive today that might not be because of technology. 

She's in her early 70's now. The exact details of it all I'm not caught up on. I think many are alive because of intuitive providers, and in some cases, technology as well. Even personally, I was telling my MIL I had to go for a gestational diabetes test and the same comment came out: "the doctors intervene too much." I then, of course, had to comment again explaining that diet, health, and family obligations are different than 50 years ago and explain the rise of diabetes during pregnancy that led to routine screening. But even so, she's correct, and as you said ultrasound was not invented in the earlier years.

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37 Posts; 1,798 Profile Views

22 minutes ago, Undercat said:

Hmmmm.  Did everyone in the rust belt need OxyContin for back pain and menstrual cramps?  Yes, yes and yes.  We intervene too much and let the patient become passive.  I think NP's who are already experienced nurses will buck this trend because they really understand what iatrogenesis is.

I think you said it very well. Too many choices lead to passive patients.

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203 Posts; 1,269 Profile Views

Absolutely! I am definitely still seeing antibiotic overuse.  The evidence shows that you don't need that Zpak for your cough or that Augmentin for your sinusitis that began 2 days ago. We are also prescribing them for sore throats without swabbing for strep.  But ya know, we gotta make the patients happy, which means we can't make them wait for the result of that strep test!

Health care workers who know better are the worst offenders when it comes to requesting antibiotics!

 

https://www.health.harvard.edu/blog/when-do-you-really-need-antibiotics-for-that-sinus-infection-2016092610399

 

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12 Followers; 3,955 Posts; 30,015 Profile Views

2 hours ago, 2BS Nurse said:

Health care workers who know better are the worst offenders when it comes to requesting antibiotics!

 

https://www.health.harvard.edu/blog/when-do-you-really-need-antibiotics-for-that-sinus-infection-2016092610399

 

Can't tell if the link was supposed to support the statement above it - - but in any case, it doesn't.

Edited by JKL33

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