NP's and docs

Specialties NP

Published

You are reading page 2 of NP's and docs

lalaxton

413 Posts

I have never worked with MD's who profess to 'hate' NP's. If this was the norm there would be many fewer NP's in both the US and Canada. In fact the numbers of NP's continues to grow. In my experience when you truly come down to it, it amounts to a turf war. MD's never complained when NP's were found mainly in rural or remote settings or in areas that the docs themselves did not want to practice, now that NP's can be found just about everywhere including some areas and specialties that can be more lucrative they are much more vocally anti-NP.

zenman

1 Article; 2,806 Posts

I work in a busy rural ED, which takes second year PA students for a clinical rotation. These students considered themselves quasi MD's because they take the same level classes for their general education. Most of them are cocky and lack clinical knowledge because they have never worked with patients before. Thus, they run around the ED with their palm computers looking for information and are most of the time in the way.

Tell them to put their palm pilots away and go talk to the patient...after all they already know what the problem is! The med students and residents do the same here...go interview the patient...look in book...write some orders...ask more questions...look in book again...write some more orders. Takes them forever, but is part of the learning process I guess.

windsurfr

13 Posts

ZENMAN.... Humor me and follow this

Patient complains of chestpain.

Go talk to the patient... no palm, no book. Give me a FULL differential diagnosis (what might it be, what not to miss, etc) including what historical findings and clinical PE findings make each more or less likely. Then (in an evidence-based and cost effective approach) what labs do you you want to order and then why. Finally, what are the primary interventions shown effective, and what needs to be done for followup.

Also just for kicks: if you mis-diagnose or mis-treat you will get sued. If you run too many tests insurance companies and hospital administrators get pissed.

Thats right... you probably dont need a book or palm pilot for that one. JUST GO TALK TO THE PATIENT and figure it out.

Please respond to that, and for extra credit:

Patient coming in with hematuria. How about a headache. How about a cough. How about a bump on the knee. But remember... no book, no palm. Just talk to the patient

zenman

1 Article; 2,806 Posts

ZENMAN.... Humor me and follow this

Patient complains of chestpain.

Go talk to the patient... no palm, no book. Give me a FULL differential diagnosis (what might it be, what not to miss, etc) including what historical findings and clinical PE findings make each more or less likely. Then (in an evidence-based and cost effective approach) what labs do you you want to order and then why. Finally, what are the primary interventions shown effective, and what needs to be done for followup.

Also just for kicks: if you mis-diagnose or mis-treat you will get sued. If you run too many tests insurance companies and hospital administrators get pissed.

Thats right... you probably dont need a book or palm pilot for that one. JUST GO TALK TO THE PATIENT and figure it out.

Please respond to that, and for extra credit:

Patient coming in with hematuria. How about a headache. How about a cough. How about a bump on the knee. But remember... no book, no palm. Just talk to the patient

It's really sad, isn't it? You don't even remember when doctors were not privy to advanced diagnostic technology and had to actually use their senses. You want to get good...don't let the patient tell you what their problem is...and don't use anything that requires electricity to diagnose them. By the way, I have lot's of extra credit built up! :chuckle

windsurfr

13 Posts

It's really sad, isn't it? You don't even remember when doctors were not privy to advanced diagnostic technology and had to actually use their senses. You want to get good...don't let the patient tell you what their problem is...and don't use anything that requires electricity to diagnose them. By the way, I have lot's of extra credit built up! :chuckle

Several things wrong with your narrow quote:

1. There has been an absolute explosion in medical knowledge. Both in disease pathophysiology, diagnostic modalities, and treatment regimens. Medicine is becoming increasingly complex (with an increasing amount of quackery to sort through) and patients actually demand current recommendations, etc. I cant tell you how many times patients have loved when I pull up a med on my PDA and tell them how much of the cost their insurance will cover.

2. The patient coming in with chest pain is not telling you what the problem is.... that was your job, remember.

3. Diagnosing is harder than you think, and even the most seasoned veteran physician went through many years of consulting books to help sort things out. Sure, if you practice 20 years things start to stick. But no one is able to just walk in and 'talk to the patient' and come up with a diagnosis right away.

4. Physicians didn't used to get sued nearly as much. This makes us all weary to get a perfect diagnosis, order the correct tests, and the right treatment.

Next homework: Patient comes in with acute exacerbation of CHF, has a history of DM/ mild Alzheimer's/chronic renal failure/ALL. He also has a Factor V Leiden mutation history and has recently been on a long flight. What workup and initial medications/interventions would you use. Do this without a PDA.

A perfect example of why you are so wrong: 20 years ago the acute MI protocol was to place the patient in the hospital with a nitro and heparin drip. Compare that to the complexities of today...

but I remember those great 'ol days when physians just had to talk to patients to figure out a diagnosis.

zenman

1 Article; 2,806 Posts

A perfect example of why you are so wrong: 20 years ago the acute MI protocol was to place the patient in the hospital with a nitro and heparin drip. Compare that to the complexities of today...

Don't forget to compare that the USA still ranks #37th in the world in terms of the health of it's people, even behind Cuba. What's wrong here? Are we focusing too much on complexity?

but I remember those great 'ol days when physians just had to talk to patients to figure out a diagnosis.

What? You were born in 1977, 7 years after I began taking care of patients! :chuckle

Maybe some day you will get it. In the meantime, do you want to parachute, with nothing but a loincloth, into a jungle tribe and have a little contest with me...seeing who can do the most good for the patients there?? :chuckle

windsurfr

13 Posts

Zenman,

I'm not much for little pissing contets and from your other posts elsewhere it is obvious that you take much joy in them.

I will stick to other boards where people can actually make replies with more gusto than "you're only 29 years old and must not know anything". You are a sad person and I hope the future treats you better.

P.S. Who is to fault for the health of our country being #38? Might it have to do with obesity, entitlement, complex health systems, etc?

zenman

1 Article; 2,806 Posts

Zenman,

I'm not much for little pissing contets and from your other posts elsewhere it is obvious that you take much joy in them.

I will stick to other boards where people can actually make replies with more gusto than "you're only 29 years old and must not know anything". You are a sad person and I hope the future treats you better.

P.S. Who is to fault for the health of our country being #38? Might it have to do with obesity, entitlement, complex health systems, etc?

I really wasn't aware that I was in a pissing contest...just thought it was funny that you remember the old time docs at your young age. You came up with "you're only 29 years old and must not know anything," not me! You young guys can benefit from those of us who not only have years of experience but experience in both Western and Eastern forms of healthcare. Our increasingly complex healthcare is on the wrong track and patients are telling you that, but few are listening. And yes, at my age, I have no problems educating people...just don't use a "pissing contest" as an excuse! And I'm a very happy, well-adjusted person...after all I'm in paradise. :chuckle

Try to get a sense of humor, will ya!

cgfnp

219 Posts

P.S. Who is to fault for the health of our country being #38? Might it have to do with obesity?

Ding ding ding ding... ladies and gentleman we have a winna winna winna winna!!!!

zenman

1 Article; 2,806 Posts

Windsurfr, perhaps I've been a little harsh with you. The main pont I want to make is not to focus entirely on being a "medicine techie." Yearly, I see docs getting further and further away from what really matters to the patient. They don't how to talk with patients or even touch them. Nurses are the same. Patients are talking with their actions, ie, spending more of their own money and making more visits to alternative practitioners than they are to Western medicine. We need to look at why? Western medicine, with all it high tech and money spent is failing bigtime on what really matters to patients. It's sad when a healthcare system has become one of the major causes of death. Instead of looking into the microscope at smaller and smaller, perhaps we should look in the other end at larger and larger.

zenman

1 Article; 2,806 Posts

Ding ding ding ding... ladies and gentleman we have a winna winna winna winna!!!!

As your professor, I'm giving you a grade of "D." You do have the opportunity of making it up.

cgfnp

219 Posts

As your professor, I'm giving you a grade of "D." You do have the opportunity of making it up.

My professor??? grade??? WTF are you talking about and grading me on?

+ Add a Comment