nurses-masquerading-as-doctors

[JeffLebowski]

I read "anger" is based on a "belief" and I'm wondering about some data, or facts? I'm not sure where the scientific basis is on below... these are perceptions and assumptions -which is fine, as an opinion, but in order to understand this on anything other than an emotional level I was looking for some science, the kind that takes some real thinking and interpretation, and not just rote imitation or emotionality. Im just wondering where, if this fight is going to be won, the case can be actually made on something other than resentment, anger or hurt feelings? How are physicians actually being hurt and what, technically is actually happening that has any real material effect on anything you do on a daily basis that will change the practice of medicine now and in the future? Do you want more money or something? That would be good all around and for me, I could actually afford to go into family medicine.

If no one is being put out of work, and no one is loosing any cashola, and you are happy with what you are thinking and doing and earning, what's the actual problema? Party on!

The short answer is burden of proof - the burden of proof is not on US to prove they CAN'T provide equivalent care, it's on THEM to prove they CAN. This is a principle of research & treatment development that is known to all physicians, and not surprisingly a lot of non-physicians are having a hard time wrapping their heads around it.

...and we're not really willing to risk the health of a big cadre of patients and just give them the benefit of the doubt while they exercise independent practice rights trying to prove they're just as good when all evidence suggests that their training is inferior and less well-regulated and the ONLY reason to even entertain a replacement for physicians is monetary.

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[Eta Carinae]

In my state, PAs are regulated by the medical board while nurses are regulated by the nursing board. That's why PAs are more beneficial to my mind. Also, the PAs scope of practice is defined by the supervising physician.

Like Batman (MD/DO) and batboy (PA) and Alfred would be the nurse?

 

[Eta Carinae]

Wasn't batboy a huge liability for batman and didn't he slow down batman since batboy frequently needed to be rescued from trouble?
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J/K

 

[glade]

Hey, if nurses and PAs are so competent, then why are they threatened by my simple suggestion that they alone take care of their patients and physicians refuse to clean up any messes? Seems to me that if they truly know that they are competent, they'd just say "fine by us." And so would the patients. But neither group will, interestingly.

 

[mooshika]

I suppose the fact that they don't have to answer to you is the perceived problem, not to mention they don't see the benefit in doing so or even care. I can see how that might piss off some physician-people who are invested in comparing training between the two professions and trying to prove that one is superior to the other.

If the respective curriculms were approaching the same objective and one was actually a watered-down cheaper, short-cut version of the other and in the end they actually received the same compensation and status, (which they do not and there is no proof of that) the "easier" route would be appealing to people who were only focused on compensation and title. I don't really see how one program can be defined as "inferior" to the other because as many of you have gone to great lengths to prove they are completely different like apples and oranges. It seem pretty clear to me that physicians go through some of the toughest professional training out there.

If you have a masters-level NP degree or even a doctorally qualified nursing degree, you are still part of the nursing profession, no matter if you call yourself doctor or mister or madame. It doesn't seem that the route to DNP is shorter or cheaper enough to justify putting yourself through all that miserable fluff they call nursing theory because you want a shortcut to being a medical doctor. And the decent programs are expensive as hell and then they make less than half of what most physicians make... not sure if there is a way to justify that and not just go for medical school instead. It seems much more interesting to me, and you can do so much more with an MD/DO degree.

Personally, I think medical doctors have it made and I can't imagine why someone would prefer a graduate nursing curriculum over medical school unless you are really into all that which is nursing and want to represent the profession.

The short answer is burden of proof - the burden of proof is not on US to prove they CAN'T provide equivalent care, it's on THEM to prove they CAN. This is a principle of research & treatment development that is known to all physicians, and not surprisingly a lot of non-physicians are having a hard time wrapping their heads around it.

...and we're not really willing to risk the health of a big cadre of patients and just give them the benefit of the doubt while they exercise independent practice rights trying to prove they're just as good when all evidence suggests that their training is inferior and less well-regulated and the ONLY reason to even entertain a replacement for physicians is monetary.

 

[mooshika]

That is interesting. Where did that happen and who specifically is threatened by your suggestion? It sounds like you must have some documentation of this exchange between yourself and the PA/NP licensing boards, and their response as you cite it.

Otherwise, can you get examples where a physician had to clean up a "mess" caused by mid-levels? - other than isolated incidents that can't also be matched by cases of physician incompetance? I am curious as to the nature of the incidents. Usually serious incidents are documented and can be accessed fairly easily.

Hey, if nurses and PAs are so competent, then why are they threatened by my simple suggestion that they alone take care of their patients and physicians refuse to clean up any messes? Seems to me that if they truly know that they are competent, they'd just say "fine by us." And so would the patients. But neither group will, interestingly.

 

[Maybeknot]

I suppose the fact that they don't have to answer to you is the perceived problem, not to mention they don't see the benefit in doing so or even care. I can see how that might piss off some physician-people who are invested in comparing training between the two professions and trying to prove that one is superior to the other.

The issue is that they are not trained to diagnose and treat complex medical problems. The training for a nurse practitioner is intended to diagnose and treat common medical problems. The DNP "movement" spearheaded by Mundinger wants to make a completely fallacious and illogical jump from limited health care practitioner to full-on physician surrogate.

If the respective curriculms were approaching the same objective and one was actually a watered-down cheaper, short-cut version of the other and in the end they actually received the same compensation and status, (which they do not and there is no proof of that) the "easier" route would be appealing to people who were only focused on compensation and title.

This is *EXACTLY* *EXACTLY* what is happening, and if you don't realize this, respectfully you are NOT PAYING ATTENTION. They want the same compensation, they want to be called "doctor" in all health care settings. Read the other posts on this thread, read the website I've been working on, look at all the linked videos from CNN and Fox where nurse practitioners are saying THAT VERY THING.

I don't really see how one program can be defined as "inferior" to the other because as many of you have gone to great lengths to prove they are completely different like apples and oranges. It seem pretty clear to me that physicians go through some of the toughest professional training out there.

You're right; the programs are completely different, but DNP's want the same exact thing-- the right for completely independent practice and completely identical compensation to primary care physicians.

And hell, listen to the DNP's. Mundinger says that DNP's should __RUN__ primary care in this country because they "have the medical knowledge and the nursing skills."

Personally, I think medical doctors have it made and I can't imagine why someone would prefer a graduate nursing curriculum over medical school unless you are really into all that which is nursing and want to represent the profession.

Because it's cheaper, it's faster, it's possibly easier and it's less competitive to get into.

 

[Eta Carinae]

Personally, I think medical doctors have it made and I can't imagine why someone would prefer a graduate nursing curriculum over medical school unless you are really into all that which is nursing and want to represent the profession.

Oh Geez. Where to begin?

 

[Dr Oops]

I suppose the fact that they don't have to answer to you is the perceived problem, not to mention they don't see the benefit in doing so or even care. I can see how that might piss off some physician-people who are invested in comparing training between the two professions and trying to prove that one is superior to the other.

If the respective curriculms were approaching the same objective and one was actually a watered-down cheaper, short-cut version of the other and in the end they actually received the same compensation and status, (which they do not and there is no proof of that) the "easier" route would be appealing to people who were only focused on compensation and title. I don't really see how one program can be defined as "inferior" to the other because as many of you have gone to great lengths to prove they are completely different like apples and oranges. It seem pretty clear to me that physicians go through some of the toughest professional training out there.

If you have a masters-level NP degree or even a doctorally qualified nursing degree, you are still part of the nursing profession, no matter if you call yourself doctor or mister or madame. It doesn't seem that the route to DNP is shorter or cheaper enough to justify putting yourself through all that miserable fluff they call nursing theory because you want a shortcut to being a medical doctor. And the decent programs are expensive as hell and then they make less than half of what most physicians make... not sure if there is a way to justify that and not just go for medical school instead. It seems much more interesting to me, and you can do so much more with an MD/DO degree.

Personally, I think medical doctors have it made and I can't imagine why someone would prefer a graduate nursing curriculum over medical school unless you are really into all that which is nursing and want to represent the profession.

You really have no idea whats going on do u.

"The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning"

"Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."
http://news.yahoo.com/s/ap/20100413/...s_med_dr_nurse


"News Anchor: So if you see a nurse practitioner, do you pay less than if you see the doctor?

Nurse Pract: You don't pay less....you're....paying... for a service...

<awkward 4 second silence>

News Anchor: ok... "
http://video.foxnews.com/v/4161870/t...ll-see-you-now


a Midwive gets paid the same as an ob/gyn! same pay half the training. If only people knew how they were getting ripped off.

This DNP degree can be done bsn(college)->dnp(online) in half the time of training a real doctor.

 

[NYRN]

You really have no idea whats going on do u.

"The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning"

"Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."
http://news.yahoo.com/s/ap/20100413/...s_med_dr_nurse


"News Anchor: So if you see a nurse practitioner, do you pay less than if you see the doctor?

Nurse Pract: You don't pay less....you're....paying... for a service...

<awkward 4 second silence>

News Anchor: ok... "
http://video.foxnews.com/v/4161870/t...ll-see-you-now


a Midwive gets paid the same as an ob/gyn! same pay half the training. If only people knew how they were getting ripped off.

This DNP degree can be done bsn(college)->dnp(online) in half the time of training a real doctor.

Midwives do not make the money that MD's do. I know this is not true. Those DNP programs that are accelerated online should not be allowed. The midwife group I know sees uncomplicated pregnancies and is in collaboration with multiple physicians even though they have their own office and have admitting rights to the hospital. If there shows to be any problem with the pregnancy, they are referred to an OB/GYN for the rest of the pregnancy. I don't know of any groups that do it any other way.

 

[Dr Oops]

Midwives do not make the money that MD's do. I know this is not true. Those DNP programs that are accelerated online should not be allowed. The midwife group I know sees uncomplicated pregnancies and is in collaboration with multiple physicians even though they have their own office and have admitting rights to the hospital. If there shows to be any problem with the pregnancy, they are referred to an OB/GYN for the rest of the pregnancy. I don't know of any groups that do it any other way.

Midwives get the same reimbursements as ob/gyn for deliveries ala the new healthcare bill (its written in the article linked above and many others). All your doing is adding a middle man. If theres no problem you pay the midwives which you could of just paid the same for the ob/gyn, if there is a problem the midwive has to call the ob/gyn. Wasting time and money as now there is an unnecessary, lesser trained, addition in the loop to pay for.

 

[NYRN]

Midwives get the same reimbursements as ob/gyn for deliveries ala the new healthcare bill (its written in the article linked above and many others). All your doing is adding a middle man. If theres no problem you pay the midwives which you could of just paid the same for the ob/gyn, if there is a problem the midwive has to call the ob/gyn. Wasting time and money as now there is an unnecessary, lesser trained, addition in the loop to pay for.

I was not aware of the new rules of reimbursement for midwives, thank you for informing me. In recent years women are using midwives more and more out of personal preference. There is a movement from the patient perspective that doctors treat pregnancy and birth as an illness state, and midwives treat childbirth and pregnancy as a natural event. Whether or not there are dangers to allowing these home births and whatnot (which I am 100% against BTW), the women are making their choices as to which provider they want to see. I think if physicians were more likely to go along with a different type of care and birthing plan, these type of women would be more likely to consider an MD rather than a midwife.
If you have never seen the Ricki Lake movie the "business of being born" you should. I take those types of films with a grain of salt, but laypeople take it pretty seriously.

 

[Rabbit Hole]

Like Batman (MD/DO) and batboy (PA) and Alfred would be the nurse?

Wasn't batboy a huge liability for batman and didn't he slow down batman since batboy frequently needed to be rescued from trouble?
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J/K

INVALID! Regarding Batman's sidekick: I demand that you recant your statement or make a correction due to the fact that the "batboy" character you mentioned does not exist. I believe the character's correct name is "Robin". I await your response.

Oh Geez. Where to begin?

I almost jumped into this argument.. but decided to back off after I realized that this person probably has less background knowledge on this subject than a DNP.

 

[Slack3r]

I was not aware of the new rules of reimbursement for midwives, thank you for informing me. In recent years women are using midwives more and more out of personal preference. There is a movement from the patient perspective that doctors treat pregnancy and birth as an illness state, and midwives treat childbirth and pregnancy as a natural event. Whether or not there are dangers to allowing these home births and whatnot (which I am 100% against BTW), the women are making their choices as to which provider they want to see. I think if physicians were more likely to go along with a different type of care and birthing plan, these type of women would be more likely to consider an MD rather than a midwife.

Yeah, everyone wants to be "holistic" and "spiritual" and all the other nonsense until something goes wrong. Then they want a REAL doctor.

 

[Eta Carinae]

INVALID! Regarding Batman's sidekick: I demand that you recant your statement or make a correction due to the fact that the "batboy" character you mentioned does not exist. I believe the character's correct name is "Robin". I await your response.

OOPS

 

[NYRN]

Yeah, everyone wants to be "holistic" and "spiritual" and all the other nonsense until something goes wrong. Then they want a REAL doctor.

I agree. I don't have kids, but when the time comes I am delivering in a hospital with a high level NICU. My RN friends who work L+D have seen many home births from lay midwives (even scarier!) that had terrible outcomes. Those are the midwives NP's and MD's should really be after. Did you know in NY state you do not have to be an NP to be a midwife? At least if the patient wants a midwife, let them have some sort of experience in nursing first, geez. The truth is, it doesn't matter what you or I think, these women have the idea that doctors treat childbirth as disease, and that they will be strapped down in 4 point restraints and forcefully catheterized and given enemas just because they are in labor. Call that crazy, but some women do really believe that.

 

[tootsweet]

I agree. I don't have kids, but when the time comes I am delivering in a hospital with a high level NICU. My RN friends who work L+D have seen many home births from lay midwives (even scarier!) that had terrible outcomes. Those are the midwives NP's and MD's should really be after. Did you know in NY state you do not have to be an NP to be a midwife? At least if the patient wants a midwife, let them have some sort of experience in nursing first, geez. The truth is, it doesn't matter what you or I think, these women have the idea that doctors treat childbirth as disease, and that they will be strapped down in 4 point restraints and forcefully catheterized and given enemas just because they are in labor. Call that crazy, but some women do really believe that.

My husband and I are doctors and had a midwife deliver our baby as we felt I'd have a lower chance of having unnecessary procedures and surgery. Rotations on a number of L+D wards at various residency programs were enough to convince me I'd have to actively avoid the ob's knife. With the national Cesarean rate at over 30% (and often much higher at some hospitals) pregnant women need to defend themselves and choose their obstetrical provider carefully. Low-risk patients are smart to choose a midwife for their delivery and avoid large city hospitals (the ones with the Level 3/4 NICUs) as they're often the hospitals with the highest Cesarean rates and are geared towards intervention, whether a patients needs it or not. It would be interesting to observe the obsterical outcomes for low-risk patients delivering at Level 3/4 NICU facilities compared to low-risk deliveries at smaller, midwifery-run L+Ds. Having an unnecessary intervention/Cesarean can pose it's own risks to the newborn.

Unfortunately, a lot of nurse-midwives are starting to act like obs and have become very interventional. I believe they should be strictly relegated to cover low-risk patients only. However, I do think midwives should be reimbursed similar to ob/gyns for low-risk deliveries (in my experience, they often do a better job as they can spend longer with the patients, offer advice on advise birthing tools and positions..not just swoop in and catch like most obs.) We don't need highly trained surgeons delivering most babies, it's clear that they're doing more harm than good. US docs should focus on high-risk deliveries and surgery.

 

[glade]

mooshika is staying in this argument by basically acting as dense as possible. Everyone makes points and she just goes "whaaaat you say? You wrong!" You can tell she's a troll because her initial post was the "lure" where she asks a question about why anyone disagrees with the concept of "doctor nurses." And since then all of her responses have been intermittent stupidity, like "can you document the conversation you had with a nurse?" You can almost envision her crouched protectively over her computer at work documenting nonsense while her patient is aspirating fifteen feet away and subsequently coding. At some point she'll look up cluelessly while everyone rushes into the room and go "gee, is that my patient?"

 

[JaggerPlate]

My husband and I are doctors and had a midwife deliver our baby as we felt I'd have a lower chance of having unnecessary procedures and surgery. Rotations on a number of L+D wards at various residency programs were enough to convince me I'd have to actively avoid the ob's knife. With the national Cesarean rate at over 30% (and often much higher at some hospitals) pregnant women need to defend themselves and choose their obstetrical provider carefully. Low-risk patients are smart to choose a midwife for their delivery and avoid large city hospitals (the ones with the Level 3/4 NICUs) as they're often the hospitals with the highest Cesarean rates and are geared towards intervention, whether a patients needs it or not. It would be interesting to observe the obsterical outcomes for low-risk patients delivering at Level 3/4 NICU facilities compared to low-risk deliveries at smaller, midwifery-run L+Ds. Having an unnecessary intervention/Cesarean can pose it's own risks to the newborn.

Unfortunately, a lot of nurse-midwives are starting to act like obs and have become very interventional. I believe they should be strictly relegated to cover low-risk patients only. However, I do think midwives should be reimbursed similar to ob/gyns for low-risk deliveries (in my experience, they often do a better job as they can spend longer with the patients, offer advice on advise birthing tools and positions..not just swoop in and catch like most obs.) We don't need highly trained surgeons delivering most babies, it's clear that they're doing more harm than good. US docs should focus on high-risk deliveries and surgery.

I'm speechless. You guys are ... doctors? Like physicians??? Speechless.

 

[Slack3r]

I'm speechless. You guys are ... doctors? Like physicians??? Speechless.

Given they're quoting the nurse tagline ("but we spend more time w/ patients!!1one"), I doubt she actually is a doctor.

 

[JaggerPlate]

Given they're quoting the nurse tagline ("but we spend more time w/ patients!!1one"), I doubt she actually is a doctor.

Same. Well, I'm not sure they are PHYSICIANS. Hence why the 'doctor' tagline can be so deceptive.

 

[illegallysmooth]

I'm speechless. You guys are ... doctors? Like physicians??? Speechless.

Actually, I agree. I've done a good amount of research on the subject. It's true that C-sections are through the roof in number and largely unneccessary. Many OBs simply don't have the time to go through things like birthing positions with the women in labor. This whole issue is hotly debated in some circles and related to issues regarding women's rights and empowerment. Keep in mind she's talking about strictly low-risk pregnancies.

What you should REALLY disagree with are home births and unassisted births. Complete lunacy.

 

[JaggerPlate]

What you should REALLY disagree with are home births. Complete lunacy.

Who advocates these? BC OB/GYN's??? Or someone "else" ....

Frankly, I take issue with almost anyone who vilifies physicians and completely dismisses years of medical knowledge and expertise. I think it's the same attitude people use when then bitch out their doctor bc WebMD says differently and the same mindset government uses to convince the general public that docs are a bunch of money grubbing a-holes who lop of healthy limbs for personal gain.

 

[illegallysmooth]

Who advocates these? BC OB/GYN's??? Or someone "else" ....

Frankly, I take issue with almost anyone who vilifies physicians and completely dismisses years of medical knowledge and expertise. I think it's the same attitude people use when then bitch out their doctor bc WebMD says differently and the same mindset government uses to convince the general public that docs are a bunch of money grubbing a-holes who lop of healthy limbs for personal gain.

It's a huge movement. Look on YouTube for "home birth"... if you don't mind mild traumatization. Or, you could look at it as prepping for your OB rotation

Also, Rikki Lake's documentary "The Business of Being Born" - makes a few good points but it's largely anti-doctor, anti-medicine, ridiculous propaganda.

 

[NYRN]

Who advocates these? BC OB/GYN's??? Or someone "else" ....

Frankly, I take issue with almost anyone who vilifies physicians and completely dismisses years of medical knowledge and expertise. I think it's the same attitude people use when then bitch out their doctor bc WebMD says differently and the same mindset government uses to convince the general public that docs are a bunch of money grubbing a-holes who lop of healthy limbs for personal gain.

If you havent seen the ricki lake movie you should. Even though you will be very angry after you see it, the truth is, there are millions of women out there who share the same views. These women ARE a huge movement and gaining more members every day. The way they see it is that labor and birth are treated as an illness by MD's. They do not want IV lines, monitors, NPO status, bedrest. They believe that doctors are going to strap them down in 4 point restraints while they are in labor and that forcefully catheterize them or give them enemas. Call it crazy, but that is what they believe.

Do I think there is some element of truth to this? I do think that because of the lawsuits from bad outcomes, doctors are much more likely to induce or perform a c-section then they were years ago. When we were born, it wasn't uncommon for our mothers to be 1-2 weeks late with us. Nowadays, if you are 2 days overdue they induce you.

Its a catch 22. If you don't go along with their birthplan, they will seek care elsewhere. If you do go along with it and something happens, than they sue you. I'm sure if there was some iron clad document that the woman could sign that releases the MD of liability for following her birth plan, more MD's would be willing to accomodate some or all of her requests. The MD's could refuse to deliver a patient if he/she does not agree beforehand with the plan if the woman makes it known, and the midwives could refuse to accept a woman who is potentially high risk.

This is one of the reasons why MD's and NP's need to work together, tort reform should be higher on the MD's agenda than the 5 DNP's who go on TV looking to take over MD positions.

 

[JaggerPlate]

^^

I'm familiar with the process and the popularity it's gaining. My aunt is a NICU nurse, and I've discussed it with her in great detail.

 

[Dr Oops]

If you havent seen the ricki lake movie you should. Even though you will be very angry after you see it, the truth is, there are millions of women out there who share the same views. These women ARE a huge movement and gaining more members every day. The way they see it is that labor and birth are treated as an illness by MD's. They do not want IV lines, monitors, NPO status, bedrest. They believe that doctors are going to strap them down in 4 point restraints while they are in labor and that forcefully catheterize them or give them enemas. Call it crazy, but that is what they believe.

Do I think there is some element of truth to this? I do think that because of the lawsuits from bad outcomes, doctors are much more likely to induce or perform a c-section then they were years ago. When we were born, it wasn't uncommon for our mothers to be 1-2 weeks late with us. Nowadays, if you are 2 days overdue they induce you.

Its a catch 22. If you don't go along with their birthplan, they will seek care elsewhere. If you do go along with it and something happens, than they sue you. I'm sure if there was some iron clad document that the woman could sign that releases the MD of liability for following her birth plan, more MD's would be willing to accomodate some or all of her requests. The MD's could refuse to deliver a patient if he/she does not agree beforehand with the plan if the woman makes it known, and the midwives could refuse to accept a woman who is potentially high risk.

This is one of the reasons why MD's and NP's need to work together, tort reform should be higher on the MD's agenda than the 5 DNP's who go on TV looking to take over MD positions.

Yea there was a movement to stop vaccinating kids too. People are stupid. Those 5 DNPs have the entire nursing lobby on their side. First we have to protect medicine and the patients from internal threats then we can deal with tort reform.

Although its a good plan from the nursing perspective. HAve fight against tort reform while subtly passing legislation to expand practice rights. Tort reform will take far more resources and lobbying then Stopping nurses from practicing medicine.

 

[eforest]

Rotations on a number of L+D wards at various residency programs were enough to convince me I'd have to actively avoid the ob's knife. With the national Cesarean rate at over 30% (and often much higher at some hospitals) pregnant women need to defend themselves and choose their obstetrical provider carefully.

Yeah- there's a high Cesarean rate although this likely has more to do with lawsuits than doctors who are gung ho about doing unnecessary surgical procedures. Patients will go on and on about holistic care, no surgical interventions, etc...

Until something goes wrong.

 

[Slack3r]

If you havent seen the ricki lake movie you should.

Never, and I mean NEVER, would I have expected to see something like this in a discussion amongst (allegedly) educated individuals.

Even though you will be very angry after you see it, the truth is, there are millions of women out there who share the same views. These women ARE a huge movement and gaining more members every day.

If there's one thing we don't have here in America, it's a shortage of idiots.

 

[NYRN]

Yea there was a movement to stop vaccinating kids too. People are stupid. Those 5 DNPs have the entire nursing lobby on their side. First we have to protect medicine and the patients from internal threats then we can deal with tort reform.

Although its a good plan from the nursing perspective. HAve fight against tort reform while subtly passing legislation to expand practice rights. Tort reform will take far more resources and lobbying then Stopping nurses from practicing medicine.

If you are convinced that most NP's are looking to go off on their own you are wrong. I don't care what these 5 DNP's say on TV. There are good and bad representatives of all professions, and I don't know anyone who endorses these people. Tort reform is a much bigger problem than these crackpots on TV.

 

[NYRN]

Never, and I mean NEVER, would I have expected to see something like this in a discussion amongst (allegedly) educated individuals.




If there's one thing we don't have here in America, it's a shortage of idiots.

I'm not saying to see the movie and agree with it, I'm saying see it to gain perspective on what a large group of women in this country think of OB/GYN's. You will be shocked what people believe. I actually saw it with my MD friend and she was shocked, but in agreement that people out there truly believe these things. Any OB/GYN will even say that although they don't agree with the views of these women, these types of movements are out there and they are plentiful.

 

[BassCaster]

dr. lisa masterson, from the doctors vs. ricki lake.

Part 1 http://www.youtube.com/watch?v=xG-2r5XGs5M
Part 2 http://www.youtube.com/watch?v=6VStSNCFeEk

it's like a televised version of an sdn thread.

 

[reedman]

so NPs can get paid as much as an OB doc for delivery. does that mean they can get sued like OB docs too? will they also have outrageous malpractice insurance rates?

what does a nurse practitioner do when an emergent c-section is needed in a delivery that was considered the picture of normal until the s**t hit the fan? what about placental abruption? what then?

 

[NYRN]

so NPs can get paid as much as an OB doc for delivery. does that mean they can get sued like OB docs too? will they also have outrageous malpractice insurance rates?

what does a nurse practitioner do when an emergent c-section is needed in a delivery that was considered the picture of normal until the s**t hit the fan? what about placental abruption? what then?

I agree that if midwives want to play the game, they should pay the fee. They will never pay as much as MD's because they are not doing c-sections.

I also agree that its scary if it hits the fan. In the large midwife practice I know of, although they have their own group, they are in collaboration with MD's and if the preg becomes high risk, the MD takes over the patient. If there is a problem during delivery, the MD or the ob/gyn residents will assist/take over. The MD group that this midwife group is in partnership with see a lot of high risk patients. I really don't think they mind the midwives taking care of low risk pregnancies.

Not saying its right, it just is what it is. The women out there just don't seem to care, they are taking their chances.

 

[reedman]

and what about home births?

also, half the battle in medicine is recognizing when something is wrong. it take 4 years of medical education just to learn what can go wrong. it takes thousands of hours of clinical experience to recognize when something is wrong, what is wrong, and what to do about it.

in a setting where there are supervising physicians in house, sure NPs, or whoever else has the skills, should be able to work within a certain scope. but pay should be commensurate with ones experience and ability, just like any other profession.

 

[Eta Carinae]

dr. lisa masterson, from the doctors vs. ricki lake.

Part 1 http://www.youtube.com/watch?v=xG-2r5XGs5M
Part 2 http://www.youtube.com/watch?v=6VStSNCFeEk

it's like a televised version of an sdn thread.

in part 2 of that video, Epstein (co-author) talks about how to have a great C-section- "talk to your surgeon..." about creating the mood by"...dimming the lights in the OR"



I think the sheeple just sunk to a new level of idiocy

 

[tootsweet]

I'm speechless. You guys are ... doctors? Like physicians??? Speechless.

Yes, we're both medical doctors and one of us has a PhD too Off hand, I can think of 4 MD friends who've delivered at home (2 female docs and 2 males with wives delivered at home.)

I'd like to refer anyone who is more interested in obstetrics in this country to read Born in the USA by Marsden Wagner, MD. Wagner is a perinatologist and perinatal epidemiologist from California and former director of Women's and Children's Health in the World Health Organization for 15 years.

I agree that much of the way obstetrics is practiced today is due to the fear of malpractice and reliance on technology that has not been shown to improve outcomes. The system is broken when doctors are performing procedures out of fear over evidence based medicine. A good example is continuous fetal monitoring.

Back to the topic at hand. Deliveries fall on a wide continuum from no intervention, no repairs..to assisted vaginal deliveries with major repairs..to C/S. I'm not sure how the bill accounts for these discrepancies in addition to the increased malpractice fees and years of schooling (and debt) that physicians incur. Anyone know? For example, how would you bill for an uncomplicated delivery by a midwifery with a 3rd degree tear requiring a doc for repair? I'm just about to start residency and have no clue on billing issues.

 

[tootsweet]

in part 2 of that video, Epstein (co-author) talks about how to have a great C-section- "talk to your surgeon..." about creating the mood by"...dimming the lights in the OR"



I think the sheeple just sunk to a new level of idiocy

agreed!!! oops, just nicked the uterine artery...I just didn't see it. Or perhaps the surgeons should just wear little headlamps and attempt laparoscopic fetal removal.

 

[J1515]

agreed!!! oops, just nicked the uterine artery...I just didn't see it. Or perhaps the surgeons should just wear little headlamps and attempt laparoscopic fetal removal.

I think I heard in that ridiculous video that 0.5% of births are home births. Crank that number up to 2% and I'll bet you'd start seeing enough complications that people will realize this isn't smart. Just like others have said, home birth is a great idea until the kid's shoulder gets caught and is born with a paralyzed arm, or develops sepsis or cerebral palsy. Then it'll be "who can I sue?" How about Drs. Ricki Lake and Jenny McCarthy?

Ah, it's so easy to give medical advice when you have no fear of being sued or losing your license. Before I went to medical school I should've told mothers to give birth in a giant tub of balloons with circus music playing and let a clown deliver the baby. Hey, I got nothing to lose.

 

[tootsweet]

I think I heard in that ridiculous video that 0.5% of births are home births. Crank that number up to 2% and I'll bet you'd start seeing enough complications that people will realize this isn't smart. Just like others have said, home birth is a great idea until the kid's shoulder gets caught and is born with a paralyzed arm, or develops sepsis or cerebral palsy. Then it'll be "who can I sue?" How about Drs. Ricki Lake and Jenny McCarthy?

Ah, it's so easy to give medical advice when you have no fear of being sued or losing your license. Before I went to medical school I should've told mothers to give birth in a giant tub of balloons with circus music playing and let a clown deliver the baby. Hey, I got nothing to lose.

30%+ of births in Holland are homebirths and they have better maternal and infant mortality rates...just something to consider. I don't think homebirth is right for every patient but I think there are models of care based around homebirth and midwifery-based birth that would be great for the US.

Here is an interesting landmark study that examines homebirth in North America.

http://www.ncbi.nlm.nih.gov/pubmed/15961814

BMJ. 2005 Jun 18;330(7505):1416.Outcomes of planned home births with certified professional midwives: large prospective study in North America.
Johnson KC, Daviss BA.

 

[DocWiki]

30%+ of births in Holland are homebirths and they have better maternal and infant mortality rates...just something to consider. I don't think homebirth is right for every patient but I think there are models of care based around homebirth and midwifery-based birth that would be great for the US. [/COLOR][/SIZE]

Following your logic you are saying that hospital birth is a risk factor for maternal and infant mortality? That is absurd.

 

[tootsweet]

Following your logic you are saying that hospital birth is a risk factor for maternal and infant mortality? That is absurd.

I wasn't implying that at all. Correlation does not imply causation, I was just pointing out an interesting phenomenon.

 

[Eta Carinae]

Yes, we're both medical doctors and one of us has a PhD too Off hand, I can think of 4 MD friends who've delivered at home (2 female docs and 2 males with wives delivered at home.)

I'd like to refer anyone who is more interested in obstetrics in this country to read Born in the USA by Marsden Wagner, MD. Wagner is a perinatologist and perinatal epidemiologist from California and former director of Women's and Children's Health in the World Health Organization for 15 years.

Perhaps this was idiosyncratic to my medical school, but the philosophy of medicine (as we were taught in OB) was that pregnancy IS categorized as a "diseased"-state, and that the fetus IS considered parasitic.

I srsly disagree with that.

Just sayin'

 

[reedman]

i think i heard in that ridiculous video that 0.5% of births are home births. Crank that number up to 2% and i'll bet you'd start seeing enough complications that people will realize this isn't smart. Just like others have said, home birth is a great idea until the kid's shoulder gets caught and is born with a paralyzed arm, or develops sepsis or cerebral palsy. Then it'll be "who can i sue?" how about drs. Ricki lake and jenny mccarthy?

Ah, it's so easy to give medical advice when you have no fear of being sued or losing your license. before i went to medical school i should've told mothers to give birth in a giant tub of balloons with circus music playing and let a clown deliver the baby. hey, i got nothing to lose.

lol!!!!

 

[tootsweet]

Perhaps this was idiosyncratic to my medical school, but the philosophy of medicine (as we were taught in OB) was that pregnancy IS categorized as a "diseased"-state, and that the fetus IS considered parasitic.

I srsly disagree with that.

Just sayin'

The symptoms of tape worm infection and pregnancy are pretty similar...xept being preggo you have the added beauty of gaining as well.

hmmm.....

Fetuses as parasites.....I'll take it!

 

[OldPsychDoc]

The symptoms of tape worm infection and pregnancy are pretty similar...xept being preggo you have the added beauty of gaining as well.

hmmm.....

Fetuses as parasites.....I'll take it!

'Taint nothin' compared to the parasitic behavior that follows for 18+ years thereafter...

 

[Eta Carinae]

The symptoms of tape worm infection and pregnancy are pretty similar...xept being preggo you have the added beauty of gaining as well.

hmmm.....

Fetuses as parasites.....I'll take it!

Me too!! Any day.

'Taint nothin' compared to the parasitic behavior that follows for 18+ years thereafter...

Oh Gosh!!

I'm dying here.

 

[illegallysmooth]

I think I heard in that ridiculous video that 0.5% of births are home births. Crank that number up to 2% and I'll bet you'd start seeing enough complications that people will realize this isn't smart. Just like others have said, home birth is a great idea until the kid's shoulder gets caught and is born with a paralyzed arm, or develops sepsis or cerebral palsy. Then it'll be "who can I sue?" How about Drs. Ricki Lake and Jenny McCarthy?

Ah, it's so easy to give medical advice when you have no fear of being sued or losing your license. Before I went to medical school I should've told mothers to give birth in a giant tub of balloons with circus music playing and let a clown deliver the baby. Hey, I got nothing to lose.

The only scenario where I would say a home birth is not a completely crazy idea is that if it is an absolutely low-risk pregnancy and there is AT LEAST one medical doctor present with adequate supplies (intubation kits, IV NS, etc), and everyone is literally a few minutes from a hospital. Unassisted births (i.e. no medically trained people, at all) are absolutely nuts, and I think it's borderline child neglect if it was done INTENTIONALLY. I don't even like the whole midwife thing with the old standby "we'll just call an ambulance if something happens" -- how long do these people think it takes for respiratory distress/arrest to kill a newborn??

As far as the research studies regarding home births - none of it matters to me. If one child died or suffered complications because he/she was intentionally born at home rather than in a hospital or with a physician present, that's too many.

 

[J1515]

30%+ of births in Holland are homebirths and they have better maternal and infant mortality rates...just something to consider. I don't think homebirth is right for every patient but I think there are models of care based around homebirth and midwifery-based birth that would be great for the US.

Here is an interesting landmark study that examines homebirth in North America.

The study in the Netherlands compared home births in Holland to hospital births in Holland. They concluded that home births did not increase the risk of mortality, but this is only relatively speaking since it was compared to hospital births in Holland only. The perinatal mortality rate in the Netherlands overall is among the worst in all of Europe (10/1000 - worse than the US). The fact that you tell me home births in Holland don't increase that risk is not encouraging in the least.

I don't know much about Holland, but I'm pretty sure in every other country besides the US you don't have someone looking to point a finger everytime something goes wrong. Sure we could wait a full 36 hours for a spontaneous vaginal delivery in a hospital after premature rupture of the membranes... but guess who gets sued if the she develops chorioamnionitis and the kid is diagnosed with cerebral palsy a year later. Doctors would be more than happy to expectantly manage any patient if people would take responsibility for their decisions instead of suing the second something goes wrong.

Don't point the finger at doctors for being quick to c/s a patient. Blame lawyers and irresponsible patients.

A midwife saying "I'll just call an ambulance if something goes wrong" is ridiculous. There's a reason why ob/gyn's rush the patient into the OR like a bat out of hell when something goes wrong. It's not so they can cash their paychecks before the bank closes.

 

[glade]

Perhaps this was idiosyncratic to my medical school, but the philosophy of medicine (as we were taught in OB) was that pregnancy IS categorized as a "diseased"-state, and that the fetus IS considered parasitic.

I srsly disagree with that.

Just sayin'

That's pretty incredible. So your school's OB department was running around acting like their calling was to eradicate disease (i.e., to abort all babies)? That would be pretty sweet. If I was on call, I'd ignore all of the patients and if the OBs said anything, I'd just say I was hoping the baby would die and the mother would be cured.