nurses-masquerading-as-doctors

[Eta Carinae]

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.

Oh .

Anything but.

Of course if the mother's life was ever at risk for any reason, the child's well being was sacrificed.

I would obviously still prefer and recommend the care of an OB/Gyn MD/DO and an in-hospital delivery for all women.

(Personally, I intend to maintain strict instructions that every measure be taken to ensure the well being and health of the baby to the detriment of mine. And I'll be willing to sign statements absolving my doc of any culpability/liability in the event of any misfortune.)

---

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[Rabbit Hole]

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.

Amen to that brother.
I feel embarassed for the person suggesting watching some bullsh*t by RICKI LAKE!? Are you kidding me?

I strongly urge these holistic and spiritual folksy people to SERIOUSLY reconsider their beliefs. I seriously wonder why seemingly intelligent people blindly diverge so far from science. If you really want to watch an interesting video watch this:
TED Talks: Michael Specter: The danger of science denial

 

[NYRN]

Amen to that brother.
I feel embarassed for the person suggesting watching some bullsh*t by RICKI LAKE!? Are you kidding me?

I strongly urge these holistic and spiritual folksy people to SERIOUSLY reconsider their beliefs. I seriously wonder why seemingly intelligent people blindly diverge so far from science. If you really want to watch an interesting video watch this:
TED Talks: Michael Specter: The danger of science denial

Am I kidding you? Nope! You have obviously never spent any real time with patients yet. You will see when you are a resident and are seeing patients on a regular basis. I recommended seeing the video in order to get the perspective of what millions of your future patients believe about doctors. You can't just tell them well I am the MD and I think its dangerous to do XYZ. If you are not aware of the cultural beliefs of your patient population or refuse to acknowledge them, you are not going to be very successful in changing these types of beliefs.

Any of the residents here will tell you that the days of the patient complying with the MD just because the MD says so are over. I'm not just talking about people with low educational level. Some of these people are highly educated. These people are reading things online, and they will come to you with a list of what they want done. They will believe that you are prescribing them drugs or vaccinating their kids because you are getting paid from the pharm companies if you do.There are some people that you will be able to reach and change their views, but its not going to happen over night, and its not going to happen if they feel you don't get where they are coming from.

I'm not saying you have to go along with these beliefs patients have, but at the very least you need to hear them out and then explain why you feel that these alternative measures are not safe and then work with the patient to get them to comply with care, not just telling them because I said its not safe.

Do I believe in all this new age stuff? Not really. I believe that there are benefits to some alternative medicine, but there is a lot more research that needs to be done before we get there.

 

[Rabbit Hole]

Am I kidding you? Nope! You have obviously never spent any real time with patients yet. You will see when you are a resident and are seeing patients on a regular basis. I recommended seeing the video in order to get the perspective of what millions of your future patients believe about doctors. You can't just tell them well I am the MD and I think its dangerous to do XYZ. If you are not aware of the cultural beliefs of your patient population or refuse to acknowledge them, you are not going to be very successful in changing these types of beliefs.

Any of the residents here will tell you that the days of the patient complying with the MD just because the MD says so are over. I'm not just talking about people with low educational level. Some of these people are highly educated. These people are reading things online, and they will come to you with a list of what they want done. They will believe that you are prescribing them drugs or vaccinating their kids because you are getting paid from the pharm companies if you do.There are some people that you will be able to reach and change their views, but its not going to happen over night, and its not going to happen if they feel you don't get where they are coming from.

I'm not saying you have to go along with these beliefs patients have, but at the very least you need to hear them out and then explain why you feel that these alternative measures are not safe and then work with the patient to get them to comply with care, not just telling them because I said its not safe.

Do I believe in all this new age stuff? Not really. I believe that there are benefits to some alternative medicine, but there is a lot more research that needs to be done before we get there.

I understand what you're saying and I agree to an extent. A healthy dose of awareness is warranted. However, if I immersed myself into trying to "understand" where these lunatics get their ideas from I would probably waste a lot of time. I would rather use my time to stay up to date with modern evidence-based medicine and use that knowledge to educate my patients. I don't need to know what Ricki Lake thinks in order to demonstrate my point.. it's not my job to entertain hoaxes and radical notions of "alternative medicine".

Patients who are that entrenched in non-scientific beliefs are probably going to need more than just a primary care visit to cure them of their mental illness.

EDIT: Those people who don't believe in science and the scientific method are mentally ill. We should help them by referring them to a psychiatrist or transport them back to Middle Ages where they belong (wishful thinking).

 

[smq123]

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.

One of my friends took a picture of an advertising poster on a NYC subway platform.

It's for a law firm, boasting that they won a $77 million lawsuit for "failure to perform a c-section."

It's not a wonder that the national c-section rate is so high; it's a wonder that (in PA and NY) it's not even higher!

 

[Instatewaiter]

If you are not aware of the cultural beliefs of your patient population or refuse to acknowledge them, you are not going to be very successful in changing these types of beliefs.

I don't mean to jump on you but every time I hear someone say you need to be aware of a person's cultural beliefs I laugh. A lot.

It's this kind of crap that makes some of the workers (who we will refer to as "furses" so their identity is kept secure) in the trauma bay ask Delta traumas as they're being wheeled in if they have any cultural beliefs we should know about.

No lady, get the fuc# out of the way. The person has a GCS of 3 and has been shot 5 times. You are in the way and wasting time.

 

[NYRN]

I don't mean to jump on you but every time I hear someone say you need to be aware of a person's cultural beliefs I laugh. A lot.

It's this kind of crap that makes some of the workers (who we will refer to as "furses" so their identity is kept secure) in the trauma bay ask Delta traumas as they're being wheeled in if they have any cultural beliefs we should know about.

No lady, get the fuc# out of the way. The person has a GCS of 3 and has been shot 5 times. You are in the way and wasting time.

For those who are doing rotations or residency in the lilly white midwest these cultural issues don't come up as much as those who are training in big cities like NYC. I'll tell you this, if a trauma or cardiac arrest come in, its much more likely for the attending or senior resident will get YOU the med student out of his/her way than me, who they know can work on the patient NOW.

Anyway, you better get used to the idea of incorporating cultural beliefs, because its being incorporated into the joint commission standards. If you refuse to follow it, and the patients are filing complaints because they claim you are insensitive to their culture or that they don't understand their care because of it, you will be gone. Have you ever been at a hospital when the joint commission is there? Everyone is on edge because if the hospital does not pass, it basically shuts down.

http://http://www.jointcommission.o...lop_Culturally_Competent_Pt_Centered_Stds.htm

How about another angle. What if this patient is a Jehovah's Witness?
They will refuse blood and all blood products. You need to know this if there is a chance this patient needs blood because then you better find another way to replace volume lost. If the patient becomes unresponsive and you give the blood anyway, you are in big trouble. These patients will carry a card in their wallet stating they do not want blood. The courts are ruling in favor of the patient in these cases. Being unresponsive does not equal implied consent in these cases. Even if the patient is a minor, you need a court order before you can give the blood.

How about this? The patient doesn't understand english well or at all. You are getting consent from them for surgery. If you cannot or refuse to provide an interpreter, the patient can sue you later saying they did not understand what they are signing.

You will learn, stick around a while.

 

[NYRN]

One of my friends took a picture of an advertising poster on a NYC subway platform.

It's for a law firm, boasting that they won a $77 million lawsuit for "failure to perform a c-section."

It's not a wonder that the national c-section rate is so high; it's a wonder that (in PA and NY) it's not even higher!

This is why I believe that there should be some sort of iron clad waiver to the MD that if they refuse c-section or other forms of fetal monitoring before it gets to the point of c-section, they cannot sue.

 

[NYRN]

I understand what you're saying and I agree to an extent. A healthy dose of awareness is warranted. However, if I immersed myself into trying to "understand" where these lunatics get their ideas from I would probably waste a lot of time. I would rather use my time to stay up to date with modern evidence-based medicine and use that knowledge to educate my patients. I don't need to know what Ricki Lake thinks in order to demonstrate my point.. it's not my job to entertain hoaxes and radical notions of "alternative medicine".

Patients who are that entrenched in non-scientific beliefs are probably going to need more than just a primary care visit to cure them of their mental illness.

EDIT: Those people who don't believe in science and the scientific method are mentally ill. We should help them by referring them to a psychiatrist or transport them back to Middle Ages where they belong (wishful thinking).

I think as long as you keep an open mind to the idea that not all people out there trust medicine today, you will do a better job educating the patients. If they understand that you are aware of how they see things, and then explain why you disagree, they will be more open to accepting your ideas than if you just blow off their ideas as soon as they are mentioned.

 

[JaggerPlate]

One of my friends took a picture of an advertising poster on a NYC subway platform.

It's for a law firm, boasting that they won a $77 million lawsuit for "failure to perform a c-section."

It's not a wonder that the national c-section rate is so high; it's a wonder that (in PA and NY) it's not even higher!

What a bunch of soulless bastards. I'd rather open a puppy kicking business and put a picture of me, in Times square, kicking a puppy in the face than make my money suing OBs and brag, via posters, about how badly I rape them.

 

[mooshika]

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.

Just want to say I support this. The compensation issue - if OB's want more compensation they should advocate for that and not go at it by discrediting the Nurse Midwives.

There is an amazing midwife-run birthing center in the poorest section of Washington DC that has had a remarkable improvement in good outcomes for births by both potentially high risk women and low income/no insurance/single parent, etc. population compared to the outcomes at the tertiary care hospital facility right down the block staffed by OB/GYN's and no Nurse Midwives. Cost was also markedly reduced compared to the hospital facility. There are a number of studies done and are published online. I will try to find the links to both the birthing center and the studies.

Yes, it is good that the hospital and the OB's are right down the street and it is utilized properly and correctly. And yes, any decent nurse midwife can assess when tertiary care interventions are needed and will/should seek them out.

 

[Slack3r]

This is why I believe that there should be some sort of iron clad waiver to the MD that if they refuse c-section or other forms of fetal monitoring before it gets to the point of c-section, they cannot sue.

Contracts and waivers don't mean **** in a court of law.

 

[goosew]

Contracts and waivers don't mean **** in a court of law.

Ok, i'm sure i'm taking this COMPLETELY out of context, but isn't that exactly what a contract is.


hell, even verbal contracts are legally binding in certain cases.

 

[Slack3r]

Ok, i'm sure i'm taking this COMPLETELY out of context, but isn't that exactly what a contract is.


hell, even verbal contracts are legally binding in certain cases.

I'm saying a waiver saying "I won't sue if something goes wrong" would probably not hold up in court if the plaintiff had a good lawyer.

 

[group_theory]

Contracts and waivers don't mean **** in a court of law.

Ok, i'm sure i'm taking this COMPLETELY out of context, but isn't that exactly what a contract is.


hell, even verbal contracts are legally binding in certain cases.

For contracts, you really need a lawyer who specializes in medical malpractice AND contract law, along with the specifics of your state laws and rules. Every state will have different laws and court rulings.

But a good site is from the American Association of Neurological Surgeons, a group that may know a thing or two about getting sued.

http://www.aans.org/library/Article.aspx?ArticleId=37402

This article will explore the ability of contract law to protect physicians from frivolous lawsuits.

Making Contracts Enforceable
To help explain what should work, it is first useful to describe what will not work. Asking a patient to forego all remedies is not a workable solution. For example, demanding that a patient not sue for any reason will not be enforceable. Public policy dictates that patients must have some remedy for negligence. That remedy is usually through the courts, although arbitration is another viable option. Having a patient sign a blanket release would be considered an "abuse of power," and courts routinely have dismissed such agreements.


If, however, the demands of a contract are narrower, the contract should withstand challenges to enforceability. The contract defines expectations regarding resolution of concerns, specifically that the physician cannot be sued for a frivolous reason and that should there be a dispute, each side will use experts who follow the code of ethics of the physician's specialty society. The following considerations for the patient-physician contract are suggested:

• Be clear on the mutuality of agreement.
  
  
• Do not make any attempt to change the physician's duty to the patient within the agreement.
  
  
• Call the patient's attention to contractual provisions.
  
  
• Allow the patient the opportunity to think about the contract and its consequences and to ask questions.
  
  
• Do not seek the patient's agreement when care is needed urgently or emergently. A better approach is to obtain agreement later (for example, in a post-hospitalization office visit) and to make the agreement retroactive -- as long as the effective date of the agreement is clearly reflected.
  
  
• Do not condition the patient's treatment on signing the agreement.

Click link to see full article (it goes into more details, such as enforceability)

 

[NYRN]

For contracts, you really need a lawyer who specializes in medical malpractice AND contract law, along with the specifics of your state laws and rules. Every state will have different laws and court rulings.

But a good site is from the American Association of Neurological Surgeons, a group that may know a thing or two about getting sued.

http://www.aans.org/library/Article.aspx?ArticleId=37402

This article will explore the ability of contract law to protect physicians from frivolous lawsuits.

Making Contracts Enforceable
To help explain what should work, it is first useful to describe what will not work. Asking a patient to forego all remedies is not a workable solution. For example, demanding that a patient not sue for any reason will not be enforceable. Public policy dictates that patients must have some remedy for negligence. That remedy is usually through the courts, although arbitration is another viable option. Having a patient sign a blanket release would be considered an "abuse of power," and courts routinely have dismissed such agreements.



If, however, the demands of a contract are narrower, the contract should withstand challenges to enforceability. The contract defines expectations regarding resolution of concerns, specifically that the physician cannot be sued for a frivolous reason and that should there be a dispute, each side will use experts who follow the code of ethics of the physician’s specialty society. The following considerations for the patient-physician contract are suggested:

• Be clear on the mutuality of agreement.
  
  
• Do not make any attempt to change the physician’s duty to the patient within the agreement.
  
  
• Call the patient’s attention to contractual provisions.
  
  
• Allow the patient the opportunity to think about the contract and its consequences and to ask questions.
  
  
• Do not seek the patient’s agreement when care is needed urgently or emergently. A better approach is to obtain agreement later (for example, in a post-hospitalization office visit) and to make the agreement retroactive -- as long as the effective date of the agreement is clearly reflected.
  
  
• Do not condition the patient’s treatment on signing the agreement.

Click link to see full article (it goes into more details, such as enforceability)

This is exactly the type thing that we need more of. People who choose to go against the advice of doctors and other professionals when the risks are explained to them should not be able to sue. These days, even when a patient signs out AMA, the MD is not 100% waived of liability. I know an attending who was sued after a patient admitted for chest pain had an MI after signing out AMA. The truth is, the insurance companies settle most of the time instead of fighting it out in court. Is this fair? Not at all.

I understand you are all up in arms about the DNP thing, but really, tort reform is a much bigger issue than a few DNP's who are not speaking for the majority. If you are not fighting the lawyers, they will be determining how you practice medicine.

http://www.medmalnj.com/index.php?option=com_content&view=article&id=91&Itemid=60

 

[goosew]

These days, even when a patient signs out AMA, the MD is not 100% waived of liability. I know an attending who was sued after a patient admitted for chest pain had an MI after signing out AMA.

someone please explain this to me. Goes against everything that makes sense to me.

I mean, we can't put 4-points on a patient if he's signing AMA.

 

[NYRN]

sorry double post

 

[NYRN]

someone please explain this to me. Goes against everything that makes sense to me.

I mean, we can't put 4-points on a patient if he's signing AMA.

I hear you. It's not fair, but it happens. This patient was in his 40's I believe, he was admitted, and did not want to wait for a bed to become available. He signed AMA, went home, had an MI and then found a lawyer to take his case. The hospital and insurance find it easier to settle than to battle it out in court, which is pretty common these days. Is the MD getting any sort of disiplinary action against his license? No, but it's now on record that his insurance paid out a claim for him which is part of public record. If a patient signs out AMA, you still have to provide them with any rx's and d/c info that they would get if they were being d/c'd normally. You can't just get them to sign a paper and then kick them out the door.

I know an MD group in a hospital that were sued because the patient claimed that they were unable to treat him. The group attempted to treat him, then referred him to a different hospital because the resources to treat him were not available at the 1st hospital. No harm was done to the patient. The patient went to the 2nd hospital, was successfully treated, and is now suing the 1st hospital. Another case that settled. Oh yeah, this person is also in the US illegally.

These things don't make sense at all, but they exist! If they can find a lawyer who will take the case, they know they are in for some easy cash at your expense. The lawyers need to be at the forefront of your fight. By taking on issues that are less of a threat to medicine than the lawyers are, you are sitting there as they are enacting laws to control how you practice. If you don't stop it now, they will set the guidelines for practice instead of doctors.

 

[emermed]

This is why I believe that there should be some sort of iron clad waiver to the MD that if they refuse c-section or other forms of fetal monitoring before it gets to the point of c-section, they cannot sue.

You should research the utility of fetal monitoring before you advocate for it...

 

[NYRN]

You should research the utility of fetal monitoring before you advocate for it...

I don't work L+D, but I have friends who are OB/GYN residents and nurses. Believe in them or not, but if you are the OB/GYN getting sued for a birth injury and you can't produce a strip showing no fetal distress, you will lose your case hands down.

 

[Apollyon]

Is the MD getting any sort of disiplinary action against his license? No, but it's now on record that his insurance paid out a claim for him which is part of public record.

Losing a suit or settling before judgment gets a person an entry into the National Practitioner Data Bank, along with those people that have a disciplinary entry. Getting a hit in the NPDB is disciplinary, although not on the state level (although events leading to a monetary judgment may bring a person to a state board's attention, and the public data (pretrial and trial arguments) can be used as prima facie evidence in a state board case of unfitness to practice, or other offenses).

 

[NYRN]

Losing a suit or settling before judgment gets a person an entry into the National Practitioner Data Bank, along with those people that have a disciplinary entry. Getting a hit in the NPDB is disciplinary, although not on the state level (although events leading to a monetary judgment may bring a person to a state board's attention, and the public data (pretrial and trial arguments) can be used as prima facie evidence in a state board case of unfitness to practice, or other offenses).

I looked up the names of the MD's I know who were involved in suits which settled and I cannot find anything on the NYS office of professions that states they were disciplined. In both of the cases I mentioned, after the settlement was done, no action was taken by the BOM against them. They are all excellent physicians and collegues and it made me so angry to see them have to go through this BS.

 

[Apollyon]

I looked up the names of the MD's I know who were involved in suits which settled and I cannot find anything on the NYS office of professions that states they were disciplined. In both of the cases I mentioned, after the settlement was done, no action was taken by the BOM against them. They are all excellent physicians and collegues and it made me so angry to see them have to go through this BS.

The NPDB is above state level, and the average person can't access it just out of curiosity.

 

[jl lin]

For those who are doing rotations or residency in the lilly white midwest these cultural issues don't come up as much as those who are training in big cities like NYC. I'll tell you this, if a trauma or cardiac arrest come in, its much more likely for the attending or senior resident will get YOU the med student out of his/her way than me, who they know can work on the patient NOW.

Anyway, you better get used to the idea of incorporating cultural beliefs, because its being incorporated into the joint commission standards. If you refuse to follow it, and the patients are filing complaints because they claim you are insensitive to their culture or that they don't understand their care because of it, you will be gone. Have you ever been at a hospital when the joint commission is there? Everyone is on edge because if the hospital does not pass, it basically shuts down.

http://http://www.jointcommission.o...lop_Culturally_Competent_Pt_Centered_Stds.htm

How about another angle. What if this patient is a Jehovah's Witness?
They will refuse blood and all blood products. You need to know this if there is a chance this patient needs blood because then you better find another way to replace volume lost. If the patient becomes unresponsive and you give the blood anyway, you are in big trouble. These patients will carry a card in their wallet stating they do not want blood. The courts are ruling in favor of the patient in these cases. Being unresponsive does not equal implied consent in these cases. Even if the patient is a minor, you need a court order before you can give the blood.

How about this? The patient doesn't understand english well or at all. You are getting consent from them for surgery. If you cannot or refuse to provide an interpreter, the patient can sue you later saying they did not understand what they are signing.

You will learn, stick around a while.

NYRN, it's a lack of understanding. I mean I get what the med student is saying. He or she just doesn't get that these questions are required. I mean it isn't like we are writing them up and mandating them ourselves. I think that some don't understand how punitive nursing can be, especially in some places. It's ridiculous, but it is what it is. For me, I wouldn't address the cultural question until priority issues are met. But if some pinhead nurse administrator is around or one of his or her cronies, yes, I may find myself being pulled into the nurse manager's (principle's) office over it.

Good points about the Jehovah's Witnesses though. This has been an issue in a number of places with some babies that indeed needed blood. People just don't get how complicated things are anymore. You can't just do what simply makes the most sense anymore--I mean, sad but true. As I said. It is what it is.

 

[jl lin]

This is exactly the type thing that we need more of. People who choose to go against the advice of doctors and other professionals when the risks are explained to them should not be able to sue. These days, even when a patient signs out AMA, the MD is not 100% waived of liability. I know an attending who was sued after a patient admitted for chest pain had an MI after signing out AMA. The truth is, the insurance companies settle most of the time instead of fighting it out in court. Is this fair? Not at all.

I understand you are all up in arms about the DNP thing, but really, tort reform is a much bigger issue than a few DNP's who are not speaking for the majority. If you are not fighting the lawyers, they will be determining how you practice medicine.

http://www.medmalnj.com/index.php?option=com_content&view=article&id=91&Itemid=60

Seriously. Great point. I am all for holding practitioner's accountable; but there has to be some sense and reason to it. Some tort reform is well overdue.

 

[NYRN]

NYRN, it's a lack of understanding. I mean I get what the med student is saying. He or she just doesn't get that these questions are required. I mean it isn't like we are writing them up and mandating them ourselves. I think that some don't understand how punitive nursing can be, especially in some places. It's ridiculous, but it is what it is. For me, I wouldn't address the cultural question until priority issues are met. But if some pinhead nurse administrator is around or one of his or her cronies, yes, I may find myself being pulled into the nurse manager's (principle's) office over it.

Good points about the Jehovah's Witnesses though. This has been an issue in a number of places with some babies that indeed needed blood. People just don't get how complicated things are anymore. You can't just do what simply makes the most sense anymore--I mean, sad but true. As I said. It is what it is.

Things certainly are changing, and they are changing fast. I think part of the problem is, so many things change in such a short period of time that med school curriculum cannot keep up with it. When we studied cultural stuff in nursing school, I said the same things they did. I thought it was BS too, but working for a few years, I have learned that you have to adjust to it and go along with it, you can't fight it. Getting an accurate history alone from a patient who is from another culture is not possible if you don't know what questions to ask related to their culture.

I was not suggesting that I would delay care because I need to do a cultural history, I just wanted these young doctors to know that it will become an important part of how they will be practicing medicine, even if they don't see that now. Med and nursing students with no prior experience have idealistic views of medicine/nursing and although they may think some of the things I say are crazy, I am trying to prepare them for real issues that they will face that they never learned in med school. I'm just telling it as it really is, my intent is good and not to argue with or put anyone down. I wish someone would have told me some of this stuff before I started.

 

[southerndoc]

I looked up the names of the MD's I know who were involved in suits which settled and I cannot find anything on the NYS office of professions that states they were disciplined. In both of the cases I mentioned, after the settlement was done, no action was taken by the BOM against them. They are all excellent physicians and collegues and it made me so angry to see them have to go through this BS.

The Georgia medical board does discipline physicians involved in suits. Any judgement/settlement above $100k must be reported to the medical board, and the case is then reviewed by a peer reviewer to see if the care met a minimum standard of care.

 

[NYRN]

The Georgia medical board does discipline physicians involved in suits. Any judgement/settlement above $100k must be reported to the medical board, and the case is then reviewed by a peer reviewer to see if the care met a minimum standard of care.

This is why tort reform is so desperately needed. A good lawyer could bilk $100k out of you easily for things that truly don't deserve it. You sutured up some child's face and now she has a little scar? Guess what, this child can now never be an actress or a model and you will compensate her for this. The kid you delivered 15 years ago is now diagnosed with oppositional defiant disorder. Must have been a birth injury! Pay up.

I am just surprised how little the docs/med students on here barely mention lawyers, yet, this is the single biggest thing that is going to effect how you practice medicine. This should be a priority long before DNP's/PA's/Physical Therapists will. If you haven't read this link, please do. I couldn't believe this. http://www.medmalnj.com/index.php?option=com_content&view=article&id=91&Itemid=60

 

[JeffLebowski]

This is why tort reform is so desperately needed. A good lawyer could bilk $100k out of you easily for things that truly don't deserve it. You sutured up some child's face and now she has a little scar? Guess what, this child can now never be an actress or a model and you will compensate her for this. The kid you delivered 15 years ago is now diagnosed with oppositional defiant disorder. Must have been a birth injury! Pay up.

I am just surprised how little the docs/med students on here barely mention lawyers, yet, this is the single biggest thing that is going to effect how you practice medicine. This should be a priority long before DNP's/PA's/Physical Therapists will. If you haven't read this link, please do. I couldn't believe this. http://www.medmalnj.com/index.php?option=com_content&view=article&id=91&Itemid=60

The only reason we don't mention tort reform and malpractice is because it's not really controversial at all. Everyone agrees that malpractice is out of control and tort reform is a good thing. There's no one coming on to SDN saying, "yes, it's great that doctors get sued for millions and millions over little stuff in the absence of proven negligence", but people are coming on here saying stuff like that DNPgator person, which was not only insulting, condescending, and disrespectful, but frightening from a patient care standpoint as well as a professional one - people like her are quite literally blathering that they are better than us and should replace us. Replace doctors. Suggesting that nurses should replace doctors. That's why we get riled up. Hopefully that makes sense.

 

[motoo]

I think politicians may find it easier to comprehend the dangers of DNP/NPs when we use a more readily accessible analogy.

construction workers take orders from architects all the time to build the house. eventually they pick up on certain patterns, but does that mean they know architecture or engineering? they may do fine building what they've always built, but ask them to design something new, and they'd be at a loss. construction workers understand their role and don't clamor to become the architects without the training of one.

why is it that the construction workers of the hospital (nurses) can take largely non-clinically oriented classes and lay claim to the same privileges and authority as that of the true architects (doctors)? is that not dangerous, for no two houses (or patients) are alike and it takes someone who has the proper background knowledge to know how to adapt it to new situations (or houses).

would you trust the structural integrity of a house built by someone who picked it up with on the job training and pattern recognition, knowing the risk you take is that the whole house could catastrophically come down upon you should something be amiss? sure it may be cheaper, but should we take that chance?

 

[NYRN]

The only reason we don't mention tort reform and malpractice is because it's not really controversial at all. Everyone agrees that malpractice is out of control and tort reform is a good thing. There's no one coming on to SDN saying, "yes, it's great that doctors get sued for millions and millions over little stuff in the absence of proven negligence", but people are coming on here saying stuff like that DNPgator person, which was not only insulting, condescending, and disrespectful, but frightening from a patient care standpoint as well as a professional one - people like her are quite literally blathering that they are better than us and should replace us. Replace doctors. Suggesting that nurses should replace doctors. That's why we get riled up. Hopefully that makes sense.

Tort reform is something that we as medical professionals need to put our differences aside and team up against lawyers deciding how the doctors practice medicine. I want doctors/nurses/pa's/np's to decide how we take care of patients, not some lawyer. If we sit back and imagine the possibilities, its scary.

The government is already not paying for hospital related infections, skin breakdown and UTI's. As we all know, sometimes these things, such as skin breakdown, cannot be avoided due to medical condition. There are no exceptions made for this. Maybe your patient has anasarca, maybe they are 200 kg or maybe they are 50 kg skin in bones. You know how difficult it is to keep that skin intact. If that patient gets a decub, you are not getting paid. Maybe the insurance company will pay for a pressure relieving bed, maybe not. Too bad either way. Have you seen all the lawyer commercials on TV asking families if thier loved one developed a bedsore in the hospital? If so, call them for a settlement. Turning and positioning the patient may or may not help. With hospitals refusing to hire more nurses or support staff, there is little time to make sure that your patient is clean and turned every 2 hours. There are MD groups that are joining nursing organizations to push for state mandated nurse-patient ratios. I think we can all agree that if a nurse has too many patients, the patients are not going to get proper care. How about the payment based on outcomes issue? Someone has to take care of high risk patients. If you a skilled MD, these patients will be referred to you and you will not be able to refuse them. Based on the poor prognosis of the patients, your outcomes will not be as good as those who are taking well patients. You take all the risk and recieve none of the benefit. This has to stop.

I have had to give a deposition in the past for a case that I really had little to do with. My name was in the chart. I have given written statements and had phone conferences with risk management in defense of MD's before.

What do I imagine in the future if we continue to allow lawyers to guide healthcare? Of course these are hypothetical situations, but you never know, this could be reality one day.

Insurance companies and lawyers will set protocols for practice. MD's must practice by these guidelines and any deviation from them will void your malpractice coverage. Board certification is required to become insured. If you don't have coverage, you don't have hospital privledges.

Hospitals and insurance companies will deem residents as a liability. Fewer attendings will agree to supervise residents, less residents will be accepted, and their ability to practice without direct supervision will be limited or eliminated. Patients will be notified on admission that they may be cared for by a resident and they can opt out if they choose. Due to the shortage of residency positions, med school admission will also be decreased, schools will shut down. The country will face a huge shortage of MD's.

All settlements and errors made by MD's will become public record. Your salary will become public record like many public politicians. You are a public servant after all (at least in the eyes of the public) and the people want to know how much money you are making.

If you refuse to accept or care for any patient, you can be held liable. Currently, the law requires patients with emergent conditions to be seen. I mean in the future if a patient shows up at your private office and wants to become your patient, you will not be able to refuse even if they have no ability to pay.

Since insurance companies, and state laws will strictly limit how you practice, other types of providers trained in specialty areas will take over many of the duties that were previously limited to the MD. Some bachelors prepared tech will screen patients via algorhythm and guidelines written by lawyers and traitor MD's to determine if the patient needs to see an MD or can see a PA/NP to save money. MD's will see patients who have complex and acute medical issues and need skilled interventions only.

These are issues that effect all of us. This is why we need to work together to keep the MD's as the primary decision makers, not lawyers or insurance companies. If the NP role scares you now, think about what will happen when they have lesser trained tech's taking over. Lawyers use the argument that capping awards gives MD's no incentive to practice safely because they can afford to buy a patient's life so to speak.

 

[daveyjwin]

What do I imagine in the future if we continue to allow lawyers to guide healthcare? Of course these are hypothetical situations, but you never know, this could be reality one day[...]

I'm just going to post and run here, but this much speculation about anything doesn't serve to further the conversation at all. It seems be be taking the slipperly slope approach to why we should be targeting lawyers and tort reform, which nobody disagrees with. This is derailing the thread from the issue at hand, that being that DNPs want equal rights/reimbursement for unequal care. Yes yes, we all understand that you personally don't feel this way, but the fact is that there is an active movement in this direction, and it needs to be addressed.

 

[NYRN]

I'm just going to post and run here, but this much speculation about anything doesn't serve to further the conversation at all. It seems be be taking the slipperly slope approach to why we should be targeting lawyers and tort reform, which nobody disagrees with. This is derailing the thread from the issue at hand, that being that DNPs want equal rights/reimbursement for unequal care. Yes yes, we all understand that you personally don't feel this way, but the fact is that there is an active movement in this direction, and it needs to be addressed.

I see what you are saying, but think about this for a minute. These organizations that are pushing for independant midlevel practice include not only NP's, but also other clinicians such as physical therapy, optometry, etc. What is not so obvious is that these groups are strongly backed by lawyers.

My point is, if your practice becomes so limited due to laws or as a requirement to obtain malpractice insurance, they will run with a campaign to the public saying that since there are "guidelines" in place for practice now that all providers must follow, NP's/PA's are following the same rules so they can be considered "equal" in many areas. They will put up some junk study of how X number of doctors every year make medical errors and pay out Y amount of money, when only X amount were paid out in damages to DNP's/PA's. They will try to convince the public that the MD's are only interested in the mighty dollar and not in patient safety as "evidenced" by all the errors that are made. If this were to happen, than exactly what you fear will happen.

 

[Dr Oops]

I see what you are saying, but think about this for a minute. These organizations that are pushing for independant midlevel practice include not only NP's, but also other clinicians such as physical therapy, optometry, etc. What is not so obvious is that these groups are strongly backed by lawyers.

My point is, if your practice becomes so limited due to laws or as a requirement to obtain malpractice insurance, they will run with a campaign to the public saying that since there are "guidelines" in place for practice now that all providers must follow, NP's/PA's are following the same rules so they can be considered "equal" in many areas. They will put up some junk study of how X number of doctors every year make medical errors and pay out Y amount of money, when only X amount were paid out in damages to DNP's/PA's. They will try to convince the public that the MD's are only interested in the mighty dollar and not in patient safety as "evidenced" by all the errors that are made. If this were to happen, than exactly what you fear will happen.

i agree with you that tort reform is a huge problem. As of right now though the lawyers help quell the amount of nurses that want to go into independent practice because they know they could get sued. The smart ones who know their training is insufficient to practice independently are just as scared of the lawyers as we are, probably more so, because its more likely they will miss something. So until we stop nurses from practicing medicine, the blood thirsty lawyers are probably holding back alot more nurses from getting on board.

 

[zenman]

http://health.blogs.foxnews.com/2010/04/15/nurses-masquerading-as-doctors/

If you quickly skim the comments section, you'll see nurses commenting in full force. Make your voices heard on the comments section as well! If we are complacent, we deserve what we get!

Ok, I put my comment:

"My Navy chaplain friend just told me that two of his family practice physician buddies diagnosed him with pneumonia and gave him a paper sack of meds. My chaplain friend just didn't believe he had pneumonia so he went to a third FP. This guy didn't listen to my friend's chest through his shirt like the other two "cream of the crop" physicians did, but actually lifted his shirt, where he noticed an amazingly hairy chest. So sad indeed that such a basic mistake was made."

 

[wine is good]

I hear you. It's not fair, but it happens. This patient was in his 40's I believe, he was admitted, and did not want to wait for a bed to become available. He signed AMA, went home, had an MI and then found a lawyer to take his case. The hospital and insurance find it easier to settle than to battle it out in court, which is pretty common these days. Is the MD getting any sort of disiplinary action against his license? No, but it's now on record that his insurance paid out a claim for him which is part of public record. If a patient signs out AMA, you still have to provide them with any rx's and d/c info that they would get if they were being d/c'd normally. You can't just get them to sign a paper and then kick them out the door.

I know an MD group in a hospital that were sued because the patient claimed that they were unable to treat him. The group attempted to treat him, then referred him to a different hospital because the resources to treat him were not available at the 1st hospital. No harm was done to the patient. The patient went to the 2nd hospital, was successfully treated, and is now suing the 1st hospital. Another case that settled. Oh yeah, this person is also in the US illegally.

These things don't make sense at all, but they exist! If they can find a lawyer who will take the case, they know they are in for some easy cash at your expense. The lawyers need to be at the forefront of your fight. By taking on issues that are less of a threat to medicine than the lawyers are, you are sitting there as they are enacting laws to control how you practice. If you don't stop it now, they will set the guidelines for practice instead of doctors.

Okay, we get it. But, still, someone signs out AMA, that's it. You can't force people to stay if they are mentally competent and want to go. Too bad if they have an MI. If the hospital gave in and settled, it's on them, doesn't change the fact that they should win if they are represented well and fight it to the end.

Yeah, tort reform is a big issue, but saying that DNP thing is not is a mistake, and is exactly the kind of attitude that we DON"T NEED. I suggest that you take that attitude to the nurse's forum. In the PHYSICIAN's forum, we care about this issue. We feel that it is a big issue, that 10-15 years down the line, it will be a bigger issue, and we need to fight this now, even if it may be a losing battle.

The rest of the stuff you say we already know. I personally have an issue with nurses who always try to over represent what they can do. I respect the hard working ones that do their job. If you do your job well, that's good. YOu don't need to keep mentioning it every 3rd post. Geesh

 

[NYRN]

Okay, we get it. But, still, someone signs out AMA, that's it. You can't force people to stay if they are mentally competent and want to go. Too bad if they have an MI. If the hospital gave in and settled, it's on them, doesn't change the fact that they should win if they are represented well and fight it to the end.

Yeah, tort reform is a big issue, but saying that DNP thing is not is a mistake, and is exactly the kind of attitude that we DON"T NEED. I suggest that you take that attitude to the nurse's forum. In the PHYSICIAN's forum, we care about this issue. We feel that it is a big issue, that 10-15 years down the line, it will be a bigger issue, and we need to fight this now, even if it may be a losing battle.

The rest of the stuff you say we already know. I personally have an issue with nurses who always try to over represent what they can do. I respect the hard working ones that do their job. If you do your job well, that's good. YOu don't need to keep mentioning it every 3rd post. Geesh

If you are fighting against DNP's who want independant practice but don't really understand what that means, you are not going to accomplish anything. Expanded scope of practice and independant practice are 2 different things. If your claim is that anyone other than MD/DO are better suited to care for patients, than you need to be fighting ANY clinician who is not an MD/DO who is pushing for expanded scope of practice. I find it strange that nobody is fighting PA's, when I think they have a much better chance of gaining equal scope due to training in the medical model. They can argue that 3/4 of their education is the same, minus classes that arent really needed, and design multi-year residencies to compete with yours.

Having the attitude of saying "oh well the patient signed out AMA who cares" is not real life. This is going to get you in trouble when you are an attending. You do realize that the hospital does not get paid by the insurance company if the patient signs out AMA? Keep letting your patients sign out AMA, I promise your chairman/woman will have a big issue with this. The board of medicine will also take notice if all your patients are signing out AMA and filing suits after.

edited to say: Quote me where I said DNP's should have equal scope to MD's. I never said that.

 

[wine is good]

If you are fighting against DNP's who want independant practice but don't really understand what that means, you are not going to accomplish anything. Expanded scope of practice and independant practice are 2 different things. If your claim is that anyone other than MD/DO are better suited to care for patients, than you need to be fighting ANY clinician who is not an MD/DO who is pushing for expanded scope of practice. I find it strange that nobody is fighting PA's, when I think they have a much better chance of gaining equal scope due to training in the medical model. They can argue that 3/4 of their education is the same, minus classes that arent really needed, and design multi-year residencies to compete with yours.

Having the attitude of saying "oh well the patient signed out AMA who cares" is not real life. This is going to get you in trouble when you are an attending. You do realize that the hospital does not get paid by the insurance company if the patient signs out AMA? Keep letting your patients sign out AMA, I promise your chairman/woman will have a big issue with this. The board of medicine will also take notice if all your patients are signing out AMA and filing suits after.

edited to say: Quote me where I said DNP's should have equal scope to MD's. I never said that.

No one's fighting PAs because they are not at the frontline of militancy. They are Physician assistants and know it. For the most part, they do not desire to be independent. They're PAs because they realize what a crazy notion it is to take on physician's responsibilities. Believe when I say that they want to go home at 4pm and don't want what I have to do.

Now in regards to your AMA comment. Look, again, if someone wants to sign out AMA, they usually are nuts. They are not rational people. And the hospital administration and the chief of staff, the chief of surgery, the PD, the attending know this. Normal human beings who are rational and who understand the consequences of their actions do not usually sign out AMA. Irrational individuals who want to be treated like princes and princesses sign out AMA. Pts signing out AMA is not a reflection of the talent and care of the attending, residents, nurses or the hospital. It's usually a reflection of the individual himself or herself. True, being in the hospital sucks and when you are admitted to a busy service or in a busy ER, it is a pain in the ass to be a pt. But, most people put up with it because they know what's good for them. And, we try to exlain to them to the best of our abilities, but then we give up. Because we are TOO damn busy to deal with this bull****. In the four years that I've been a resident, a person signing out AMA has not been an issue and I have rotated in 6 different hospitals. You may present some anecdotal evidence to the contrary but that doesn't usually hold water.

Please, stop trying to educate people here about your profound fund of knowledge. We know this stuff already.

 

[NYRN]

No one's fighting PAs because they are not at the frontline of militancy. They are Physician assistants and know it. For the most part, they do not desire to be independent. They're PAs because they realize what a crazy notion it is to take on physician's responsibilities. Believe when I say that they want to go home at 4pm and don't want what I have to do.

You may present some anecdotal evidence to the contrary but that doesn't usually hold water.

Please, stop trying to educate people here about your profound fund of knowledge. We know this stuff already.

You say most PA's don't want the responsibility of an MD, well the truth is, neither do the NP's. If 3 PA's went on TV and said they want to be treated like MD's would you automatically assume that they represent the majority of PA's?

What I offer here is real life in the medical field. You can be as anti-nursing as you want, but nothing I say on here isn't true. There was already someone on this thread that didn't know that an MD can still be held liable if someone signed out AMA. I have been to 2 depositions so far. Guess who didn't have to show up? The resident. They don't care what the resident has to say, since the attending is the one who has to take the heat for their mistakes. Maybe that is why you haven't seen it as a problem. Once you are an attending and are responsible for your own actions, you will change your tune. The bottom line for the hospital is money. If you or I are costing them, not making them money, we will be let go. If you have a high percentage of patients signing out AMA compared to other MD's, they will see a problem with you.

 

[jbz24]

You say most PA's don't want the responsibility of an MD, well the truth is, neither do the NP's. If 3 PA's went on TV and said they want to be treated like MD's would you automatically assume that they represent the majority of PA's?

What I offer here is real life in the medical field. You can be as anti-nursing as you want, but nothing I say on here isn't true. There was already someone on this thread that didn't know that an MD can still be held liable if someone signed out AMA. I have been to 2 depositions so far. Guess who didn't have to show up? The resident. They don't care what the resident has to say, since the attending is the one who has to take the heat for their mistakes. Maybe that is why you haven't seen it as a problem. Once you are an attending and are responsible for your own actions, you will change your tune. The bottom line for the hospital is money. If you or I are costing them, not making them money, we will be let go. If you have a high percentage of patients signing out AMA compared to other MD's, they will see a problem with you.

How is obtaining an NP in any way an advantage over PA? Shouldn't a NP be concerned with the nursing aspects of a patient care? PAs, while not as extensively trained as an MD/DO, are educated by the same model as an MD/DO. So if NPs are not concerned by the nursing aspects and are not educated in the same manner as a PA, what EXACTLY is the advantage?

 

[wine is good]

You say most PA's don't want the responsibility of an MD, well the truth is, neither do the NP's. If 3 PA's went on TV and said they want to be treated like MD's would you automatically assume that they represent the majority of PA's?

What I offer here is real life in the medical field. You can be as anti-nursing as you want, but nothing I say on here isn't true. There was already someone on this thread that didn't know that an MD can still be held liable if someone signed out AMA. I have been to 2 depositions so far. Guess who didn't have to show up? The resident. They don't care what the resident has to say, since the attending is the one who has to take the heat for their mistakes. Maybe that is why you haven't seen it as a problem. Once you are an attending and are responsible for your own actions, you will change your tune. The bottom line for the hospital is money. If you or I are costing them, not making them money, we will be let go. If you have a high percentage of patients signing out AMA compared to other MD's, they will see a problem with you.

You are very slippery. You think you can choose to respond to certain points. Which organization is currently trying to compete with physicians for independent practice and fee rights? HUH? Tell me. Stop trying to hijack the thead.

I'm NOT anti-nurse. My position on nurses was mentioned earlier. Go back and read it.

I have an anecdotal point for you. Thief robs a house, falls through the roof, sues the owner, wins. Yeah, we've all heard it. So, from now on, everyone has to build really strong roofs. So that any potential thieves don't fall and hurt themselves, so that the landlords don't get sued. Nice. I love it. Please tell me more. NO MORE AMA. Pt has to stay in house. I will physicially handcuff the pt to the bed and prevent him from leaving. Then, go to court and be sued and explain why didn't allow a perfectly sane human adult from leaving the hospital, thus be charged with wrontgful imprisonment, kidnapping, unlawful arrest, sodomy, sexual assault, etc etc.
Okay, everyone, we have just been educated by our esteemed colleague here. Thank you.

 

[NYRN]

You are very slippery. You think you can choose to respond to certain points. Which organization is currently trying to compete with physicians for independent practice and fee rights? HUH? Tell me. Stop trying to hijack the thead.

Just because you don't like what I have to say, doesn't make it inaccurate. I'm trying to have a discussion with what I would assume to be educated, intellegent people. Doctors do not exist in a bubble, and other healthcare providers are going to be involved with your patients. We need to get along in order to do what is best for THEM. Again, you have to choose your battle. Are you against NP's or other midlevels seeking broader scope of practice, or are you against them billing for services they perform alone without giving the MD a cut? If an NP were to set up a practice like I had mentioned earlier, I don't see why anyone would have a problem with that. It would not be a replacement for the treatment of the MD, but something that the patient could choose in order to compliment the MD's plan of care.

I don't care about a few DNP's who go on TV and claim they have the backing of all NP's. They don't. If 3 MD's went on TV and claimed that ALL MD's are in the pockets of the drug companies, would you want the public to believe that?

 

[Dr Oops]

You say most PA's don't want the responsibility of an MD, well the truth is, neither do the NP's. If 3 PA's went on TV and said they want to be treated like MD's would you automatically assume that they represent the majority of PA's?

What I offer here is real life in the medical field. You can be as anti-nursing as you want, but nothing I say on here isn't true. There was already someone on this thread that didn't know that an MD can still be held liable if someone signed out AMA. I have been to 2 depositions so far. Guess who didn't have to show up? The resident. They don't care what the resident has to say, since the attending is the one who has to take the heat for their mistakes. Maybe that is why you haven't seen it as a problem. Once you are an attending and are responsible for your own actions, you will change your tune. The bottom line for the hospital is money. If you or I are costing them, not making them money, we will be let go. If you have a high percentage of patients signing out AMA compared to other MD's, they will see a problem with you.

The difference is that PAs are regulated under the board of medicine when they practice medicine, while NPs are under the board of nursing while practicing medicine. Also residents have been pulled into lawsuits too.

Doesnt matter if its three or 1 or even if none of you wants it. What matters is the legislative changes which as you have said before nurses are very good at getting laws passed.

 

[Dr Oops]

Just because you don't like what I have to say, doesn't make it inaccurate. I'm trying to have a discussion with what I would assume to be educated, intellegent people. Doctors do not exist in a bubble, and other healthcare providers are going to be involved with your patients. We need to get along in order to do what is best for THEM. Again, you have to choose your battle. Are you against NP's or other midlevels seeking broader scope of practice, or are you against them billing for services they perform alone without giving the MD a cut? If an NP were to set up a practice like I had mentioned earlier, I don't see why anyone would have a problem with that. It would not be a replacement for the treatment of the MD, but something that the patient could choose in order to compliment the MD's plan of care.

I don't care about a few DNP's who go on TV and claim they have the backing of all NP's. They don't. If 3 MD's went on TV and claimed that ALL MD's are in the pockets of the drug companies, would you want the public to believe that?

We wouldnt like it at all and this happens. The public believes the AMA speaks for all doctors. So when they were on board with the healthcare bill, everyone believed all doctors were. It didnt matter whether most doctor were or werent. The representative body was the one that decided where the field went. If you really have a problem with this then you need to go to your representative body, but you've also said before you wouldnt sign any legislation to any effect of limiting nursing scope of practice to nursing, which is understandable.

 

[NYRN]

We wouldnt like it at all and this happens. The public believes the AMA speaks for all doctors. So when they were on board with the healthcare bill, everyone believed all doctors were. It didnt matter whether most doctor were or werent. The representative body was the one that decided where the field went. If you really have a problem with this then you need to go to your representative body, but you've also said before you wouldnt sign any legislation to any effect of limiting nursing scope of practice to nursing, which is understandable.

I feel that MD's and PA/NP's have been working in the current state nicely for the past 30 years. I don't see any reason to change that. I would not sign any document that is going to reduce our scope of practice as it is now. I WOULD sign any document, even if drafted by the AMA, that NP scope of practice should not be equal to an MD.

I did not choose to go to NP school because I want a shortcut to MD. I want to practice with more independence than an RN, but I do not want the responsibility of the MD. If I am not willing to take on that level of responsibility or recieve an equivalent education, than I am limited to my scope of practice. That is the choice someone makes to go NP/PA instead of MD. All NP's that I personally know, including my professors (some of who are DNP's) agree with that concept.

 

[wine is good]

Just because you don't like what I have to say, doesn't make it inaccurate. I'm trying to have a discussion with what I would assume to be educated, intellegent people. Doctors do not exist in a bubble, and other healthcare providers are going to be involved with your patients. We need to get along in order to do what is best for THEM. Again, you have to choose your battle. Are you against NP's or other midlevels seeking broader scope of practice, or are you against them billing for services they perform alone without giving the MD a cut? If an NP were to set up a practice like I had mentioned earlier, I don't see why anyone would have a problem with that. It would not be a replacement for the treatment of the MD, but something that the patient could choose in order to compliment the MD's plan of care.

I don't care about a few DNP's who go on TV and claim they have the backing of all NP's. They don't. If 3 MD's went on TV and claimed that ALL MD's are in the pockets of the drug companies, would you want the public to believe that?

Do know you of a single MD that goes on national TV and claims ALL MDs are in the pockets of drug companies? Prove it.

You don't care about the few DNP's that do that. Well, looks like we do. So, perhaps you're in the wrong forum, my dear.

We have a problem with NP claiming equivalence to physicians, wanting equal payment, while attaining that privilege through a short cut. If there is to be a short cut, meaning fewer years of training, it should be the privilege of DOCTORS first, not nurses.

 

[fab4fan]

I feel that MD's and PA/NP's have been working in the current state nicely for the past 30 years. I don't see any reason to change that. I would not sign any document that is going to reduce our scope of practice as it is now. I WOULD sign any document, even if drafted by the AMA, that NP scope of practice should not be equal to an MD.

I did not choose to go to NP school because I want a shortcut to MD. I want to practice with more independence than an RN, but I do not want the responsibility of the MD. If I am not willing to take on that level of responsibility or recieve an equivalent education, than I am limited to my scope of practice. That is the choice someone makes to go NP/PA instead of MD. All NP's that I personally know, including my professors (some of who are DNP's) agree with that concept.

Equivalent education to what? These two sentences are contradictory, unless I am misreading them.

 

[NYRN]

Do know you of a single MD that goes on national TV and claims ALL MDs are in the pockets of drug companies? Prove it.

You don't care about the few DNP's that do that. Well, looks like we do. So, perhaps you're in the wrong forum, my dear.

We have a problem with NP claiming equivalence to physicians, wanting equal payment, while attaining that privilege through a short cut. If there is to be a short cut, meaning fewer years of training, it should be the privilege of DOCTORS first, not nurses.

I never said that there was a group that actually claimed all MD's are in the pockets of the drug companies. I was saying that IF there were a few MD's who went on TV saying "although you Joe Plumber don't know it, your doctor is doing it too even if you don't know about it", would you want these MD's representing YOU?

Maybe it was on the other thread where I posted that NP/PA/ND/Chiropractors should accept the fact that if they did not to medical school they cannot expect to practice the same as physicians. These DNP's that go on TV are as representative of our profession as those few MD's described above would be of you.

 

[wine is good]

I feel that MD's and PA/NP's have been working in the current state nicely for the past 30 years. I don't see any reason to change that. I would not sign any document that is going to reduce our scope of practice as it is now. I WOULD sign any document, even if drafted by the AMA, that NP scope of practice should not be equal to an MD.

I did not choose to go to NP school because I want a shortcut to MD. I want to practice with more independence than an RN, but I do not want the responsibility of the MD. If I am not willing to take on that level of responsibility or recieve an equivalent education, than I am limited to my scope of practice. That is the choice someone makes to go NP/PA instead of MD. All NP's that I personally know, including my professors (some of who are DNP's) agree with that concept.

What the hell, man. You can't have it both ways. You don't want to replace a physician, but you want independence. But, then, you're practicing as an independent practitioner. You're limited in your practice, from what you say, but, still are independent. Well, so is a general practitioner with an MD/DO. They might feel they can't handle complicated diabetics, so they refer out. THat's what you're gonna do. You are doing what he/she would do. YOu got there by going to nursing school and then getting limited training. You have equavalence. Don't you get it? It's demanding equivalence without actually demanding equivaldence, at least in your own words. And let me enlighten you. You are absolutely taking on the same responsibility. YOu are delusional if you think you are not. If you are treating someone's family member, you better come to that realization. What a joke. That's misleading. You are very slippery.

I'm tired. This whole issue is a masquerade.