What are the best specialties to avoid the encroachment of nurses?

[MOHS_01]

You're really funny. However, the above is more true than you realize. I do have abilities you probably don't have, but it's due to exploring other fields vs keeping my nose stuck in one area and believing that's the holy grail.

If I have a healthy ego it's due to other people patting me on the back. That's one of the reasons I have no trouble confronting the idiots running around.

Are your eyes brown?

---

Members don't see this ad.

 

[Radonkulous]

You're really funny. However, the above is more true than you realize. I do have abilities you probably don't have, but it's due to exploring other fields vs keeping my nose stuck in one area and believing that's the holy grail.

If I have a healthy ego it's due to other people patting me on the back. That's one of the reasons I have no trouble confronting the idiots running around.

LOL. Seems to me you are overcompensating for your inability to get into medical school.

 

[zenman]

Are your eyes brown?

Bright blue.

 

[zenman]

LOL. Seems to me you are overcompensating for your inability to get into medical school.

I never wanted to go to medical school. I was so poor I was in the Army 3 days after graduating from high school just so I could have regular meals. But I did wind up with 2 masters plus post-masters and an ability to understand the human in front of me.

 

[RDlv]

I do have abilities you probably don't have, but it's due to exploring other fields

Hahahahahahaha. God, you're unreal.

Obi Wan and Han Solo had this very same argument.

I still think nursing is the way to go if you want to avoid the encroachment of nurses. Seems to be the only healthcare field they don't want to run. Thanks for the tip though!

The irony is how nurses will rip on each other, even (especially) at the NP level. I would wager that a majority of those NPs pursuing or considering the DNP are doing it simply out of fear of being "left behind," vs. any great ideological reasons. Yet the PhDs rip on DNPs, the DNPs rip on the masters NPs, the NPs rip on bedside RNs, BSN RNs rip on ADNs, etc.

I used to think you all were really over-selling the whole DNP "power grab" thing. Now that I've spent some time in close company of the Ivory Tower, I've learned (somewhat to my dismay) that much of what you say has been repeated by these nurse academics and NP professors. It is taken as fact in my program that NPs require no statutory supervision or collaboration with physicians, that NPs provide "the same or better care at a lower cost" than physicians, etc. Discussions to the contrary are really not appreciated (believe me, I know first hand).

One irony is that my program is having some difficulty recruiting preceptors for the NP programs, and has built some elaborate conspiracy theories about why community physicians would rather precept students from medical and PA programs. My suggestion that this may instead be linked to NP politics and attitudes towards the medical profession is dismissed out of hand.

Individual NPs can be excellent clinicians, and if they are distant from the world of academia (as many are), the reactions of the medical profession can seem inordinate and lead to some defensiveness. I'd wager that if these NPs knew what was being said about physicians ostensibly on behalf of "all NPs" (i.e. at the regulatory, academic, and political levels) they might have a bit more understanding where you all are coming from.

 

[zenman]

This is a perfect example of the ego that these nurses have. They think that they know everything, but the reality is is that they don't know what they don't know (there's a whole other world of medicine that most nurses don't know exists). The thought that less training, less academic rigor, and less overall experience will lead to a better practitioner is laughable. In the end it's the patients that suffer.

No we don’t know everything any more than you do. But every time I hear someone, even nurses who have gone through medical school, say “you don’t know what you don’t know,” I wonder just how you wound up in higher education in the first place. Now if you said, “you don’t know what it’s like to go through the training that we do, in which our scores to emphasize with patients drop every year we are in training,” then you’d be correct. But anytime I want to know what I don’t know I just stroll in the nearest medical school library and buy your textbooks, or pick up one of the ones scattered all over my house...or I talk to a physician, or surf the net, especially medical school sites with online videos and references. So where is this secret stuff that only you are privy to? Point it out to me please.

 

[zenman]

Obi Wan and Han Solo had this very same argument.

If you were a physician, and say a medical anthropologist, would you not have a different way of looking at your patient vs someone who only went through medical school? That's what I'm saying.

Individual NPs can be excellent clinicians, and if they are distant from the world of academia (as many are), the reactions of the medical profession can seem inordinate and lead to some defensiveness. I'd wager that if these NPs knew what was being said about physicians ostensibly on behalf of "all NPs" (i.e. at the regulatory, academic, and political levels) they might have a bit more understanding where you all are coming from.

I've been an assistant professor and never heard any other professors talk bad about a physician...oh wait, I once did but that married nephrologist was trying to pick up nursing students. But I'm sure it probably happens. Academia is also the last place I want to be. Now excuse me while I go over to a DNP forum and rip them a new one.

 

[RDlv]

If you were a physician, and say a medical anthropologist, would you not have a different way of looking at your patient vs someone who only went through medical school? That's what I'm saying.



I've been an assistant professor and never heard any other professors talk bad about a physician...oh wait, I once did but that married nephrologist was trying to pick up nursing students. But I'm sure it probably happens. Academia is also the last place I want to be. Now excuse me while I go over to a DNP forum and rip them a new one.

And I should be very clear here...saying bad things about individual physicians is not something I've seen often in this environment. Which is part of the disconnect for me. These NP instructors for the most part put in some clinical hours weekly at an existing practice with collaborating physicians. Although the NPs will tell funny anecdotes occasionally, this is more about the mannerisms of the docs, and almost never about any professional issues. Yet, they don't seem to see how the medical establishment can be defensive about NP independent practice rights (or to a lesser extent, the whole "Doctor" title issue) while still being called upon to take us NP students on as preceptees, to open up part-time positions for NP professors to practice, etc. It's an interesting dynamic to observe from the inside.

 

[AzEMMD]

No we don’t know everything any more than you do. But every time I hear someone, even nurses who have gone through medical school, say “you don’t know what you don’t know,” I wonder just how you wound up in higher education in the first place. Now if you said, “you don’t know what it’s like to go through the training that we do, in which our scores to emphasize with patients drop every year we are in training,” then you’d be correct. But anytime I want to know what I don’t know I just stroll in the nearest medical school library and buy your textbooks, or pick up one of the ones scattered all over my house...or I talk to a physician, or surf the net, especially medical school sites with online videos and references. So where is this secret stuff that only you are privy to? Point it out to me please.

The passive-aggressive in you is strong. Your suggestion that you can make up for the vigorous training that real doctors go through with your casual review of textbooks while watching House MD on the TV in the background just lends itself to the idea that you really "don't know what you don't know". I understand that nurses have a role in healthcare, but to suggest that nurses that get their education through community college and online coursework are somehow just as capable as real doctors is an insult to my profession and a danger to my patients.

Oh, and the whole "I couldn't afford med school" thing is a joke, no one can...that's why people take out loans. My colleagues and I would respect you more if you owned up to what you truly are and are not capable of rather than this continued need to feed your ego.

 

[JaggerPlate]

And I should be very clear here...saying bad things about individual physicians is not something I've seen often in this environment. Which is part of the disconnect for me. These NP instructors for the most part put in some clinical hours weekly at an existing practice with collaborating physicians. Although the NPs will tell funny anecdotes occasionally, this is more about the mannerisms of the docs, and almost never about any professional issues. Yet, they don't seem to see how the medical establishment can be defensive about NP independent practice rights (or to a lesser extent, the whole "Doctor" title issue) while still being called upon to take us NP students on as preceptees, to open up part-time positions for NP professors to practice, etc. It's an interesting dynamic to observe from the inside.

They get their foot in the door with lies about filling gaps in primary care, use physicians until enough are trained to pseudo-train themselves, turn viciously on doctors and smear the crap out of them to obtain some LEGAL level of semi-equality, then bitch, moan, and make up absurd justifications when doctors aren't inviting them to partner in practices and scrub up in the OR.

It's the same thing that happened with the CRNAs - claimed they were created/needed to fill gaps, anesthesiologist trained them, eventually they were able to train themselves and now look at that absurd battle. I recently read a thread where CRNAs were so shocked that the Anesthesiologists would even dream of monitoring their gas work and thought they were being such bullies that they were threatening an anti-trust lawsuit if Anesthesiologists refused to train/work with these people. Probably wouldn't go anywhere, but just think if the mindset.

Also, with regard to your first post ....

While I've been screaming my lungs out about this for years, I actually get less worried the closer I get to the end goal. Don't get me wrong, NPs will still continue to militantly push for the ability to prance around independently in a white coat telling people they are a doctor, but I see the disparities in knowledge base and the absurd insecurity of someone like Zen and I simply see this as no threat to ANYONE besides patients.

I mean for God sake, the guy is ranting about how he is the only one properly trained to treat the human condition and will make up for the 7+ years of missing medical education by flipping through a textbook for a course he never took or googling something?

The passive-aggressive in you is strong. Your suggestion that you can make up for the vigorous training that real doctors go through with your casual review of textbooks while watching House MD on the TV in the background just lends itself to the idea that you really "don't know what you don't know". I understand that nurses have a role in healthcare, but to suggest that nurses that get their education through community college and online coursework are somehow just as capable as real doctors is an insult to my profession and a danger to my patients.

Oh, and the whole "I couldn't afford med school" thing is a joke, no one can...that's why people take out loans. My colleagues and I would respect you more if you owned up to what you truly are and are not capable of rather than this continued need to feed your ego.

Great post.

 

[zenman]

The passive-aggressive in you is strong. while watching House MD on the TV in the background just lends itself to the idea that you really "don't know what you don't know". I understand that nurses have a role in healthcare, but to suggest that nurses that get their education through community college and online coursework are somehow just as capable as real doctors is an insult to my profession and a danger to my patients.

Oh, and the whole "I couldn't afford med school" thing is a joke, no one can...that's why people take out loans. My colleagues and I would respect you more if you owned up to what you truly are and are not capable of rather than this continued need to feed your ego.

And how did you come up with, "Your suggestion that you can make up for the vigorous training that real doctors go through with your casual review of textbooks...?" Training and education are two different things, as is information and knowledge.

I'm not feeding my ego as it's a healthy one and doesn't need stroking. What I will do is confront any of you youngsters who come up with bull crap, so you can continue to expect that.Take out loans? Are you kidding me? My first masters I was paid $800 bucks a month (1983) and all books and tuition paid for. The second one was paid for in cash as was my post-masters course. I haven't had a house note in 7 yrs as I get free housing. You think I want to be owing money? You're funny! I've been to community college as well as a total of 12 universities. I know a little about education. Perhaps you need to look at the research on distance education, as well as videos and other online material available from medical schools. Maybe then you'd be as smart as your ego thinks it is. You kids are certainly fun to play with. Where's Panda Bear? Did he fade away? I'm still here

 

[AzEMMD]

And how did you come up with, "Your suggestion that you can make up for the vigorous training that real doctors go through with your casual review of textbooks...?" Training and education are two different things, as is information and knowledge.

I'm not feeding my ego as it's a healthy one and doesn't need stroking. What I will do is confront any of you youngsters who come up with bull crap, so you can continue to expect that.Take out loans? Are you kidding me? My first masters I was paid $800 bucks a month (1983) and all books and tuition paid for. The second one was paid for in cash as was my post-masters course. I haven't had a house note in 7 yrs as I get free housing. You think I want to be owing money? You're funny! I've been to community college as well as a total of 12 universities. I know a little about education. Perhaps you need to look at the research on distance education, as well as videos and other online material available from medical schools. Maybe then you'd be as smart as your ego thinks it is. You kids are certainly fun to play with. Where's Panda Bear? Did he fade away? I'm still here

I don't really see what point you are trying to make with this post, but either way the tone is similar to an old man yelling at the neighborhood kids to get off his lawn. Seeing as you went to school before most of us were born, I think your ideas about today's standards of education are a tad outdated. I don't mean to offend, but I'd hate to have your level of insecurity when I'm at your age.

Anyways if someone wants to make a relevant post about the standards of NP training and how it compares to real doctor training then I'd love to hear it.

 

[zenman]

I don't really see what point you are trying to make with this post, but either way the tone is similar to an old man yelling at the neighborhood kids to get off his lawn. Seeing as you went to school before most of us were born, I think your ideas about today's standards of education are a tad outdated. I don't mean to offend, but I'd hate to have your level of insecurity when I'm at your age.

Anyways if someone wants to make a relevant post about the standards of NP training and how it compares to real doctor training then I'd love to hear it.

The point is that when someone make claims about which they know nothing I'll confront them. You miss a lot on an internet forum but if you think I'm insecure perhaps I should send you a pic of me petting a non-drugged tiger, or SCUBA diving, riding a scooter in Bangkok, driving an elephant, zip-lining through the jungle canopy, doing 6 months in CPP in Denton Cooley's OR (or should I say OR's), ceremonies with Shipibo shamans in the Amazon, being in a riot in Bangladesh, uprising in Greece, etc, etc.. All I'm doing here is bringing myself down to your level so you can see your reflection. I wouldn't act like this on other "professional" threads.

"Real doctor" training is for the Ph.D.. I'm sure you meant "physician training." Now, NP training is not the same as physician training, never has been and never will be. You will always be the top dog, the one who calls the shots...oh wait, that's the insurance guys and CEO's. Nurses are trained in nursing theory. Physicians are trained...well, they are trained. There is a difference in what we do, how we approach people, how we look at problems. You look through one end of the microscope to narrow a problem down to it's one single cause. I look through the other end.

I'm pretty much on top of education, at least a little, since I apparently love learning. My teacher wife also keeps me up to date on how far down education has dropped, but that's another story. So don't downgrade distance education till you read the research about it. You don't hear me knocking all the online videos from medical schools that I had to study for in NP school do you? Do you still listen to a Walkman or do you live in the current century? Things change.

I'm nowhere near perfect and I make mistakes, but I study like the dickens and I'm still learning. And look up the meaning of passive-aggression, will you? And if you ever run into me I'll buy you beer and a meal.

 

[Instatewaiter]

The point is that when someone make claims about which they know nothing I'll confront them.

Don't make me break out the hard facts of hours in the classroom and especially hours of clinical education in DNP programs... i mean really? you think 500-800 hours is enough for clinical education? And you think it somehow compares to 15,000 hours?

Really?

You miss a lot on an internet forum but if you think I'm insecure perhaps I should send you a pic of me petting a non-drugged tiger, or SCUBA diving, riding a scooter in Bangkok, driving an elephant, zip-lining through the jungle canopy, doing 6 months in CPP in Denton Cooley's OR (or should I say OR's), ceremonies with Shipibo shamans in the Amazon, being in a riot in Bangladesh, uprising in Greece, etc, etc..

None of those show you aren't terribly insecure. Actually, by posting them, they show the opposite.

 

[Instatewaiter]

Let me add to the clinical hours picture:
In this year alone I have logged almost 4,000 clinical hours, after 4 years of medical school and I can say definitively that I am not safe or fit for solo practice yet.

 

[AzEMMD]

The point is that when someone make claims about which they know nothing I'll confront them. You miss a lot on an internet forum but if you think I'm insecure perhaps I should send you a pic of me petting a non-drugged tiger, or SCUBA diving, riding a scooter in Bangkok, driving an elephant, zip-lining through the jungle canopy, doing 6 months in CPP in Denton Cooley's OR (or should I say OR's), ceremonies with Shipibo shamans in the Amazon, being in a riot in Bangladesh, uprising in Greece, etc, etc.. All I'm doing here is bringing myself down to your level so you can see your reflection. I wouldn't act like this on other "professional" threads.

"Real doctor" training is for the Ph.D.. I'm sure you meant "physician training." Now, NP training is not the same as physician training, never has been and never will be. You will always be the top dog, the one who calls the shots...oh wait, that's the insurance guys and CEO's. Nurses are trained in nursing theory. Physicians are trained...well, they are trained. There is a difference in what we do, how we approach people, how we look at problems. You look through one end of the microscope to narrow a problem down to it's one single cause. I look through the other end.

I'm pretty much on top of education, at least a little, since I apparently love learning. My teacher wife also keeps me up to date on how far down education has dropped, but that's another story. So don't downgrade distance education till you read the research about it. You don't hear me knocking all the online videos from medical schools that I had to study for in NP school do you? Do you still listen to a Walkman or do you live in the current century? Things change.

I'm nowhere near perfect and I make mistakes, but I study like the dickens and I'm still learning. And look up the meaning of passive-aggression, will you? And if you ever run into me I'll buy you beer and a meal.

Your responses are starting to get petty and I'd prefer that you stay on topic. (Why would I need to remind someone nearing retirement age of this? ) There is really no need to justify your life to me (this is just showing me more of your insecurity). No need to look up the definition of passive-aggressive, the second paragraph of your last post is the perfect example. Physicians aren't the real doctors, PhD's are! Physicians aren't the decision makers, CEO's are! Physicians don't treat holistically, nurses do! Get real, if you truly believed in nursing theory you wouldn't need to crap all over physicians the way that you do here.

You can try to avoid the topic all you want, but the fact remains that educational standards are lower for nurses and their experience is much more limited. Yes, community college and online coursework pales in comparison to today's standard of medical education and training. The 1000 hours of clinical work that nurse practitioners do is about 1/20 of the clinical exposure a real doctor gets. Less intelligence, less academic rigor, less experience = lesser practitioner...there's no other way of looking at it. I have no problem with NPs, I just think the militant ones such as yourself that feel you are somehow superior to real doctors are endangering patients just to help inflate their own ego.

 

[zenman]

Don't make me break out the hard facts of hours in the classroom and especially hours of clinical education in DNP programs... i mean really? you think 500-800 hours is enough for clinical education? And you think it somehow compares to 15,000 hours?

Really?



None of those show you aren't terribly insecure. Actually, by posting them, they show the opposite.

No, 500 hrs does not equal 15,000. That's one point I argue on a DNP forum.

By posting the fun stuff I like to do, not compensatory stuff, I'm hoping you get an inkling that you really don't know whether I'm insecure or not.

 

[zenman]

Let me add to the clinical hours picture:
In this year alone I have logged almost 4,000 clinical hours, after 4 years of medical school and I can say definitively that I am not safe or fit for solo practice yet.

You're never ready; you just have to do it. Just don't look insecure standing in front of a patient.

 

[zenman]

Your responses are starting to get petty and I'd prefer that you stay on topic. (Why would I need to remind someone nearing retirement age of this? ) There is really no need to justify your life to me (this is just showing me more of your insecurity). No need to look up the definition of passive-aggressive, the second paragraph of your last post is the perfect example. Physicians aren't the real doctors, PhD's are! Physicians aren't the decision makers, CEO's are! Physicians don't treat holistically, nurses do! Get real, if you truly believed in nursing theory you wouldn't need to crap all over physicians the way that you do here.

You can try to avoid the topic all you want, but the fact remains that educational standards are lower for nurses and their experience is much more limited. Yes, community college and online coursework pales in comparison to today's standard of medical education and training. The 1000 hours of clinical work that nurse practitioners do is about 1/20 of the clinical exposure a real doctor gets. Less intelligence, less academic rigor, less experience = lesser practitioner...there's no other way of looking at it. I have no problem with NPs, I just think the militant ones such as yourself that feel you are somehow superior to real doctors are endangering patients just to help inflate their own ego.

Actually I like physicians and have only run into a few a**holes in my entire life. You want me to stick to the topic but you're not realizing it when I do. Physicians started losing all power back in the 80's when DRG's came along. You don't think others have the power to tell you what to do? You better get real and talk to a hospital CEO or just tell CIGNA what you want to order for a patient.

Nurses have less experience and training that physicians for one simple fact, they're not physicians and are not trying to be, except for the 2-3 that are throwing you off track. But here you mess up again, bringing up intelligence. You want to explain that one? And just for the record, don't call me militant when I confront you. I'm in a state where many patients use FNP's as their PCP. Are they endangered? They would be if the FNP's were't there that's for sure. Now, if you want to argue from an intelligent position, quit throwing out insults.

 

[AzEMMD]

Actually I like physicians and have only run into a few a**holes in my entire life. You want me to stick to the topic but you're not realizing it when I do. Physicians started losing all power back in the 80's when DRG's came along. You don't think others have the power to tell you what to do? You better get real and talk to a hospital CEO or just tell CIGNA what you want to order for a patient.

Nurses have less experience and training that physicians for one simple fact, they're not physicians and are not trying to be, except for the 2-3 that are throwing you off track. But here you mess up again, bringing up intelligence. You want to explain that one? And just for the record, don't call me militant when I confront you. I'm in a state where many patients use FNP's as their PCP. Are they endangered? They would be if the FNP's were't there that's for sure. Now, if you want to argue from an intelligent position, quit throwing out insults.

The intelligence difference is very easy to explain, and I'm sure you're not so naive as to not understand it. Only the top performing undergraduates (who go to a real university) have a chance to be admitted to medical school (average GPA was 3.7 years ago when I applied). Add on the fact that these students also partake in research, volunteering, tutoring, teaching, EMT, etc...and you're left with an extremely select group of individuals who are both motivated and academically gifted. Now compare that to the nurses, who can get into any community college program as long as they have a pulse and a bank account. Add on a few online courses in biostatistics and health policy and they're set to go practice. If you don't see the lunacy in that then there's no hope with us moving forward here. It doesn't take a physician to realize that the latter group is not as capable as a real doctor. I don't know what to tell you if you find this insulting, because the fact is is that this is reality.

What you continue to not understand is how insulting it is to physicians that you would even consider yourselves equivalent. Of course, of the little clinical exposure that the NPs get, the majority of them are dependent on MD preceptors. None of this would be an issue if the militant NP ego would understand their role in healthcare, but this continued need to push yourselves as equivalent/superior is doing nothing to help your cause.

If you want to continue to make a case, please use critical reasoning skills (I know these skills aren't honed in community college nursing programs, but do your best ) to address to topic itself.

 

[zenman]

The intelligence difference is very easy to explain, and I'm sure you're not so naive as to not understand it. Only the top performing undergraduates (who go to a real university) have a chance to be admitted to medical school (average GPA was 3.7 years ago when I applied). Add on the fact that these students also partake in research, volunteering, tutoring, teaching, EMT, etc...and you're left with an extremely select group of individuals who are both motivated and academically gifted. Now compare that to the nurses, who can get into any community college program as long as they have a pulse and a bank account. Add on a few online courses in biostatistics and health policy and they're set to go practice. If you don't see the lunacy in that then there's no hope with us moving forward here. It doesn't take a physician to realize that the latter group is not as capable as a real doctor. I don't know what to tell you if you find this insulting, because the fact is is that this is reality.

You do know there are very intelligent people outside of the medical field who are academically gifted don't you. Many chose to go into other fields because of personal interest. And then there are the very intelligent ones who graduate as physicians and have no common sense what so ever. I had to work with such a product and there was many times I almost wrote a letter to the medical school dean in my home state asking how he could have turned such a person loose on society.

What you continue to not understand is how insulting it is to physicians that you would even consider yourselves equivalent. Of course, of the little clinical exposure that the NPs get, the majority of them are dependent on MD preceptors. None of this would be an issue if the militant NP ego would understand their role in healthcare, but this continued need to push yourselves as equivalent/superior is doing nothing to help your cause.

I think what you and many others are doing is fighting an enemy that doesn't exist. I personally don't think I'm equivalent to a physician and I don't know any NP's who do. I practice in an independent state an d I want it that way as I don't have to worry about losing my practice if a collaborating doc decides to change his mind. I can have a chat with the clinic supervisor via telemed any time I want, and as of yesterday I also have a locums shrink in the next office. The issue may also be that your training is too extensive (and expensive), especially when compared to physicians in other countries who seem to do quite well. Using your logic we need to get rid off all EMTs, paramedics, medics, corpsmen, and Special Forces medics who are lessor trained and replace them with the most highly trained professional there is...you. What going to happen when they come out with studies showing for ex, that care provided by primary care docs and FNP 's is equal. There have already been some but of course they are being picked apart. Just saw a new one the other day about PA's/NP's in ICU and one in Britian where an NP outperformed a surgeon in picking up breast tumors.

And another:
http://www.washingtonpost.com/natio...-and-cirrhosis/2011/05/19/AGd0hdTH_story.html

If you want to continue to make a case, please use critical reasoning skills (I know these skills aren't honed in community college nursing programs, but do your best ) to address to topic itself.

I wouldn't bash community colleges as they serve a lot of people, including ADN graduates. I only had one semester in CC by the way. Now tell me just what you think the topic is when you're fighting an enemy of your own making?

 

[deleted87716]

And another:
http://www.washingtonpost.com/natio...-and-cirrhosis/2011/05/19/AGd0hdTH_story.html

The only thing that article illustrates are the pitfalls of fragmented care.

I would've ordered the correct labs on the first visit. Hereditary hemochromatosis isn't exactly a zebra.

 

[zenman]

The only thing that article illustrates are the pitfalls of fragmented care.

I would've ordered the correct labs on the first visit. Hereditary hemochromatosis isn't exactly a zebra.

Why is it fragmented, Blue Dog?

 

[deleted87716]

Why is it fragmented, Blue Dog?

Seriously...? Let's count.

HMO
Optometrist
Urgent care
Hospital (who knows how many)
Retired pathologist
Back to the HMO

Ironically, somebody in the hospital actually ordered a ferritin, but blew it off. As an acute phase reactant, it's not diagnostic of hemochromatosis, but given the atypical presentation for alcoholic cirrhosis, it should've been followed up.

Still not sure why you posted that article in the first place, as it does nothing to support your premise of nurses out-thinking doctors. Even the nurse in the story was skeptical.

 

[AzEMMD]

Using your logic we need to get rid off all EMTs, paramedics, medics, corpsmen, and Special Forces medics who are lessor trained and replace them with the most highly trained professional there is...you.

This must be some sort of community college level deduction, because I have no idea how you came up with this.

What going to happen when they come out with studies showing for ex, that care provided by primary care docs and FNP 's is equal. There have already been some but of course they are being picked apart. Just saw a new one the other day about PA's/NP's in ICU and one in Britian where an NP outperformed a surgeon in picking up breast tumors.

And another:
http://www.washingtonpost.com/natio...-and-cirrhosis/2011/05/19/AGd0hdTH_story.html

What's scary about you posting these studies is how unaware you are of how bad these studies are. The PA/NP ICU study was one of the most poorly put together studies I have ever seen published. The reason this is scary is because I can see you changing your practice and prescribing habits based on poor studies because you don't have the background to truly appraise articles. Again, this comes back to the "you don't know what you don't know" premise.

 

[zenman]

Seriously...? Let's count.

HMO
Optometrist
Urgent care
Hospital (who knows how many)
Retired pathologist
Back to the HMO

Ironically, somebody in the hospital actually ordered a ferritin, but blew it off. As an acute phase reactant, it's not diagnostic of hemochromatosis, but given the atypical presentation for alcoholic cirrhosis, it should've been followed up.

Still not sure why you posted that article in the first place, as it does nothing to support your premise of nurses out-thinking doctors. Even the nurse in the story was skeptical.

Actually I meant Why is our health care fragmented? In general, not the article.

 

[Reductio]

What going to happen when they come out with studies showing for ex, that care provided by primary care docs and FNP 's is equal.

This point is a major one which illustrates why physicians have such a problem with the types of arguments that NPs make.

Physicians dont argue that the care is un-equal.

We (RNs, NPs, MDs) all know that a paramedic identifies acute pulmonary edema, and treats it in the field with Lasix Morphine Nitro oxygen and positive pressure ventilation.

We all know that an ER doc identifies acute pulmonary edema, and treats it in the field with Lasix Morphine Nitro oxygen and positive pressure ventilation.

We all know that they provide the same care. And we all know that medics =/= MDs

Similarly,
We all know that NPs in primary care use the same guidelines as MDs when treating HTN, DM, etc. So the "care" (read: Rx -or- outcomes) is expected to be about the same. So, telling us that data will show that we're equal illustrates the "you dont know what you dont know effect" because MDs arent talking about different care. We're talking about a different thought process. And as you mentioned, theres Nursing Theory, and Physician..... Training? (you dont even know what to call the Allopathic model of disease and treatment?). Whatever the prescription/outcome, the attention to possible complications, alternatives, prognosis, etc is incomplete. You simply can't get the full picture in 2 years of training.

The issue isnt what NPs do.... because we know they do what's within their scope just fine. The issue is... like paramedics... NPs need to realize what they DONT do.

Paramedics remember all the time that they don't know everything. In the game of medicine/chess, they can only think 2 moves ahead and move 3 pieces. NPs can think 5 moves ahead, and move 8 pieces. MDs are expected to think of EVERY POSSIBLE MOVE known to medical science. and we MDs only move the pieces that we are fully comfortable with, because its that daunting of a responsibility.

Just so you understand, whatever stories you tell us about riots and tigers and whatnot... you aren't communicating whatever educated opinion you may have. Instead, our take-home point from your posts is that we're inexperienced in medicine, or in international adventure - both of which we know. But what is your point?

If your point is, that experience can trump initial education - we know that. We all know about Dr Blalocks uneducated assistant who could operate on hearts just as good as he could. We also know that this is vanishingly rare.

So, I'll ask you. What are you advising us about that we dont already know?..... and how do you expect to change our minds when we know that after 4 years of med school, and 12,000 hours of residency we are barely able to provide primary care, So we know that in 1000 hours NPs are NOT able to provide it safely.

 

[zenman]

This must be some sort of community college level deduction, because I have no idea how you came up with this.

What's scary about you posting these studies is how unaware you are of how bad these studies are. The PA/NP ICU study was one of the most poorly put together studies I have ever seen published. The reason this is scary is because I can see you changing your practice and prescribing habits based on poor studies because you don't have the background to truly appraise articles. Again, this comes back to the "you don't know what you don't know" premise.

Jesus, I feel like I'm dealing with special ed students here. Let me break it way down. There are people with lessor training than you who are very effective, save lives, and sometimes do the same "stuff" you do and they don't have 15,000 hr of clinical training. I just can't drop any lower to explain something you should already be aware of.

I'm not posting any studies, just an article about a study. Let me post this again:

"Lies, Damned Lies, And Medical Science" Dr. (physician and math prodigy) John Ioannidis and his team applied rigorous statistics analysis and found:
1. 80 % of non-randomized studies turn out to be wrong
2. 25 % of gold-standard randomized trials are wrong
3. As much as 10 % of platinum standard large randomized trials are wrong

The reason this is scary is because I can see you changing your practice and prescribing habits based on poor studies because you don't have the background to truly appraise articles. Again, this comes back to the "you don't know what you don't know" premise. Are you putting out big bucks to learn a lot of "wrong" stuff. Really sad, fellow. Blind faith, eh?

In my practice I subscribe to several clinical reports as well as Journal of Psychopharmacology. I do have to have someone read the big words for me though.

 

[AzEMMD]

Jesus, I feel like I'm dealing with special ed students here. Let me break it way down. There are people with lessor training than you who are very effective, save lives, and sometimes do the same "stuff" you do and they don't have 15,000 hr of clinical training. I just can't drop any lower to explain something you should already be aware of.

I'm not posting any studies, just an article about a study. Let me post this again:

"Lies, Damned Lies, And Medical Science" Dr. (physician and math prodigy) John Ioannidis and his team applied rigorous statistics analysis and found:
1. 80 % of non-randomized studies turn out to be wrong
2. 25 % of gold-standard randomized trials are wrong
3. As much as 10 % of platinum standard large randomized trials are wrong

The reason this is scary is because I can see you changing your practice and prescribing habits based on poor studies because you don't have the background to truly appraise articles. Again, this comes back to the "you don't know what you don't know" premise. Are you putting out big bucks to learn a lot of "wrong" stuff. Really sad, fellow. Blind faith, eh?

In my practice I subscribe to several clinical reports as well as Journal of Psychopharmacology. I do have to have someone read the big words for me though.

Oh brother, now you're trying to suggest that evidence based medicine isn't the proper approach to healthcare? What are they teaching you in these nurse quacktitioner programs? The more you respond with this kind of stuff, the more faith I lose in NPs as a whole. Part of the reason we see you as the enemy is the same reason we see naturopaths as an enemy, your are a danger to society and you don't even know it. I honestly don't know what else to tell you, but something tells me that this continued stubbornness that you show here is a result of an old man who has become bitter with his lot in life.

 

[zenman]

This point is a major one which illustrates why physicians have such a problem with the types of arguments that NPs make.

Physicians dont argue that the care is un-equal.

We (RNs, NPs, MDs) all know that a paramedic identifies acute pulmonary edema, and treats it in the field with Lasix Morphine Nitro oxygen and positive pressure ventilation.

We all know that an ER doc identifies acute pulmonary edema, and treats it in the field with Lasix Morphine Nitro oxygen and positive pressure ventilation.

We all know that they provide the same care. And we all know that medics =/= MDs

Similarly,
We all know that NPs in primary care use the same guidelines as MDs when treating HTN, DM, etc. So the "care" (read: Rx -or- outcomes) is expected to be about the same. So, telling us that data will show that we're equal illustrates the "you dont know what you dont know effect" because MDs arent talking about different care. We're talking about a different thought process. And as you mentioned, theres Nursing Theory, and Physician..... Training? (you dont even know what to call the Allopathic model of disease and treatment?). Whatever the prescription/outcome, the attention to possible complications, alternatives, prognosis, etc is incomplete. You simply can't get the full picture in 2 years of training.

The issue isnt what NPs do.... because we know they do what's within their scope just fine. The issue is... like paramedics... NPs need to realize what they DONT do.

Paramedics remember all the time that they don't know everything. In the game of medicine/chess, they can only think 2 moves ahead and move 3 pieces. NPs can think 5 moves ahead, and move 8 pieces. MDs are expected to think of EVERY POSSIBLE MOVE known to medical science. and we MDs only move the pieces that we are fully comfortable with, because its that daunting of a responsibility.

Just so you understand, whatever stories you tell us about riots and tigers and whatnot... you aren't communicating whatever educated opinion you may have. Instead, our take-home point from your posts is that we're inexperienced in medicine, or in international adventure - both of which we know. But what is your point?

If your point is, that experience can trump initial education - we know that. We all know about Dr Blalocks uneducated assistant who could operate on hearts just as good as he could. We also know that this is vanishingly rare.

So, I'll ask you. What are you advising us about that we dont already know?..... and how do you expect to change our minds when we know that after 4 years of med school, and 12,000 hours of residency we are barely able to provide primary care, So we know that in 1000 hours NPs are NOT able to provide it safely.

Finally, a smart person who nails it! I heard physicians upset because of the "we do the same thing" argument, but you have the correct viewpoint. Personally, I know I don't have the knowledge background you have but please don't tell me I'm of lower intelligence. (I know you didn't). My take-home point is that there are patients, people I care about, that don't have access to physicians. They are suffering. Give them an NP to help them. If no NP, an RN, paramedic, EMT, Army medic, whatever. We all know our limits and I have no problem asking for help. I know I need to do that when I run out of options and I feel the need to ask someone with hair grayer than mine.
Great post.

 

[zenman]

Oh brother, now you're trying to suggest that evidence based medicine isn't the proper approach to healthcare? What are they teaching you in these nurse quacktitioner programs? The more you respond with this kind of stuff, the more faith I lose in NPs as a whole. Part of the reason we see you as the enemy is the same reason we see naturopaths as an enemy, your are a danger to society and you don't even know it. I honestly don't know what else to tell you, but something tells me that this continued stubbornness that you show here is a result of an old man who has become bitter with his lot in life.

Fellow, that's one of your very expert peers who's telling you to not believe every study you read and base your practice on it. Very simple, I thought. You don't believe me; you don't believe a physician expert in research either. What can I say? Why are you seeing me as an enemy? You're not my enemy? I can quote you what my physician preceptor told me on my evaluation. I can also tell you my physician supervisor likes my work. You want to come check me out also?

An old man bitter with life? Are ya kidding? I've done things most people never have the opportunity to do. My life is so full I can hardly stand it. Beautiful wife, beautiful kids, and grandkids. Great job, no debt. Even have a beautiful custom rifle heading my way in a few days. This is making me so depressed. Where's that Sertraline?

 

[deleted87716]

Fellow, that's one of your very expert peers who's telling you to not believe every study you read and base your practice on it.

Straw man. Who in their right mind changes their practice based on a single study? Nobody.

Most studies are crap, including those claiming that midlevels provide "equivalent" care.

Way to disprove your own argument.

 

[deleted87716]

Actually I meant Why is our health care fragmented? In general, not the article.

In a nutshell, because we don't have a real healthcare "system," but rather a patchwork of cottage industries where shared information and true teamwork is a rarity.

 

[zenman]

Straw man. Who in their right mind changes their practice based on a single study? Nobody.

Most studies are crap, including those claiming that midlevels provide "equivalent" care.

Way to disprove your own argument.

That's correct. I looked at all studies with healthy disrespect, even before Dr. John's article came out. I didn't have an argument to disprove.

 

[LovinFL]

Just thought I would drop in... for a few clarifications....

It takes more than a pulse and a bank account to get into NS EVEN at the community college level. In most of our 50 states it takes a 3.8+ to get in and even with that, student could potentially be put on 2 yr waiting lists.

"Real University"...ok, my first college was Manhattan College where I obtained my BE-EE. (So much for the Physics argument!) At the time, I admit to having the same prejudices against non-"real" college education at what was then called JR colleges. As I went back to school, I started at that level because of the lower cost. Honestly, those courses are just as rigorous as those taught in "real" universities. Nice surprise.

Nurses aren't nurses because they couldn't get into Med school or lacked the intelligence to get into med school. My SATs (from way back) were 300 points higher than my husbands urologists! I won't even get into what my IQ is. My mother wanted to go to med school but was dissuaded by her father's lack of permission. (Tells you how old Mom is!) She had the grades and the intellect and retired after 35 yrs of nursing where she saved many a skin of a young inexperienced (arrogant) MD. Thank God we now live in a world where women can choose to become MDs or NPs.

Remember that Nurses are your last line of defense. If the MD prescribes the wrong dose and the nurse does not catch it...and the patient dies, the nurse's career goes down in flames. Your career continues with a disciplinary action and a lawsuit settlement.
(Feel free to correct me if it ends your career too.)

I cannot count the number of times an MD, spending 10 min with a patient, misses the real diagnosis. That makes you human. You can't know everything, but the nurse is there with that patient hour after hour. My ex credits a nurse for saving his life a year ago when he was in a coma and sinking fast. It was the nurse who "suggested" that the MDs look at the "possibility" of a specific diagnosis. She was right. As nurses, even if we can "see" the diagnosis ourselves, we are limited by the Nurse Practice Act from making a diagnosis because that is MD scope.

Please do not think that the fulfilling of a vacuum in medical care is a farce. When you see what your education bill is and what FP or GP care pays, you sub-specialize. We have patients who have an assigned MD...who never comes to the facility. They send their PA or their NP. Cheaper to the MD. We do have 2 MD who work at the facility and DO show up. One is a sweet gentleman who has the same gait as my 75 yo father. (Guessing MD is about the same generation.) I respect this man for still 'kicking it'! One of my AOx3 patients bemoans the fact that he hasn't seen his MD since he was admitted (months ago). [Just a view from the other side of the nursing station desk.]

Yes! I plan on getting my NP. It is not my goal to be a Noctor. I am choosing a different field than you. Doesn't invalidate my goal or what I may ultimately practice. Directly undermining NPs because we fill that which you don't want to do only hurts the patient in the long run. I would hope that your goal isn't power or money, but appropriate treatment for the community.

I wish you all the best on your pursuit of your MDs. May you have the skill and compassion to be the best clinician and a great nurse with you to get your back!

 

[citizenbang]

Please take a break in the arguing and answer one question:

Are oncologists safe from NP encroachment? What are all of your thoughts?

 

[mfrizzo3]

Just thought I would drop in... for a few clarifications....

It takes more than a pulse and a bank account to get into NS EVEN at the community college level. In most of our 50 states it takes a 3.8+ to get in and even with that, student could potentially be put on 2 yr waiting lists.

"Real University"...ok, my first college was Manhattan College where I obtained my BE-EE. (So much for the Physics argument!) At the time, I admit to having the same prejudices against non-"real" college education at what was then called JR colleges. As I went back to school, I started at that level because of the lower cost. Honestly, those courses are just as rigorous as those taught in "real" universities. Nice surprise.

Nurses aren't nurses because they couldn't get into Med school or lacked the intelligence to get into med school. My SATs (from way back) were 300 points higher than my husbands urologists! I won't even get into what my IQ is. My mother wanted to go to med school but was dissuaded by her father's lack of permission. (Tells you how old Mom is!) She had the grades and the intellect and retired after 35 yrs of nursing where she saved many a skin of a young inexperienced (arrogant) MD. Thank God we now live in a world where women can choose to become MDs or NPs.

Remember that Nurses are your last line of defense. If the MD prescribes the wrong dose and the nurse does not catch it...and the patient dies, the nurse's career goes down in flames. Your career continues with a disciplinary action and a lawsuit settlement.
(Feel free to correct me if it ends your career too.)

I cannot count the number of times an MD, spending 10 min with a patient, misses the real diagnosis. That makes you human. You can't know everything, but the nurse is there with that patient hour after hour. My ex credits a nurse for saving his life a year ago when he was in a coma and sinking fast. It was the nurse who "suggested" that the MDs look at the "possibility" of a specific diagnosis. She was right. As nurses, even if we can "see" the diagnosis ourselves, we are limited by the Nurse Practice Act from making a diagnosis because that is MD scope.

Please do not think that the fulfilling of a vacuum in medical care is a farce. When you see what your education bill is and what FP or GP care pays, you sub-specialize. We have patients who have an assigned MD...who never comes to the facility. They send their PA or their NP. Cheaper to the MD. We do have 2 MD who work at the facility and DO show up. One is a sweet gentleman who has the same gait as my 75 yo father. (Guessing MD is about the same generation.) I respect this man for still 'kicking it'! One of my AOx3 patients bemoans the fact that he hasn't seen his MD since he was admitted (months ago). [Just a view from the other side of the nursing station desk.]

Yes! I plan on getting my NP. It is not my goal to be a Noctor. I am choosing a different field than you. Doesn't invalidate my goal or what I may ultimately practice. Directly undermining NPs because we fill that which you don't want to do only hurts the patient in the long run. I would hope that your goal isn't power or money, but appropriate treatment for the community.

I wish you all the best on your pursuit of your MDs. May you have the skill and compassion to be the best clinician and a great nurse with you to get your back!

Well, what is your IQ?

 

[Instatewaiter]

Please take a break in the arguing and answer one question:

Are oncologists safe from NP encroachment? What are all of your thoughts?

At least for now, yes. NPs that work in oncology basically act as residents and physician extenders. I highly doubt that NPs will do solo oncology practice anytime soon.

 

[JaggerPlate]

Please take a break in the arguing and answer one question:

Are oncologists safe from NP encroachment? What are all of your thoughts?

No. Why would they be?

 

[ghost dog]

Fellow, that's one of your very expert peers who's telling you to not believe every study you read and base your practice on it. Very simple, I thought. You don't believe me; you don't believe a physician expert in research either. What can I say? Why are you seeing me as an enemy? You're not my enemy? I can quote you what my physician preceptor told me on my evaluation. I can also tell you my physician supervisor likes my work. You want to come check me out also?

An old man bitter with life? Are ya kidding? I've done things most people never have the opportunity to do. My life is so full I can hardly stand it. Beautiful wife, beautiful kids, and grandkids. Great job, no debt. Even have a beautiful custom rifle heading my way in a few days. This is making me so depressed. Where's that Sertraline?

This guy makes no sense whatsoever.

First he presents a study, then he presents a counter argument stating that EBM is not to be believed ??

With any luck, the Noctors will over supply themselves (much like the CRNA schools are starting to), resulting in a downward trend in salaries.

We will then see how interested they really are in the credo of life long learning and patient care advocacy.

 

[zenman]

This guy makes no sense whatsoever.

First he presents a study, then he presents a counter argument stating that EBM is not to be believed ??

With any luck, the Noctors will over supply themselves (much like the CRNA schools are starting to), resulting in a downward trend in salaries.

We will then see how interested they really are in the credo of life long learning and patient care advocacy.

It should make plenty of sense to you. I'm only "presenting" the work of one of your senior peers. Doesn't matter to me whether you believe it or not. Really very simple.

 

[unhappyrnstudnt]

Sorry to bring this thread back up, but I have a question for you all as MD's regarding the defined scope of practice. I just started nursing school (2 months in and this pre-defined scope of practice crap has made me hate it), and whenever I can't get an answer to a physiology/science question, it's always because it's "outside the scope of nursing practice." From your perspective, should students in nursing school be uninformed when they want to know the "why" or "how" behind, for example, a certain sign/symptom or procedure? While it may not be in the scope of practice, I find it stupid to limit your knowledge just so you without a doubt will stay "within that scope."

FYI, I've been strongly considering premed/med school after getting done with this miserable program, so there's very little you can say at this point that will offend me.

 

[zenman]

Sorry to bring this thread back up, but I have a question for you all as MD's regarding the defined scope of practice. I just started nursing school (2 months in and this pre-defined scope of practice crap has made me hate it), and whenever I can't get an answer to a physiology/science question, it's always because it's "outside the scope of nursing practice." From your perspective, should students in nursing school be uninformed when they want to know the "why" or "how" behind, for example, a certain sign/symptom or procedure? While it may not be in the scope of practice, I find it stupid to limit your knowledge just so you without a doubt will stay "within that scope."

FYI, I've been strongly considering premed/med school after getting done with this miserable program, so there's very little you can say at this point that will offend me.

I'm not an M.D. but I think you just ran into the wrong professors. You better know the who, when, what, why, how, and anything else you can think of...

 

[unhappyrnstudnt]

I'm not an M.D. but I think you just ran into the wrong professors. You better know the who, when, what, why, how, and anything else you can think of...

Yeah, my professors are constantly talking about how nurses are always having to correct doctors and basically making them out to sound like idiots who don't know what they are doing. Yet they are never able to give me scientific reasoning behind what's going on.

I hate school.

 

[Jack is Back]

Sorry to bring this thread back up, but I have a question for you all as MD's regarding the defined scope of practice. I just started nursing school (2 months in and this pre-defined scope of practice crap has made me hate it), and whenever I can't get an answer to a physiology/science question, it's always because it's "outside the scope of nursing practice." From your perspective, should students in nursing school be uninformed when they want to know the "why" or "how" behind, for example, a certain sign/symptom or procedure? While it may not be in the scope of practice, I find it stupid to limit your knowledge just so you without a doubt will stay "within that scope."

FYI, I've been strongly considering premed/med school after getting done with this miserable program, so there's very little you can say at this point that will offend me.

I'm an M1. I think you will get that answer a lot because they simply don't know. Lets face it, most people are only going to cover the curriculum, nursing has never been about knowing the process behind the procedures. It is about knowing to do XYZ when _____ is presented. The "why" is left to the physicians and researchers, who will not only need to know why for treatment plans and creativity but also to make advances in the field.

 

[zenman]

Yeah, my professors are constantly talking about how nurses are always having to correct doctors and basically making them out to sound like idiots who don't know what they are doing. Yet they are never able to give me scientific reasoning behind what's going on.

I hate school.

You might like it even more when you realize "scientific reasoning" can sometimes be an oxymoron, lol!

 

[zenman]

I'm an M1. I think you will get that answer a lot because they simply don't know. Lets face it, most people are only going to cover the curriculum, nursing has never been about knowing the process behind the procedures. It is about knowing to do XYZ when _____ is presented. The "why" is left to the physicians and researchers, who will not only need to know why for treatment plans and creativity but also to make advances in the field.

You're an M1. No offense but you don't even know why a shovel has a handle. Nursing has always been about knowing why. I was told "why" when I was even a nurse's aide. Try barking up another tree.

 

[unhappyrnstudnt]

You're an M1. No offense but you don't even know why a shovel has a handle. Nursing has always been about knowing why. I was told "why" when I was even a nurse's aide. Try barking up another tree.

My professors tell me "why," but it's very limited. The "why" things I want to know are never answered.

For example, I was told in lab that a sign of an acute asthma attack is coughing and I needed to look for it. I asked why. The instructor said because the patient can't breath and is trying to get air in the lungs. The first thing that popped into my mind about not adding up was that when a patient chokes, they can't breath, but they also can't cough. I asked what the physiological differences were between those two situations of not being able to breath (outside of the obvious one has their airway obstructed with food and the other one has severe bronchoconstriction). I wondered if there were nervous system response differences causing the different reactions, and if so, the pathways, etc.

My professor just gave me a vacant cow-like stare, finally saying she didn't understand. I rephrased my question a few times, and 5 minutes later she just told me to know that asthmatics cough when they aren't getting any air.

Maybe my question really doesn't make sense, or maybe the professor so poorly explained coughing while in an asthma attack that it sparked a question about a non-existent correlation. I have no idea and still don't know. But I WANT to know why...to a point it drives me mad. I'm so mad, I'm considering medical school, which I never in a million years would've considered. And now the more I think about it, the more I want it.

But anyway, I need to get some sleep before I explode from all this self-analysis.

 

[zenman]

My professors tell me "why," but it's very limited. The "why" things I want to know are never answered.

For example, I was told in lab that a sign of an acute asthma attack is coughing and I needed to look for it. I asked why. The instructor said because the patient can't breath and is trying to get air in the lungs. The first thing that popped into my mind about not adding up was that when a patient chokes, they can't breath, but they also can't cough. I asked what the physiological differences were between those two situations of not being able to breath (outside of the obvious one has their airway obstructed with food and the other one has severe bronchoconstriction). I wondered if there were nervous system response differences causing the different reactions, and if so, the pathways, etc.

My professor just gave me a vacant cow-like stare, finally saying she didn't understand. I rephrased my question a few times, and 5 minutes later she just told me to know that asthmatics cough when they aren't getting any air.

Maybe my question really doesn't make sense, or maybe the professor so poorly explained coughing while in an asthma attack that it sparked a question about a non-existent correlation. I have no idea and still don't know. But I WANT to know why...to a point it drives me mad. I'm so mad, I'm considering medical school, which I never in a million years would've considered. And now the more I think about it, the more I want it.

But anyway, I need to get some sleep before I explode from all this self-analysis.

I'm in psych now but I think the cough is caused by bronchial spasms as a result of an allergen or irritant

 

[unhappyrnstudnt]

I'm in psych now but I think the cough is caused by bronchial spasms as a result of an allergen or irritant

Well, my professor explained it very poorly, then. She specifically said the cough occurred because the client can't breath. She did say it was an attempt to open up the airways, but definitely stated VERY clearly that the cough occurred because the client can't breath in a severe asthmatic episode.

I really hate this program. I wanna be in the health sciences, but not like this.