When your doctor isn't a doctor

[Urzuz]

Great news story that I came across. I'm really glad that this story combined with the other one in pediatric dentistry are gaining traction in the media...makes me hopeful that it's only a matter of time before they shine a light directly on the prevalence of nurses administering solo anesthetics.

When Your Doc Is Not a Doc: Should Nurse Practitioners Be Autonomous?

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[anbuitachi]

More of these need to be published.
U think there has to be a law mandating only certain individuals to be allowed to be doctor in clinical setting. PhD in history or JD shouldn't not be introducing as Dr XYZ to the patient . Many patients are not well educated and it can get very confusing. They know what a doctor is. They equate it to a physician. Some might not even know what PhD is or what NP is.

 

[Noyac]

Great story.

 

[Ronin786]

"She still thinks of the boy, reminding herself to be careful in how she handles her patients. The nurse practitioner missed the diagnosis, but she had the mother’s trust, Irving says. “Having that trust, whether you’re a doctor or a nurse, is important. The problem is, doctors just don’t have time now.”"

This is it in a nutshell. I'd rather have somebody who gets the diagnosis right than someone who makes me feel good. That said, that's why you have doctors for the real diagnoses and the tough decisions and nurses for some of the other aspects of patient care.

 

[Man o War]

"She still thinks of the boy, reminding herself to be careful in how she handles her patients. The nurse practitioner missed the diagnosis, but she had the mother’s trust, Irving says. “Having that trust, whether you’re a doctor or a nurse, is important. The problem is, doctors just don’t have time now.”"

This is it in a nutshell. I'd rather have somebody who gets the diagnosis right than someone who makes me feel good. That said, that's why you have doctors for the real diagnoses and the tough decisions and nurses for some of the other aspects of patient care.

Few things make me cringe more than when I hear someone say they're not going to have surgery with best surgeon in the hospital because they didn't like his bedside manner.
Are you effing kidding me....give me the biggest jerk on the planet if I will get the best outcome.

 

[Aether2000]

Welcome to our new age touchy feely society, where major life decisions are based on what "feels right" rather than what statistics, outcomes, or professional history show. This will become much more pronounced over the next 10 years.

 

[bronx43]

Few things make me cringe more than when I hear someone say they're not going to have surgery with best surgeon in the hospital because they didn't like his bedside manner.
Are you effing kidding me....give me the biggest jerk on the planet if I will get the best outcome.

This.
If I wanted friends, I'd go make friends. If I want to have good health care, I go to a physician. Is that not simple?

But, honestly I think the best strategy against midlevels is to ALLOW them to practice independently. Don't give them the benefit of having a physician look over their shoulders and sign their charts. Release the Kraken. Then when s*** gets f***ed up, blow it wide open. Get the press on it. Do studies on it. Do whatever we have to to to rid the country of this charade.

 

[Mehd School]

This.
If I wanted friends, I'd go make friends. If I want to have good health care, I go to a physician. Is that not simple?

But, honestly I think the best strategy against midlevels is to ALLOW them to practice independently. Don't give them the benefit of having a physician look over their shoulders and sign their charts. Release the Kraken. Then when s*** gets f***ed up, blow it wide open. Get the press on it. Do studies on it. Do whatever we have to to to rid the country of this charade.

If only patients didn't have to suffer by going this route. Patients are dumb and part of our job is to protect them from their own stupidity.

 

[Man o War]

I sent my mother in law to the best THR guy in the region- he's a total prick but does a top notch first time anterior THR in 30 minutes or less and he does them all day every day. She didn't like him, he wasn't nice she said. I of course explained to her what we are discussing here, the benefits of being in and out quickly at her age, etc. She reluctantly agreed to allow him to do her surgery but it took a ton of convincing. I'm sure she represents a large portion of the population which is why nurses who have no business practicing medicine are.

 

[deleted171991]

Welcome to our new age touchy feely society, where major life decisions are based on what "feels right" rather than what statistics, outcomes, or professional history show. This will become much more pronounced over the next 10 years.

It's not touchy-feely. It's lack of scientific education in K-12, even in many colleges. To begin with, 38% of our society still believes in creationism. All those people lack a scientific approach to problems. And I am sure there are also others.

There is also a huge lack of logical skills among adults, mainly due to the fact that there is not enough Mathematics in K-12. There are kids in America who graduate high school with as much Math exposure as a 6th grader in other countries, because they are allowed to study other subjects instead. Plus the Math curriculum in K-12 is just laughable, for 2017. Let's not talk about advanced (for the US, not Korea or similar) physics, and understanding of natural phenomena. Our youth study in college stuff that I studied in high school abroad 25+ years ago (and still remember).

 

[bronx43]

If only patients didn't have to suffer by going this route. Patients are dumb and part of our job is to protect them from their own stupidity.

It's already happening... Nps are already able to practice independently in many states and are gaining ground in other states. You think physicians can actually hold off this barrage? The best thing for safety of patients is that we allow the floodgates to open so that an epiphany can come to the public as quickly as possible. Otherwise, this whole thing will come about insidiously, and patients will die in silence... drowned out by the war chants of a million DNP/CRNA/CCRN/APNP/MS/PHD/RN/BSN.

 

[Mehd School]

It's already happening... Nps are already able to practice independently in many states and are gaining ground in other states. You think physicians can actually hold off this barrage? The best thing for safety of patients is that we allow the floodgates to open so that an epiphany can come to the public as quickly as possible. Otherwise, this whole thing will come about insidiously, and patients will die in silence... drowned out by the war chants of a million DNP/CRNA/CCRN/APNP/MS/PHD/RN/BSN.

I live in one of those states. At least from the inpatient side on the wards, the NP's make an effort to befriend an MD/DO to hold their hand for anything that doesn't fall in their little red book of algorithms. Not much changes.

 

[deleted171991]

I live in one of those states. At least from the inpatient side on the wards, the NP's make an effort to befriend an MD/DO to hold their hand for anything that doesn't fall in their little red book of algorithms. Not much changes.

For now.

Also, I don't want to be their friend. They are not my partners or my colleagues. We are not a "team" and should not be expected to be. I am not their firefighter or fixer. If they are "independent providers", they shouldn't need a physician to help them out. If they need one, they should be allowed to work only under supervision. Also, I wouldn't do any curbside consults for them; if they want me on board, I write a note, bill for it, and let the patient know why I am there. If they want to play with the big boys, they should expect to be treated accordingly; if they want handholding, they should keep playing in the sandbox.

 

[BLADEMDA]

“People that want to practice medicine without a lot of training, whatever level you’re at, you don’t know enough to know what you don’t know. You know just enough to be dangerous. The humility is important.”

That's the concluding remarks of the article and it's spot on.

 

[mostwanted]

It's not touchy-feely. It's lack of scientific education in K-12, even in many colleges. To begin with, 38% of our society still believes in creationism. All those people lack a scientific approach to problems.

I agree with the overall sentiment in this thread, but this is just ridiculous. To suggest that people who believe in God or a higher being don't scientifically assess problems or somehow you are of higher intelligence or a better physician because you don't believe in God is ignorant at best. I know many medical/non-medical professionals who are intelligent and excellent at what they do and they also believe in God as I'm sure there are others who don't and are great as well.


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[dhb]

People here bitch about paying 25 or 30€ for a doctors visit although they get reimbursed 20 or 24. But they have no problem paying 50 for homeopathy or a dietician with no reimbursement... and lets not talk about veterinarians.

 

[deleted171991]

I agree with the overall sentiment in this thread, but this is just ridiculous. To suggest that people who believe in God or a higher being don't scientifically assess problems or somehow you are of higher intelligence or a better physician because you don't believe in God is ignorant at best. I know many medical/non-medical professionals who are intelligent and excellent at what they do and they also believe in God as I'm sure there are others who don't and are great as well.


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By creationism I mean the denial of evolution, not belief in a higher power. Or do you really think that only 38% of Americans believe in God(s)?

And yes, I do consider people who believe literally in some sacred text (written by humans), even when contradicted by scientific proof (evolution comes to mind again), as less intelligent. They are also known as religious fundamentalists, and have been at the root of many wars.

Btw, I am agnostic, so I don't judge other people's beliefs to be right or wrong, except when obviously (i.e. scientifically proven to be) false.

 

[anbuitachi]

People here bitch about paying 25 or 30€ for a doctors visit although they get reimbursed 20 or 24. But they have no problem paying 50 for homeopathy or a dietician with no reimbursement... and lets not talk about veterinarians.

and mechanic for their car... or a plumber.. pretty much anything except for their own health.. cause thats supposed to be free

 

[bronx43]

I live in one of those states. At least from the inpatient side on the wards, the NP's make an effort to befriend an MD/DO to hold their hand for anything that doesn't fall in their little red book of algorithms. Not much changes.

So docs need to stop holding their hand... and even if they do, do you really think that the ONLY medical mistakes are made when they REALIZE they need help? When talking about NPs, always assume that for every one question they ask to MDs, they have missed 10 things that may or has gone on to hurt the patient.

 

[D P356]

Few things make me cringe more than when I hear someone say they're not going to have surgery with best surgeon in the hospital because they didn't like his bedside manner.
Are you effing kidding me....give me the biggest jerk on the planet if I will get the best outcome.

After surgery, follow up in the clinic with, "so people told me you were a POS, but a good surgeon. They were right on both."

 

[HIPAAHasOneP]

When Your Doc Is Not a Doc: Should Nurse Practitioners Be Autonomous?

This patient made an appointment to see a neurologist, and no one had the courtesy to alert her in advance she would be seeing a NP instead. That's really rude. I've had the bait and switch once, and now I make it clear when I make the appointment that I want to see the physician. I don't have the energy to worry about the NP or PA getting their feelings hurt because I want to see my doctor. If the physician is tied up, I'll wait for a later appointment. It was good to read this article because I am in Houston and now know to avoid Methodist for emergency care.

 

[anbuitachi]

This patient made an appointment to see a neurologist, and no one had the courtesy to alert her in advance she would be seeing a NP instead. That's really rude. I've had the bait and switch once, and now I make it clear when I make the appointment that I want to see the physician. I don't have the energy to worry about the NP or PA getting their feelings hurt because I want to see my doctor. If the physician is tied up, I'll wait for a later appointment. It was good to read this article because I am in Houston and now know to avoid Methodist for emergency care.

Same its super rude. That happened to me with dermatologist. PA saw me even though i made appiontment with the doctor.

 

[Robotic Wis-Hipple]

Same its super rude. That happened to me with dermatologist. PA saw me even though i made appiontment with the doctor.

This is crazy, you probably paid a Specialist copay etc. If an IM trained doc can't hang a Dermatology shingle why is it ok for an NP?

 

[deleted171991]

This is crazy, you probably paid a Specialist copay etc. If an IM trained doc can't hang a Dermatology shingle why is it ok for an NP?

Because the NP/PA did a dermatology "residency".

 

[IkeBoy18]

This is crazy, you probably paid a Specialist copay etc. If an IM trained doc can't hang a Dermatology shingle why is it ok for an NP?

I thought they could hang a dermatology shingle, they just cant claim to be a dermatologist, or board certified by the ABD?

 

[Robotic Wis-Hipple]

I thought they could hang a dermatology shingle, they just cant claim to be a dermatologist, or board certified by the ABD?

Maybe. But I can't imagine they could do anything other than a cash practice.

 

[IkeBoy18]

Maybe. But I can't imagine they could do anything other than a cash practice.

Aah ok youre probably right abt that. I know a few non derm trained physicians doing several cosmetic procedures (botox, fillers, skin penning, microderm, etc), even vitamins and hangover tx. A bunch of boutique stuff. Cash only. People dont mind paying for that stuff.

 

[HIPAAHasOneP]

Maybe. But I can't imagine they could do anything other than a cash practice.

Aah ok youre probably right abt that. I know a few non derm trained physicians doing several cosmetic procedures (botox, fillers, skin penning, microderm, etc), even vitamins and hangover tx. A bunch of boutique stuff. Cash only. People dont mind paying for that stuff.

At the dermatology practice I use the PAs do more than just the cosmetic stuff. On their website it states this about one of their PAs, "XXXX works in both medical and cosmetic dermatology, focusing primarily on the evaluation, treatment and prevention of skin cancers." This is why I always, always double check that my appointment is with the physician and not the PA. I want skin cancer screenings including the decision of what to remove and what to leave alone to be made by the physician.

 

[857770]

If only patients didn't have to suffer by going this route. Patients are dumb and part of our job is to protect them from their own stupidity.

Umm. Not exactly. Many still ask to see a doctor. In one case, patients were sent to an Urgent Care Center (their doctor was sick) and were upset that they only saw a nurse practioner. They complained to their DUMB doctor who said that NPs were just as good as doctors were.

 

[sevoman777]

I am waiting for the day when I get on a plane and hear the voice on the PA say "Hello, I am Jenny Wilkinson, your certified registered pilot flier".

Great news story that I came across. I'm really glad that this story combined with the other one in pediatric dentistry are gaining traction in the media...makes me hopeful that it's only a matter of time before they shine a light directly on the prevalence of nurses administering solo anesthetics.

When Your Doc Is Not a Doc: Should Nurse Practitioners Be Autonomous?

 

[Noyac]

I am waiting for the day when I get on a plane and hear the voice on the PA say "Hello, I am Jenny Wilkinson, your certified registered pilot flier".

I'm waiting for the day when the flight attendant gets on the PA and says, " is there an Advanced Practice Nurse aboard this flight? We need an APN on aisle 10!"

 

[Robotic Wis-Hipple]

I'm waiting for the day when the flight attendant gets on the PA and says, " is there an Advanced Practice Nurse aboard this flight? We need an APN on aisle 10!"

That will never happen. They'll just ask for a Doctor and get a DNP.

 

[deleted162650]

I'm waiting for the day when the flight attendant gets on the PA and says, " is there an Advanced Practice Nurse aboard this flight? We need an APN on aisle 10!"

You know the joke about the cardiac anesthesiologist on the plane right?

 

[Noyac]

You know the joke about the cardiac anesthesiologist on the plane right?

I forget.

 

[sevoman777]

You know the joke about the cardiac anesthesiologist on the plane right?

Say it!
(move the chair back?)

 

[deleted162650]

A cardiac anesthesiologist is midway through his flight heading out on vacation when the flight attendant comes on over the loudspeaker "Attention passengers, would any of you onboard happen to be a cardiac anesthesiologist? We are in need of a cardiac anesthesiologist." Excited and surprised, he pushes his call button, "This is incredible he thinks to himself - I'm always behind the drapes, never getting any credit or recognition. This is my time to shine for once!" The flight attendant comes over and asks the man if he needs anything. He responds "Yes, I heard the announcement. I am a cardiac anesthesiologist. What's the problem? Is someone sick??" The flight attendant says "Oh no sir, it's nothing like that. We have a cardiac surgeon up in first class, and he needs his table adjusted."

 

[bashwell]

In keeping with the theme of this post:

What's the difference between a CRNA and a bullet? A bullet only kills once.

 

[sevoman777]

In keeping with the theme of this post:

What's the difference between a CRNA and a bullet? A bullet only kills once.

lmfao... this is gold. thanks.

 

[pgg]

Difference between God and a surgeon?


God doesn't think he's a surgeon.

 

[deleted162650]

In keeping with the theme of this post:

What's the difference between a CRNA and a bullet? A bullet only kills once.

The other punchline to that joke is:

A bullet can be fired.

 

[deleted171991]

A cardiac anesthesiologist is midway through his flight heading out on vacation when the flight attendant comes on over the loudspeaker "Attention passengers, would any of you onboard happen to be a cardiac anesthesiologist? We are in need of a cardiac anesthesiologist." Excited and surprised, he pushes his call button, "This is incredible he thinks to himself - I'm always behind the drapes, never getting any credit or recognition. This is my time to shine for once!" The flight attendant comes over and asks the man if he needs anything. He responds "Yes, I heard the announcement. I am a cardiac anesthesiologist. What's the problem? Is someone sick??" The flight attendant says "Oh no sir, it's nothing like that. We have a cardiac surgeon up in first class, and he needs his table adjusted."

I am so sorry I can like this only once.

 

[ambiturner]

The other punchline to that joke is:

A bullet can be fired.

I learned this joke with VA nurses, which gives you a third possible answer:

A bullet can draw blood

 

[teeva]

I heard all three punchlines at one VA. I wonder if it's a universal joke across them all.