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nurse practitioners


olecranon

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My point is that medical training goes beyond just EBM. If it were as simple as EBM then there would be algorithms for everything, and our jobs would be uninteresting at best.

 

As for CES, what about things that are rarer than that? You can't have a powerful study regarding diseases that are 1 in a few million. But these diseases exist and are what I think medical doctors are trained for. We are trained not to just manage the common EBM algorithmic stuff but to also recognize the rare things when nobody else can. This is what separates us from the nurses. Sure EBM and common things are just great and all, but when you're that 1 patient with that weird illness or strange presentation, then all the EBM won't make a lick of difference to you.

 

Not to mention that the CES red-flags are based on the understanding of neurophysiology which midlevels lack. I bet a few could list the red flags but none could describe the reason behind them. Furthermore, there are even rarer things than CES that can present similarly, and midlevels would have a tough time coming up with a reasonable differential.

 

The fact of the matter is that EBM works great for common things, not so great for uncommon things, and I would say somewhat poor for rare things.

 

Overall, medicine is a combination of trying to get good evidence, combined with using clinical judgment and experience, to provide the right kind of care for all patients.

 

I still don't understand your point.

 

Doctors are trained to thinking scientifically, and EBM is based on scientific principles.

 

Medical training is founded on helping as many people as possible, and thus it makes complete sense that common pathology is taught first, with rarer issues identified in a logical way on an exclusionary basis.

 

MDs aren't magical. We didn't go to Hogwarts (at least I didn't).

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Ah, you didn't miss anything that you know of - there was a case in dialogue with a patient presenting with subtle endocarditis.

 

Had this 18 yr old been to the dentist recently ? Did you ask about this ? No ones perfect - but the lawyer's expect us to be.

 

I would post the dialogue case, but I can't access it on the web. Check it out - it's an interesting case.

 

I had a similiar case a few years ago, and the pt ended up needing a prosthetic valve.

 

I think I read the same one a while ago. The difference is that doc had a patient who presented with fever and flu like symptoms multiple times with no resolution over the course of something like 4-6 weeks. The problem was the fact that after multiple visits with no improvement the doc did no change the diagnosis of viral illness or conduct more tests to rule anything else out. If I recall correctly anyway.

 

Was it in the CMPA magazine this month?

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I think I read the same one a while ago. The difference is that doc had a patient who presented with fever and flu like symptoms multiple times with no resolution over the course of something like 4-6 weeks. The problem was the fact that after multiple visits with no improvement the doc did no change the diagnosis of viral illness or conduct more tests to rule anything else out. If I recall correctly anyway.

 

Was it in the CMPA magazine this month?

 

Yep, that's the one. I think we get lulled into a sense of false security in ambulatory care, because the pre-test probability of such conditions are so low. But they do happen.

 

This is a good argument for not having mid levels practice independently - except in this case, the subtle case slipped by the doc !

 

I find teaching medical students, residents and IMGs keeps me on my toes. Also makes the day more interesting too. Doesn't hurt the old resume either :cool:

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