maximus Posted November 22, 2012 Report Share Posted November 22, 2012 Well you are wrong in assuming that nurses do not learn about the whole body. (In regard to prescribing medication, I am mostly talking about NPs).For you to call the education watered-down is extremely ignorant and it is for this exact reason that people do not want to see doctors anymore (I'm assuming you are a med student). Patients want a say in their health care, they do not want to be told what to do. I certainly believe there needs to be a review of the medical system and the current policies in place, but you would be naive to think that expanding the scope of care that health providers other than MDs can provide would be detrimental or non-successful. What you're suggesting is a paternalistic medical practice. However, I think you're misunderstanding the doctor's duties. The doctor generally knows what is the best course of action for the patient. It would be stupid to suggest that the patient have a say in what is best unless they are properly educated. The best method for a patient to derive autonomy from their medical professional experience is to get multiple accounts of what the problem might be from multiple doctors. What you're suggesting is absurd becuase it implies that doctors don't communicate at all with their patients, when in fact all they do is try to find out as much infomration as possible and provide a medical diagnosis. Just because you talk to the nurse doesn't mean you get a better experience or that your claim to autonomy through such action is beneficial to you. It's that simple. Link to comment Share on other sites More sharing options...
aaronjw Posted November 22, 2012 Report Share Posted November 22, 2012 What you're suggesting is a paternalistic medical practice. However, I think you're misunderstanding the doctor's duties. The doctor generally knows what is the best course of action for the patient. It would be stupid to suggest that the patient have a say in what is best unless they are properly educated. The best method for a patient to derive autonomy from their medical professional experience is to get multiple accounts of what the problem might be from multiple doctors. What you're suggesting is absurd becuase it implies that doctors don't communicate at all with their patients, when in fact all they do is try to find out as much infomration as possible and provide a medical diagnosis. Just because you talk to the nurse doesn't mean you get a better experience or that your claim to autonomy through such action is beneficial to you. It's that simple. Boy are you wrong if you think doctors are such elite communicators with patients. FAR from it based on my experience, that of my family (even those in the medical profession), and close friends. In fact it is the absolute number one complaint. Link to comment Share on other sites More sharing options...
maximus Posted November 22, 2012 Report Share Posted November 22, 2012 Can someone reply to my nurse practitinoer thread? Link to comment Share on other sites More sharing options...
leijona88 Posted November 22, 2012 Report Share Posted November 22, 2012 What you're suggesting is a paternalistic medical practice. However, I think you're misunderstanding the doctor's duties. The doctor generally knows what is the best course of action for the patient. It would be stupid to suggest that the patient have a say in what is best unless they are properly educated. The best method for a patient to derive autonomy from their medical professional experience is to get multiple accounts of what the problem might be from multiple doctors. What you're suggesting is absurd becuase it implies that doctors don't communicate at all with their patients, when in fact all they do is try to find out as much infomration as possible and provide a medical diagnosis. Just because you talk to the nurse doesn't mean you get a better experience or that your claim to autonomy through such action is beneficial to you. It's that simple. To input, the MD may know the best course of action medically, but the patient/client may have cultural/religious/personal/situational reasons for wishing for a different course of action. So the MDs role is (ought to be) to discuss with the patient what is happening physiologically, and outline the patient's options, stating the pros and cons of each, as well as the pros and cons of doing nothing. If the MD (or NP or nurse) leaves out any of that info, the patient is not making an informed decision, which would mean that the clinician is leaving out information so that the patient is essentially coerced to consent to the plan of care that the clinician believes is best. Whether or not the clinician does this 'for the patient's own good' makes no difference. I'm not saying this is different from what you said, just thought I would elaborate a bit. Link to comment Share on other sites More sharing options...
NutritionRunner Posted November 22, 2012 Report Share Posted November 22, 2012 There are also plenty of times when the physician doesn't have a clue what is going on with the patient. I saw three gynaecologists for severe menstrual pain, the kind that would leave me in the fetal position for at least two days every cycle, unable to function, and none of them was able to determine what the problem was (was with the first until she retired, then saw a second one, then saw a third when I moved to a new city). Endometriosis was never even mentioned as a possible problem until I ended up in the ER one evening, with pain that was so severe I couldn't do anything except vomit. My family physician actually sent me to the ER that day, as she was suspecting appendicitis. Well, it wasn't appendicitis, but the gyn on call at the time in the hospital suspected endometriosis, which was the first time I had heard of such a thing, but said he couldn't confirm without surgery. Low and behold, when I had a laparoscopy, there were endometriosis lesions all over the outside of my uterus and covering both ovaries. So why had no doctor ever suggested the possibility before? Especially the gyns, who you would think would have had experience with the disease! (My family doctors - one in each city - were no better of course, but at least gyn problems weren't their main area of study!) So doctors are hardly infallible. They make plenty of mistakes and, with some of them, I honestly wonder how they managed to get into medical school and make it through clerkship and residency. Link to comment Share on other sites More sharing options...
leviathan Posted November 23, 2012 Report Share Posted November 23, 2012 There are also plenty of times when the physician doesn't have a clue what is going on with the patient. I saw three gynaecologists for severe menstrual pain, the kind that would leave me in the fetal position for at least two days every cycle, unable to function, and none of them was able to determine what the problem was (was with the first until she retired, then saw a second one, then saw a third when I moved to a new city). Endometriosis was never even mentioned as a possible problem until I ended up in the ER one evening, with pain that was so severe I couldn't do anything except vomit. My family physician actually sent me to the ER that day, as she was suspecting appendicitis. Well, it wasn't appendicitis, but the gyn on call at the time in the hospital suspected endometriosis, which was the first time I had heard of such a thing, but said he couldn't confirm without surgery. Low and behold, when I had a laparoscopy, there were endometriosis lesions all over the outside of my uterus and covering both ovaries. So why had no doctor ever suggested the possibility before? Especially the gyns, who you would think would have had experience with the disease! (My family doctors - one in each city - were no better of course, but at least gyn problems weren't their main area of study!) So doctors are hardly infallible. They make plenty of mistakes and, with some of them, I honestly wonder how they managed to get into medical school and make it through clerkship and residency. Sorry to hear about your problems. Considering that physicians are the highest trained, imagine how much more you would have been mismanaged by seeing a lesser trained individual, e.g. a nurse practitioner? Link to comment Share on other sites More sharing options...
aaronjw Posted November 23, 2012 Report Share Posted November 23, 2012 Sorry to hear about your problems. Considering that physicians are the highest trained, imagine how much more you would have been mismanaged by seeing a lesser trained individual, e.g. a nurse practitioner? you really think a nurse practitioner would have done worse than the other physicians outside of the EM physicians? Link to comment Share on other sites More sharing options...
leviathan Posted November 23, 2012 Report Share Posted November 23, 2012 you really think a nurse practitioner would have done worse than the other physicians outside of the EM physicians? Maybe not for this particular case but overall they are going to make more mistakes. It's common sense that everyone will miss things or make mistakes, but those mistakes will multiply if you put someone in charge with lesser and lesser knowledge/experience. Link to comment Share on other sites More sharing options...
youngdad Posted November 24, 2012 Report Share Posted November 24, 2012 There are also plenty of times when the physician doesn't have a clue what is going on with the patient. I saw three gynaecologists for severe menstrual pain, the kind that would leave me in the fetal position for at least two days every cycle, unable to function, and none of them was able to determine what the problem was (was with the first until she retired, then saw a second one, then saw a third when I moved to a new city). Endometriosis was never even mentioned as a possible problem until I ended up in the ER one evening, with pain that was so severe I couldn't do anything except vomit. My family physician actually sent me to the ER that day, as she was suspecting appendicitis. Well, it wasn't appendicitis, but the gyn on call at the time in the hospital suspected endometriosis, which was the first time I had heard of such a thing, but said he couldn't confirm without surgery. Low and behold, when I had a laparoscopy, there were endometriosis lesions all over the outside of my uterus and covering both ovaries. So why had no doctor ever suggested the possibility before? Especially the gyns, who you would think would have had experience with the disease! (My family doctors - one in each city - were no better of course, but at least gyn problems weren't their main area of study!) So doctors are hardly infallible. They make plenty of mistakes and, with some of them, I honestly wonder how they managed to get into medical school and make it through clerkship and residency. So, a doctor got it right. That gyne was a doctor. I don't get it. Link to comment Share on other sites More sharing options...
A-Stark Posted November 24, 2012 Report Share Posted November 24, 2012 you really think a nurse practitioner would have done worse than the other physicians outside of the EM physicians? Yes. I can't figure out how several gynes didn't consider endometriosis as part of the differential (sounds most likely by history!) or trial an OCP, but NPs do NOT have the experience or training equal to family physicians let alone anyone else. They're very good at routine/chronic stuff, but when it comes to something like distinguishing cholelithiasis from cholecystitis or performing DREs there are big gaps. Link to comment Share on other sites More sharing options...
NutritionRunner Posted November 24, 2012 Report Share Posted November 24, 2012 So, a doctor got it right. That gyne was a doctor. I don't get it. The point is that multiple doctors got it wrong over multiple years. So, doctors are not infallible, which seems to be what many people on this forum are saying. Link to comment Share on other sites More sharing options...
A-Stark Posted November 24, 2012 Report Share Posted November 24, 2012 I don't think that's what people are saying. The training is not adequate to the practice of medicine, because they are trained for nursing. Not the same thing. For example, maybe not all physicians know why C. diff cannot be treated with IV Vanco, but RNs in one emerg don't seem to know and aren't even familiar with PO Vanco. Link to comment Share on other sites More sharing options...
concernedmedstudent Posted November 25, 2012 Report Share Posted November 25, 2012 I don't think that's what people are saying. The training is not adequate to the practice of medicine, because they are trained for nursing. Not the same thing. For example, maybe not all physicians know why C. diff cannot be treated with IV Vanco, but RNs in one emerg don't seem to know and aren't even familiar with PO Vanco. Nurses are better than doctors at nursing and doctors are better than nurses at being doctors. Its apples and oranges. Pilots are better at flying airplanes than flight attendants but the flight attendants are probably better at being flight attendants. It is silly when people try to practice outside of their scope. If you want to be a doctor you should get an undergraduate degree (if you haven't already), go to medical school and complete a residency its as simple as that. The lines seem to be blurred in medicine more than most other professions but this is not a unique problem. I would imagine there are probably a fair number of paralegals that try to practice like lawyers and maybe even some dental hygienists and athletic trainers that try and act like dentists or physical therapists. The reality is they are two very different careers with very different amounts of training that share the same common goal of providing the best quality care to their patients, so in this sense they function as a team. Like any good team, there are many different positions, from coach, to player to water boy and it is very important that everyone contributes to the best of their ability within their role. Link to comment Share on other sites More sharing options...
JacquiDent Posted December 9, 2012 Report Share Posted December 9, 2012 Exactly concernedmedstudent. Everything is relative to your training and scope of practice. Many nurses on the Neurosciences unit I work on could be said to be more familiar with meds commonly used for Neuro patients that many GPs have limited knowledge on. However, does that mean an RN from Neuro go work in a GP office for a day? Or tell that GP all about meds etc? Heck no. We know what we know within our scope. Neurologists know which meds to prescribe, and we give them accordingly. The GPs turn to the Neuros. And so on. When my patients are having family crisis do I step in to try to solve all that? No. Offer empathy and some support, and submit a referral to social work. Back to NPs... they are useful within their area and with the support of RNs, physicians, PT/OT, etc. Everything in healthcare is about teamwork and understanding where your limits are and when to seek help from a different professional. I've worked with a couple NPs(one on a cardiac surgical unit) who were fabulous and were well-aware of their limitations and when to refer to the cardiologists and surgeons. In any field though, you will get the individual who does act "God-like" (The nurse who thinks they know more than the Dr, the new NP who thinks they know more than the seasoned nurses, etc.), and that's where you get mistakes being made, wrong diagnosis, etc. It's all relative to individuals on different units/clinics. Link to comment Share on other sites More sharing options...
futureGP Posted March 6, 2013 Report Share Posted March 6, 2013 one thing i don't get is.. if NPs don't get education on pathophysiological processes of human body systems, how are they supposed to diagnose/plan management just like what GPs do? is it solely based on the assumption that with they have seen the patients for some number of years, they'll be able to instinctively diagnose based on experience? since not likely (unless i'm misinformed about their education based on http://bloomberg.nursing.utoronto.ca/academic/programs/master/nurse-practitioner#content3 which includes 1 single course each on pathophysiological process and pharmacotherapeutics for adult/pediatrics) my conclusion is, NPs don't act like GPs...or shouldn't act like GPs... so then what is really the role of NPs? Link to comment Share on other sites More sharing options...
rmorelan Posted March 6, 2013 Report Share Posted March 6, 2013 one thing i don't get is.. if NPs don't get education on pathophysiological processes of human body systems, how are they supposed to diagnose/plan management just like what GPs do? is it solely based on the assumption that with they have seen the patients for some number of years, they'll be able to instinctively diagnose based on experience? since not likely (unless i'm misinformed about their education based on http://bloomberg.nursing.utoronto.ca/academic/programs/master/nurse-practitioner#content3 which includes 1 single course each on pathophysiological process and pharmacotherapeutics for adult/pediatrics) my conclusion is, NPs don't act like GPs...or shouldn't act like GPs... so then what is really the role of NPs? A lot of them that I know don't diagnosis at all really - but once you know what the problem is you can come up with a plan for a wide variety of things - if the person is unexpected not improving on the standard level of care you can consult with a doctor for more advanced planning. Link to comment Share on other sites More sharing options...
Lunasly Posted March 6, 2013 Report Share Posted March 6, 2013 Here's one really good reason why nurses shouldn't be acting like GP's: Only 50% of nurses were able to pass a simplified version of the step 3 exam. http://www.amednews.com/article/20090608/profession/306089978/1/ Link to comment Share on other sites More sharing options...
leijona88 Posted March 12, 2013 Report Share Posted March 12, 2013 Here's one really good reason why nurses shouldn't be acting like GP's: Only 50% of nurses were able to pass a simplified version of the step 3 exam. http://www.amednews.com/article/20090608/profession/306089978/1/ ONLY 50% ? I think it's pretty good that half of nurses passed without going to med school.. ? Link to comment Share on other sites More sharing options...
leviathan Posted March 12, 2013 Report Share Posted March 12, 2013 ONLY 50% ? I think it's pretty good that half of nurses passed without going to med school.. ? These are advanced practice nurses who went to nurse practitioner school and also a nurse doctorate school. Also this was not the Step 3, but a simplified version which they were still unable to pass. Link to comment Share on other sites More sharing options...
kpm Posted March 12, 2013 Report Share Posted March 12, 2013 But... these nurses also didn't have the advantage of having done Step 1 or 2 to familiarize themselves with what the test would be like. I assume that they also did not have access to the abundance of practice materials that are available to MDs for the full Step 3 test. Link to comment Share on other sites More sharing options...
thebouque Posted March 12, 2013 Report Share Posted March 12, 2013 But... these nurses also didn't have the advantage of having done Step 1 or 2 to familiarize themselves with what the test would be like. I assume that they also did not have access to the abundance of practice materials that are available to MDs for the full Step 3 test. 1) Step 1 and step 2 don't help for step 3. The style of the exam is very different, therefore one doesn't have any advantage because he familiarized himself with the previous exams. 2) Why wouldn't they have access to the practice material? USMLE world and first aid are pretty much all you need and everyone has access to it. Maybe by practice material you mean a solid education and training? Well that's the heart of the problem. Link to comment Share on other sites More sharing options...
AtomSmasher19 Posted March 14, 2013 Report Share Posted March 14, 2013 A 50% pass rate means that you have a 50% chance of getting an acceptable level of medical treatment - and that's good enough. If you get screwed by one of the 50% of NPs who didn't pass, take one for the team - consider yourself to have sacraficed your own health for the greater good of maintaining the public healthcare system. STOP being so selfish! Canadians have to pull together to make the healthcare system work! WHY WON'T ANYBODY THINK ABOUT INTERPROFESSIONAL COLLABORATION? HOW UNPROFESSIONAL OF YOU ALL!!!! (sarcasm) Link to comment Share on other sites More sharing options...
Legion Posted March 14, 2013 Report Share Posted March 14, 2013 one thing i don't get is.. if NPs don't get education on pathophysiological processes of human body systems, how are they supposed to diagnose/plan management just like what GPs do? is it solely based on the assumption that with they have seen the patients for some number of years, they'll be able to instinctively diagnose based on experience? since not likely (unless i'm misinformed about their education based on http://bloomberg.nursing.utoronto.ca/academic/programs/master/nurse-practitioner#content3 which includes 1 single course each on pathophysiological process and pharmacotherapeutics for adult/pediatrics) my conclusion is, NPs don't act like GPs...or shouldn't act like GPs... so then what is really the role of NPs? I would also like to know the answer to that. And is there really a substantial difference between PAs and NPs when it comes to day to day practice? Link to comment Share on other sites More sharing options...
AtomSmasher19 Posted March 14, 2013 Report Share Posted March 14, 2013 I would also like to know the answer to that. And is there really a substantial difference between PAs and NPs when it comes to day to day practice? The raison d'être of the NP is to compete directly with the GP. The nurses opportunistically took advantage of the GP shortage so they could expand their territory. The medical establishment, being useless when it comes to collective negotiations, failed to point out the fact that NPs have lower productivity than GPs per taxpayer dollar spent and provide lower quality care. Link to comment Share on other sites More sharing options...
Guest Physioprospect Posted March 15, 2013 Report Share Posted March 15, 2013 The nurses probobly didnt have access to the ridiculous data base of past questions that all the physicians have access too when writing their exams. Dont talk about having a 50% chance of recieving good health care from nurses, its prob way worse odds for physicians. http://www.cnn.com/2012/01/13/health/prescription-for-cheating Tons more stories like this. Link to comment Share on other sites More sharing options...
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