Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 Saying that elected politicians are supposed to represent the people is a big lie.It's also cheaper for them to have half of Canadian doctors leave Canada by cutting their earnings. I don't know where you take your stats, but since 2004 the trend has been inverted in Canada's favor (http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20070502canadiandocs.html) Link to comment Share on other sites More sharing options...
Birdy Posted June 20, 2012 Report Share Posted June 20, 2012 Who are hypocrites? Pharmacists? Bah some view them as an increasingly aggressive lobby who want their part of the cake. The problem lies in the fact that they are most often used to minor complaints and not always aware of how the presentation of aggressive and complex diseases may be indolent, slow and benign-looking. Only someone trained to take a good history and perform a physical examination should put a Dx and then prescribe a Rx, it is not only common sense but primordial in a global health perspective imo. I'm actually on the fence about pharmacists being able to prescribe. For instance, I've had asthma my whole life. I need a salbutamol inhaler on hand at all times, and have since earliest childhood, and take a maintenance medication which I have taken for five years now. Lacking a family physician, this means upwards of four hours waiting in a walk-in clinic to get refills for medications. When I see a doctor, no exam is performed. I tell them my meds (or they read the form that I filled out), they write the scrip, that's it. Takes less than two minutes. I don't see why a pharmacist can't do that from a safety standpoint. Or something like birth control, for a woman who has been on it previously. Doctors, in my experience as a patient, dont take history (except for what med is being taken) or perform an exam for those simple kinds of refills. Some doctors will even call them in without seeing the patient at all. I get the conflict of interest argument, though, and that's why I'm on the fence. Link to comment Share on other sites More sharing options...
future_doc Posted June 20, 2012 Report Share Posted June 20, 2012 I've yet to be aware of any nurse doing such a follow up in the example you have given. Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 Let me spell this out for you using an example you made. Patient has diabetic foot ulcer. Patient is evaluated by MD. Diagnosis and treatment plan agreed upon by all parties involved. MD allows nurse to perform follow up on this patient. Nurse does not recognize something that an MD would have recognized. Nurse does not have the equivalent training. Patient has bad outcome. Patient sues. Who is responsible? Certainly it can't be the nurse! It's that over paid, over educated, bum of a physician, who is passing off his or her workload to a nurse... Please don't let the door hit you on the way out... Sry to tell you this but... It's already HAPPENING wooohooooo *dramatic music* Nurses already perform this kind of F/U. Oh and you know what? Next time you'll be in your critical care rotation I DARE you to double check every single actions made by the nurses. I DARE you to mandate to keep a stool sample to make sure you won't miss melena. I DARE you to mandate to keep endotracheal secretions to make sure it doesn't look like some sticky-purulent-mrsa colonized crap Medicine is about team working. It's about time people understand that. Link to comment Share on other sites More sharing options...
Robin Hood Posted June 20, 2012 Report Share Posted June 20, 2012 I suggest you to re-read my comment.Nobody EXCEPT MDs should be allowed to make a Dx and prescribe Rx. HOWEVER, minor counseling or wounds checking by a nurse has very little chance to be harmful. Don't take the denigrating route as it would only show your lack of open-mindedness towards options reducing MDs futile workload For minor counseling and wounds, I agree with you since it doesn't necessitate Dx and Rx. Not all problems necessitate an MD. Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 I'm actually on the fence about pharmacists being able to prescribe. For instance, I've had asthma my whole life. I need a salbutamol inhaler on hand at all times, and have since earliest childhood, and take a maintenance medication which I have taken for five years now. Lacking a family physician, this means upwards of four hours waiting in a walk-in clinic to get refills for medications. When I see a doctor, no exam is performed. I tell them my meds (or they read the form that I filled out), they write the scrip, that's it. Takes less than two minutes. I don't see why a pharmacist can't do that from a safety standpoint. Or something like birth control, for a woman who has been on it previously. Doctors, in my experience as a patient, dont take history (except for what med is being taken) or perform an exam for those simple kinds of refills. Some doctors will even call them in without seeing the patient at all. I get the conflict of interest argument, though, and that's why I'm on the fence. In this case I think it would just be easier to allow physicians to make 2 yrs prescriptions for very chronic and stable diseases. You would be invited to go to your yearly exam tho as it is an opportunity to discuss about other potential health concerns. Pharmacists would be against this proposition as they bill each time they fill a prescription. Link to comment Share on other sites More sharing options...
Robin Hood Posted June 20, 2012 Report Share Posted June 20, 2012 I don't know where you take your stats, but since 2004 the trend has been inverted in Canada's favor (http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20070502canadiandocs.html) I was referring to Ontario, and some provinces want to take the lead, and cutting doctors' earnings means more doctors will leave (especially if it turns out to be true that some Ontarian physicians will lose half of their earnings as stated here). Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 I've yet to be aware of any nurse doing such a follow up in the example you have given. Really? Tons of them in every area with decreased access to MDs as I heard. At least in Mtl I've met a lot of them Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 I was referring to Ontario, and some provinces want to take the lead, and cutting doctors' earnings means more doctors will leave (especially if it turns out to be true that some Ontarian physicians will lose half of their earnings as stated here). Please. Don't make me start on this. The cardio/ophto/radio lobby is heavily bluffing, the grass is absolutely not greener south of the border, but is probably in some western canadian provinces I concede Link to comment Share on other sites More sharing options...
MCATwannabe Posted June 20, 2012 Report Share Posted June 20, 2012 I didn't want to participate in this debate because it's somewhat political, but having a first hand experience with my family physician, who is not a physician actually , and rather an NP I think I need to voice my concern. First of all, I don't know how is it that when I signed up for a Family Doctor, I got a Nurse Practitioner? As far as I have learned Nurse Practitioners are NOT doctors, and I would agree to see her as a Walk in basis, but as a family doctor, No way. Let me tell you an example of how I think NPs are not particularly well trained, at least my experience has verified this notion for me. Every time I go to see my NP, I have more information about things than she does. Take the Vaccination for Dental school for example. For some unknown reason, the antibodies to NMR vaccine, which I have taken three times, were not showing up in my blood. So I ask my NP whether I need to take another NMR. She didn't know. So she asked another nurse who was not an NP to see if I needed this fourth dose. Not surprisingly she did not know either. So I had to actually go to another clinic to get a second opinion and get my vaccine. This wasn't just for NMR either. I had positive response to TB test nine years ago because I had BCG vaccine, and every time I need to take an x-ray. Again, my NP Didn't know, and had to ask the same nurse to get more information. Think that was enough? think again. My NP did not know about Surface antigen testing for Hep B, and testing for antibodies for Hep B. I told her what test I wanted. I like her as a person, and she is very kind, but I'm sorry when I visit a family physician (ironically not a physician in this case) I deserve to get someone who can answer my questions without the advise of other people. I'm not saying it's wrong to ask others, but it's wrong to ask another nurse who has lower credentials than you. All in all, I truly believe educating NPs in order to replace doctors is a practice that is useless. Every time I visited my NP, I ended up visiting another doctor to get a proper answer, and this is definitely not helping the province. Province is paying double the amount it should every time. Solution: Cut NPs, add more MDs. Link to comment Share on other sites More sharing options...
jerkstore Posted June 20, 2012 Report Share Posted June 20, 2012 In this case I think it would just be easier to allow physicians to make 2 yrs prescriptions for very chronic and stable diseases. You would be invited to go to your yearly exam tho as it is an opportunity to discuss about other potential health concerns. Pharmacists would be against this proposition as they bill each time they fill a prescription. WHAT!!!??? Link to comment Share on other sites More sharing options...
future_doc Posted June 20, 2012 Report Share Posted June 20, 2012 Really? Tons of them in every area with decreased access to MDs as I heard. At least in Mtl I've met a lot of them I was referring to the diabetic patient example. I've often accompanied such patients to clinics (for support) and only doctors have examined them, never a nurse. At RVH in Montreal anyways. Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 I didn't want to participate in this debate because it's somewhat political, but having a first hand experience with my family physician, who is not a physician actually , and rather an NP I think I need to voice my concern.First of all, I don't know how is it that when I signed up for a Family Doctor, I got a Nurse Practitioner? As far as I have learned Nurse Practitioners are NOT doctors, and I would agree to see her as a Walk in basis, but as a family doctor, No way. Let me tell you an example of how I think NPs are not particularly well trained, at least my experience has verified this notion for me. Every time I go to see my NP, I have more information about things than she does. Take the Vaccination for Dental school for example. For some unknown reason, the antibodies to NMR vaccine, which I have taken three times, were not showing up in my blood. So I ask my NP whether I need to take another NMR. She didn't know. So she asked another nurse who was not an NP to see if I needed this fourth dose. Not surprisingly she did not know either. So I had to actually go to another clinic to get a second opinion and get my vaccine. This wasn't just for NMR either. I had positive response to TB test nine years ago because I had BCG vaccine, and every time I need to take an x-ray. Again, my NP Didn't know, and had to ask the same nurse to get more information. I like her as a person, and she is very kind, but I'm sorry when I visit a family physician (ironically not a physician in this case) I deserve to get someone who can answer my questions without the advise of other people. I'm not saying it's wrong to ask others, but it's wrong to ask another nurse who has lower credentials than you. All in all, I truly believe educating NPs in order to replace doctors is a practice that is useless. Every time I visited my NP, i ended up visiting another doctor to get a proper answer, and this is not definitely helping the province. Province is paying double the amount it should every time. Solution: Cut NPs, add more MDs. This tricky situation shows that the practice of NP should have strict limitations I agree. I do not totally agree however when you say it costs more than it saves. Although every time you saw here she had to refer you to the MDs, how many patients has she been able to manage by herself, saving the cost of a visit? PS: Is she calling herself doctor? Link to comment Share on other sites More sharing options...
Med0123 Posted June 20, 2012 Report Share Posted June 20, 2012 @f_d, well I assure you they exist lol, such follow up may be like every 2 days with the nurse and every week with the FP. The arrangement is at the MD's discretion WHAT!!!??? Yes. It's kind of shocking isn't it? Link to comment Share on other sites More sharing options...
Birdy Posted June 20, 2012 Report Share Posted June 20, 2012 In this case I think it would just be easier to allow physicians to make 2 yrs prescriptions for very chronic and stable diseases. You would be invited to go to your yearly exam tho as it is an opportunity to discuss about other potential health concerns. Pharmacists would be against this proposition as they bill each time they fill a prescription. I don't have a yearly exam, as I don't have a family doctor. Any medical contact I have is initiated by me via walk-in clinic, and they will only address one concern per visit. Walk-in doctors will not do an annual physical here, though I don't know if that is the case elsewhere. One looked at me like I had two heads when I asked how to go about booking one recently. Of the past ten years, I have had a family doctor for three, about one year each of three different doctors (two moved, one I moved away from.) As I said, I can see the conflict of interest (edit: /financial benefit) argument, but not a safety one for cases such as mine. Link to comment Share on other sites More sharing options...
jerkstore Posted June 20, 2012 Report Share Posted June 20, 2012 @f_d, well I assure you they exist lol, such follow up may be like every 2 days with the nurse and every week with the FP. The arrangement is at the MD's discretion Yes. It's kind of shocking isn't it? They are far and away my most hated profession. No offense to any pre-pharms. Link to comment Share on other sites More sharing options...
Birdy Posted June 20, 2012 Report Share Posted June 20, 2012 They are far and away my most hated profession. No offense to any pre-pharms. Come on, now. How about homeopaths? Link to comment Share on other sites More sharing options...
Robin Hood Posted June 20, 2012 Report Share Posted June 20, 2012 They are far and away my most hated profession. No offense to any pre-pharms. A lot of pharmacists or pharm students are med school rejectees. There are countless premeds who put pharmacy as a backup. Link to comment Share on other sites More sharing options...
jerkstore Posted June 20, 2012 Report Share Posted June 20, 2012 Come on, now. How about homeopaths? I have nothing against the gays. Link to comment Share on other sites More sharing options...
Robin Hood Posted June 20, 2012 Report Share Posted June 20, 2012 Come on, now. How about homeopaths? Only someone who's ignorant in chemistry will believe these charlatans. Only one of their remedies was proven right till now. Link to comment Share on other sites More sharing options...
Birdy Posted June 20, 2012 Report Share Posted June 20, 2012 Only someone who's ignorant in chemistry will believe these charlatans. Only one of their remedies was proven right till now. Oh I know, lol. I was challenging his declaration that pharmacists were his most hated profession by offering another place to direct his ire. Link to comment Share on other sites More sharing options...
MCATwannabe Posted June 20, 2012 Report Share Posted June 20, 2012 This tricky situation shows that the practice of NP should have strict limitations I agree. I do not totally agree however when you say it costs more than it saves. Although every time you saw here she had to refer you to the MDs, how many patients has she been able to manage by herself, saving the cost of a visit? PS: Is she calling herself doctor? Honestly, I don't know how tricky the situation is. Basic knowledge of vaccines is required for any doctor and even nurses. If nurse practitioners need advice for vaccines, they should not practice. period. I don't see how can you limit practice of a nurse practitioners so that he/she doesn't give vaccine consultations without actually cutting his/her powers entirely. As for cost to the province, I stand by my reasoning. My situation was a simple vaccine consultation, and even for that I needed a second opinion. Sure I could have walked away, but I wouldn't have gotten proper care. If province is trying to save money by half-assing (excuse me for the language) the health care, I think we need to fire who ever came up with the idea. What about those who have complicated situations such as cancer, heart disease and others? Can we afford to half-ass health-care for them too? In my case my NP has caused me a great deal of time and money to get second opinions. In more sever cases, time matters. Imagine a cancer patient with stage three pancreatic cancer has to go through this process? As far as I know, every hour counts for severe cancers like that. Can we afford to lose time this way by referring a patient to an NP. I say no. Apart from that, lets even say province is saving money by employing NPs who act as Primary Care physicians. What about the money I lost because I had to cancel my work to see a separate doctor on a separate day? As for you question of whether she calls herself a Dr, one of her stickers had the title. When I called in and tried to make an appointment the clerk told me she was an NP. So no, she calls herself an NP for sure. But I SIGNED up for a family Doctor, not an NP. The medical centre assigned her to me (the medical centre says province assigned her to me). Link to comment Share on other sites More sharing options...
medisforme Posted June 20, 2012 Report Share Posted June 20, 2012 BUT, nurses are territorial when it comes to their jobs. They don't want anyone to infringe on their responsibilities, so why should they infringe on a physicians responsibilities? Let me ask you this. Which is a better option for our health care sytem, having RN's do flu shot clinics who make between 35-40$/hr or a family physician who charges close to that for administering a single flu injection for a patient. Some physicians make ++money performing these types of services I would argue they are overqualified for. Link to comment Share on other sites More sharing options...
medisforme Posted June 20, 2012 Report Share Posted June 20, 2012 Nurses do more than administer medication, bandage, clean sh!t, monitor vitals, take charts, brief physicals, and the occasional nasogastric intubation? I suppose a surgical nurse does none of the above besides clean sh!t, bandage, and hand instruments to the surgeon - if that's what you meant by "depending on the specialty" aka. in which department does the nurse do up to everything I listed above. Thank you for clarifying my beliefs that your knowledge of RN job descriptions is non-existent Link to comment Share on other sites More sharing options...
jerkstore Posted June 20, 2012 Report Share Posted June 20, 2012 Thank you for clarifying my beliefs that your knowledge of RN job descriptions is non-existent Wow I was off on all of that? Amazing. Mind filling me in? Link to comment Share on other sites More sharing options...
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