Comments on: The dumbing down of doctors to providers http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Happyman http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81614 Happyman Sun, 04 Nov 2007 02:05:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81614 the problem with mid-levels is that, once you realize they missed something that an MD would've picked up, it's generally too late: a couple of examples - <br/><br/>1- creatinine for a young "healthy" person doubles from 0.6-1.2 - still "normal" per lab record, but an MD would pick it up;<br/><br/>2- the ubiquitous chf exacerbation masquerading as a "URI"<br/><br/>so the myth that they can handle "simple things" is that recognizing when something ISN'T simple is a challenge that comes with years of education & training. <br/><br/>I look back at my basic science texts, ICU book, washington manual, etc. that all are highlighted & underlined like crazy, and I'm just amazed how much knowledge was taken in in those years. I'd say that the first semester of med school was more info than all of high school & college put together. Internship was way more than that even.<br/><br/>And somehow an RN with just 2 years of NP school goes from doling out meds ordered by an MD, to prescribing narcotics, juggling multiple meds in the elderly, and diagnosing & treating all sorts of conditions? just doesn't make sense to me.<br/><br/>but people will clearly trade quality for cost. so be it. the problem with mid-levels is that, once you realize they missed something that an MD would’ve picked up, it’s generally too late: a couple of examples –

1- creatinine for a young “healthy” person doubles from 0.6-1.2 – still “normal” per lab record, but an MD would pick it up;

2- the ubiquitous chf exacerbation masquerading as a “URI”

so the myth that they can handle “simple things” is that recognizing when something ISN’T simple is a challenge that comes with years of education & training.

I look back at my basic science texts, ICU book, washington manual, etc. that all are highlighted & underlined like crazy, and I’m just amazed how much knowledge was taken in in those years. I’d say that the first semester of med school was more info than all of high school & college put together. Internship was way more than that even.

And somehow an RN with just 2 years of NP school goes from doling out meds ordered by an MD, to prescribing narcotics, juggling multiple meds in the elderly, and diagnosing & treating all sorts of conditions? just doesn’t make sense to me.

but people will clearly trade quality for cost. so be it.

]]> By: Rachel http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81585 Rachel Sat, 03 Nov 2007 14:02:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81585 I have to chime in and say that I have generally deliberately chosen to use NPs for my primary care for the past several years, because I feel that I get more time with the provider and am treated as more of a whole person than when I go to regular docs. However, I should probably qualify that by saying that I have a specialist for my major ongoing issue (thyroid), and work in a large academic medical center. I really only need a PCP at this stage for basic things like general illnesses (strep, etc.), and I don't see why an NP can't handle that. I have to chime in and say that I have generally deliberately chosen to use NPs for my primary care for the past several years, because I feel that I get more time with the provider and am treated as more of a whole person than when I go to regular docs. However, I should probably qualify that by saying that I have a specialist for my major ongoing issue (thyroid), and work in a large academic medical center. I really only need a PCP at this stage for basic things like general illnesses (strep, etc.), and I don’t see why an NP can’t handle that.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81548 Anonymous Fri, 02 Nov 2007 22:26:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81548 Guess, we'll all have to post as "anonymous".<br/><br/>:) Guess, we’ll all have to post as “anonymous”.

:)

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81538 Anonymous Fri, 02 Nov 2007 15:22:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81538 Thanks Koko "PhD" for your "insightful" and "relevant" comment. I happen to have a Ph.D and an MD. This is what I know from my experience. <br/><br/>1: Having a Ph.D does not mean you are medically trained and that you "know more" than a doctor or a nurse. <br/><br/>2: Having an MD does not mean you are trained to do research (many MD's make this mistake).<br/><br/>Having done a postdoc and a residency I can say that In med school/residency I learned little on how to complete scientific research projects. Conversly, as grad student/post-doc I learned little nothing as to how to manage medical patients. Like most things in life Koko Ph.D it is EXPERIENCE that trains us to be competent in our chosen field.<br/><br/>Food for thought. <br/><br/>PS: Please do correct my spelling and make any pithy comments you would like. Thanks Koko “PhD” for your “insightful” and “relevant” comment. I happen to have a Ph.D and an MD. This is what I know from my experience.

1: Having a Ph.D does not mean you are medically trained and that you “know more” than a doctor or a nurse.

2: Having an MD does not mean you are trained to do research (many MD’s make this mistake).

Having done a postdoc and a residency I can say that In med school/residency I learned little on how to complete scientific research projects. Conversly, as grad student/post-doc I learned little nothing as to how to manage medical patients. Like most things in life Koko Ph.D it is EXPERIENCE that trains us to be competent in our chosen field.

Food for thought.

PS: Please do correct my spelling and make any pithy comments you would like.

]]> By: KoKo http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81533 KoKo Fri, 02 Nov 2007 14:49:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81533 "I guess KoKo cant read well." <br/># posted by ERMurse : 10:13 PM<br/><br/>Looks like "male" nurse failed English 101. Duh!<br/><br/>KoKo, PhD. “I guess KoKo cant read well.”
# posted by ERMurse : 10:13 PM

Looks like “male” nurse failed English 101. Duh!

KoKo, PhD.

]]> By: ERMurse http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81526 ERMurse Fri, 02 Nov 2007 03:13:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81526 I guess KoKo cant read well. Also, Dr Tice has it totally wrong. RN's are not midlevel providers - NP's and PA's are. In case you havent realized it there is a difference. I guess KoKo cant read well. Also, Dr Tice has it totally wrong. RN’s are not midlevel providers – NP’s and PA’s are. In case you havent realized it there is a difference.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81523 Anonymous Fri, 02 Nov 2007 02:08:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81523 "Why should I, when I know more medicine than an RN?"<br/><br/>You really think reading medical blogs and some type of science background means you know more medicine than an RN Koko? You are deluded. “Why should I, when I know more medicine than an RN?”

You really think reading medical blogs and some type of science background means you know more medicine than an RN Koko? You are deluded.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81520 Anonymous Fri, 02 Nov 2007 00:32:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81520 Using PAs and NPs for primary care wont work, because SHOCK! they want the higher paying specialties just like doctors do. Furthermore, SHOCK! they like the big cities much better than the poor underserved rural areas, again just like the doctors do.<br/><br/>I always laugh when I hear PAs/NPs are going to take over primary care. Over 70% of new PAs coming out of school work in specialty fields and want absolutely nothing to do with primary care.<br/><br/>I guess the politicians next idea is to let regular RNs and lab technicians write scripts and take over primary care. Good luck with that idea. Using PAs and NPs for primary care wont work, because SHOCK! they want the higher paying specialties just like doctors do. Furthermore, SHOCK! they like the big cities much better than the poor underserved rural areas, again just like the doctors do.

I always laugh when I hear PAs/NPs are going to take over primary care. Over 70% of new PAs coming out of school work in specialty fields and want absolutely nothing to do with primary care.

I guess the politicians next idea is to let regular RNs and lab technicians write scripts and take over primary care. Good luck with that idea.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81517 Anonymous Thu, 01 Nov 2007 21:50:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81517 Good. This is how it should be. Good. This is how it should be.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/11/dumbing-down-of-doctors-to-providers.html/comment-page-1#comment-81516 Anonymous Thu, 01 Nov 2007 21:04:00 +0000 http://clients.emmense.com/kevinmd/2007/11/the-dumbing-down-of-doctors-to-providers.html#comment-81516 This has already happened at the VA Health System in Western New York. When my husband got his pacemaker in July 2005, a physician did the procedure, but otherwise he sees two nurse practitioners - one for cardiology and one for diabetes management and other primary care. He hasn't seen an actual doctor in at least two years. This has already happened at the VA Health System in Western New York. When my husband got his pacemaker in July 2005, a physician did the procedure, but otherwise he sees two nurse practitioners – one for cardiology and one for diabetes management and other primary care. He hasn’t seen an actual doctor in at least two years.

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