| March 25, 2008
Not supervising your mid-levels can cost you.
< Previous post Profiting from screening
Next post > A specificity problem with breast MRIs?
Comments are moderated before they are published. Please read the comment policy.
Well so much for retail store clinics. That was fast. Nice while it lasted.
Your “headline” is so sensationalized that I assume you want to start another “mid-level” bashing thread. Haven’t we beat this one to death??
What is the take home here? 1. Prescribe antibiotics for all cases of rhinorrhea & headache 2. Have a physician see every patient that a PA sees because they are bound to screw up or 3. Have physicians better understand the working collaborative/supervisory relationship between either a PA or NP and therefore not make the practice agreements unrealistic?
Based on the limited amount of clinical information in this link, who would’ve really treated this patient much differently?
I enjoy reading your blog however, the constant undertones of “mid-level” incompetence is wearing thin on me. I have see lots of anecodotal comments with regards to NPs/PAs. The reality is every state has different regulatory requirements and then they differ from both NPs & PAs. It is everyone’s responsibility to understand the working relationships between physicians and NPs & PAs, that is, if you have such a relationship. I think there are a vast number of misconceptions out there and I truly hope that this dialogue helps to clear some of them up so that we can respectively continue caring for patients as we’ve been educated and trained to do.
Now comes the in-store CT scanner for those questionable cases. Reading will be done in India.
NP, Kevin has an agenda he’s working. Facts are irrelevant. When it’s a verdict for the plaintiff, no matter how sketchy the info in the article, it’s an outrage and another reason to demagogue.
When it’s a verdict for the defense or even a physician accused, the media doesn’t do medicine well and we should wait and see, no matter how egregious the act.
It’s not about you NPs and PAs so much as it is his view of malpractice.
No, I thought the point of the article was that their agreement called for a physician to see ever patient the PA saw, and they failed to do that.
So “set your rules and live up to them” is the moral of the story.
Had the patient seen the Dr., even if he/she had done the same thing they wouldn’t have felt that the Dr. office short-shifted them and sued.
The article starts out saying the patient went to see the Dr., but got a PA instead.
When I make an appointment, even a same day one, I am told clearly by the clerk if I will be seeing a Doctor, and NP or a PA. If I don’t want to see an NP or a PA I have the opportunity to see a Doctor (often at a later time).
I think these doctors were lax in the way they ran their operation.
Agree with Anon 4:43 about Kevin’s agenda. But his take is prevalent throughout medicine. Docs whine about how hard it is, what with insurance and the guvmint and all, and still live in fear of the lawsuit. Sounds like a miserable job to me…Universal access, single payer would of course solve the malpractice issue, but it’s hard to let go of that nut inside the coconut…
Anonymous : 4:43 PM
Nice irrelevant argumentum ad hominum.
Once again, Kevin fails logic. If we accept what was said in the article, the PA acted as the doctors would have. Thus, the problem was not that PAs screw-up (because it is admitted that doctors would have screwed up just as badly), it’s a badly drafted service agreement.
this case says nothing about PAs and med mal or PAs in/competence relative to physicians.
Ya… your right! The Doctors defense should have been that the PA screwed up really bad and PAs really aren’t as good as doctors. That would have worked real well! Of course they are going to say the PA didn’t screw up. The truth of the matter is that they aren’t better because they really don’t have as much experience is the vast majority of cases.
Disclaimer: Please spare me the story about the super PA that you know because these are 1 in a million especially with the way they train them now compared to how they used to be trained (medic, etc.).
All Kevin said is that your midlevels can cost you. And they did in the article.
CAn one person who is flipping out on this comment board explain how anything Kevin said is incorrect???
Everyone who watched the Gray’s Anatomy episode on such a case would immediately know the answer to this differential diagnosis. The patient got his diagnosis after prolonged symptomatology and false treatments. Only the “prolonged” aspect of this case led to the diagnosis.
There is no duty to diagnose weird diagnostic puzzles from TV shows. The chief resident on that show would certainly not appreciate being called a mid-level. Because most of the medical facts on that show are based on actual cases, misdiagnosis seems to be within the standard of due care.
Everyone with a runny nose should not get a brain MRI. The case should get dismissed on policy grounds. The outcome of the case risks inducing this catastrophic standard of care for defensive medicine.
If you insist on having a policy manual, make it of the most general, non-committal, inscrutable gibberish type. If you spell out a procedure, lawyers will pounce on the manual for what it is. It is a list of enacted statutes for the entity. A violation of a written policy becomes like a violation of a law or regulation. It makes adverse outcomes, negligence per se. The lawyer no longer needs to prove direct harm, just the violation.
If you hit a kid running out from between cars, you can argue, it was his carelessness that caused the injury. However, be doing 26 mph in a 25 mph zone, and the negligence is per se (automatic). For the entity covered by a policy manual, the claim is similar.
If you must have a manual, review it with attorney. Ask that weasel, escape clauses accompany every written requirement.
And Walmart wants to join in on the fray? I guarantee a 100 million dollar missed cancer verdict and the board is going look to string up the guy that came up with a retail clinic in Walmart. There are no deeper pockets than Walmart.
I’m guessing you’ve never made a claim against Wal-Mart.
The best of KevinMD.com.
Only on Facebook.
"A comprehensive and extremely useful roadmap for doctors."
-Eric Topol, MD, author of The Creative Destruction of Medicine
site by Out:think Group
Welcome to KevinMD.com, social media's leading physician voice.
Receive regular updates delivered free to your inbox.
KevinMD.com is also on Facebook, Twitter and LinkedIn.