"Choose your battles carefully," goes the old saying. My physician colleagues would do well to heed that advice. For the past several years, physicians in many states have been engaged in battles with nurse practitioners in their respective states who are seeking to remove antiquated regulations. These regulations preclude nurse practitioners from practicing to the full extent of their education, as recommended by the Institute Medicine report:
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As Southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation.  While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base.  They should not identify themselves as “doctors” despite having a doctor of nursing practice (DNP) degree.  It is misleading to patients, as most do not ...

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Mr. O was my new patient but had been known to our practice for several years.  He was 74 years old. He had been complaining of “dizziness” for some time.  He came in for his visit accompanied by his home health aide.  He was born in the Dominican Republic, and he spoke Spanish with limited English proficiency.  I scanned his former notes and saw that his aide typically provided translation.  ...

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It happens to us all. I was frustrated with one of my patients about two years ago, angered because she did not want to help herself. She kept requesting help for her mental disorder, and when the help was given, she would literally run away. She would start then stop taking a medication that even she had to admit did help her. Medication was just not for her she would ...

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Amidst the mid-morning rush at clinic, I’m saying goodbye to a patient whose visit just concluded. In the corner of my eye, I see a woman sitting in the area where patients wait after they have gotten their vitals. She is shifting continuously in her seat. Suddenly, the woman springs up out of her chair and walks toward the nurses’ station. The patient I am speaking with remarks, “Oh! Wonder ...

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When I was in television, I was friends with the late Gene Siskel (the film critic’s syndicated show would shoot in our Chicago CBS studio). Siskel would drop by my office to talk and get free medical advice. Siskel was, you might say, frugal. I remember when I was in contract negotiations with CBS, my bosses couldn’t praise me enough — but the money wasn’t there. When I told Siskel about ...

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The young woman in my clinic, whom I’ll call Nicole, was 8 months pregnant with her third child. It should have been a joyous time -- but she was in a county jail. Nicole was awaiting trial for a misdemeanor, and while a judge had set bail, she couldn’t afford to pay it. I’m a public health researcher and physician in the Los Angeles County Jails, the largest jail system in ...

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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments. While we are a very busy practice, and this is not ...

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Burned out cardiac surgeon seeks opportunities or empathy,” one message reads. “I feel stuck,” another confides. A third says simply, “I don’t want to be a doctor anymore!” The posts come in from across the globe, each generating its own thread of commiseration and advice. “I just wanted to reach out and let you know I feel your pain,” a doctor-turned-MBA replies to one surgeon. “Your story is so similar to ...

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Monday morning and no place to go. After 35 years of practicing medicine and GI, including a year of eager anticipation, the day had arrived when there were no patients in my schedule. Nor would there be tomorrow. Nor the next day. I was happily accustomed to a scheduled life. For me it had been decades of awakening early, working out, assembling a breakfast to inhale in the car, kissing the ...

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