Calling out the Noctors

ghost dog said:

Ok.

Here is where the MDs post some simple clinical questions for the nurse practioners...

Click to expand...

What's a practioner?

I know I'm only an RN, but...

Couldn't resist, as a doctor (could have been a pre med) threw out some grammar smack (regarding ellipses) down on me and others a while back, and the tone of his post was a gratuitous dig at nursing.
So the irony was too funny to pass up, sorry

Going out on a limb here, but I've got my own take on any scenario you would give out.
I would submit that physicians would differ on your above scenario.
Now, my experiences (20+ years as an ER RN in 10+ ERs in two states) are completely anecdotal, but, I have discussed (with countless ED docs) how management of the same patient will differ amongst themselves (no noctors, just docs)

What I have noticed, is that it depends on many factors (where one trained, with whom one trained, if one has been 'burned' by a zebra or just burned, which ED in which one works, etc.)

For example, I was working at an ER in a retirement community. A pt came in one day with L arm pain/numbness. Pt had a significant cardiac HX, so (based on our protocols, written by the docs) I ordered an EKG, as the doc was tied up.
The EKG tech came down within 3-5 minutes, and the doc came out of the room from a pelvic. He stopped the EKG tech, did a brief HX on the pt, and dc'd her with ulnar neuropathy, no labs, no EKG.

I certainly defer to his education and expertise. (And I think some of these protocols are waaay overused by nursing)
My point is: he was questioned by his partner (another MD), words were exchanged, and the pt's dispo remained. They disagreed with what seemed like a slam dunk justification for an EKG.

Some docs will order a CT based on 'X' chief complaint, others won't. I may be an RN, but I have seen so much variability (I get that I haven't been to medical school and that I don't have the knowledge base to know all of the differentials for 'proper' course of treatment.)

The last ER job I had ('famous peds hospital in Phoenix) every baby <3 months, with a (stated) history of a fever (afebrile upon presentation), got tapped and labs drawn immediately. then before a single lab result ever came back, within minutes, we were giving two ABX and and one antiviral.
In my current hospital, the ED doc will admit the kid immediately, we usually don't draw labs in the ER, and things take more of a different course, depending on ______________ (with the rural/community pediatrician commanding the ship; meanwhile, back at the teaching hospital there are two attendings, hosts of residents, etc. and lots of obscure tests ordered)

I'm just saying that I've seen docs question other docs in the ER from time to time (of their management for a particular CC or condition)

I think even seasoned physicians would differ on the 'proper' course of treatment, as we can't see your patient and there is not enough history attached to your scenario.

I don't like solo NP/PA treatment either;

Look at some scenarios proposed on other parts of this board (by docs, for docs). The courses of treatments offered (by seemingly very seasoned docs) differs between the varied responses.

Your point is well taken, but not very fair and applicable to the real world.

Pardon my rambling and derailment, but I think one doc's routine choice of treatment, is another's idea of looking for a zebra.

This thread can only end well......

*pulls up a chair*

chimichanga said:

Look at some scenarios proposed on other parts of this board (by docs, for docs). The courses of treatments offered (by seemingly very seasoned docs) differs between the varied responses.

Your point is well taken, but not very fair and applicable to the real world.

Pardon my rambling and derailment, but I think one doc's routine choice of treatment, is another's idea of looking for a zebra.

Click to expand...

Wait a sec - you have "20+ years as an ER RN in 10+ ERs in two states" (which actually would be of concern to me as an employer, but I digress) - and you think this is "not very fair and applicable to the real world" Seriously? This is an extremely typical presentation every day in offices and clinics around the world.

I would work per diem in 2-3 ERs at a time...schedules come out 1-2 months ahead of time...
I was single, and have been an RN for 23 years.

not a big deal really, as I have done 13 week assignments for travel nurse companies; actually pretty common among young, single RNs who like to see the country

I don't dispute that the case is all too common, so my choice of words (applicable to the real world) was incorrect.

It's just that, in my experiences, the practice styles of ER docs is so varied and depends on many factors; I would submit that even docs that would respond here would differ on their treatment.

MedPsy82 said:

popcorn?

Click to expand...

Why yes, that would be splendid. Thank you!

ghost dog said:

Ok.

Here is where the MDs post some simple clinical questions for the nurse practioners and see if they can answer them. Although a highly artificial situation (as they can look them up at their leisure) , I would be interested in the responses.

An example would be a simple scenario, and the request to back up the response with an appropriate clinical guideline.

I'll start:

A 14 yr old comes in with a sore throat and no cough.

On exam : T = 37 degrees C. No cervical LTathy and no tonsillar exudate. Ears and chest normal.

What is the diagnosis ?

What is your treatment ?

What guideline would you like to follow?

Click to expand...

why not have the MD and PA also respond to the simple questions. Oh wait, I know why, stupid example?

Hmmm not anything more than an audiologist but I can tell you what would happen most places.

Child would be given a rapid strep test. Most likely sent out the door with a script for amox or zpack and the parents told to call if he gets worse.

Now one could show concern of whether the little guy has swallowed something he shouldn't have and run some labs to check counts, one could also naso scope him to check for anything.

I just don't see what you think you're acomplishing besides making yourself look like an arrogant jerk who wants to match his e-penis up against someone else's.

I could give you countless examples of catching things that general practitioners miss such as glomus tumors, BPPV, CPA tumors, chronic mastoiditis with bacterial meningitis, etc.

We are all human and we all miss things at times. Sometimes even the most simple cut and dry cases are not simple and a lot of the time patients are not much help with providing insight.

definitely in.

ghost dog said:

Because we want to see the noctor's knowledge base, and how they are able to apply this knowledge.

Come on, this is a really easy question.

And in reply to chimichanga: no, this is not a " grey area " topic.
It is a very straight-forward clinical scenario, with a well defined guideline set up for evaluating this patient population.

I find the fire and brimstone response interesting , though.

Click to expand...

therapeutic touch

...or a z-pack

.....but not both, that'd be silly

For the sake of argument, isn't the fundamental flaw to these types of scenarios the assumption that an NP will miss the zebra diagnosis XX% of the time, whereas the FP doctor will catch the zebra diagnosis 100% of the time?

FiremedicMike said:

For the sake of argument, isn't the fundamental flaw to these types of scenarios the assumption that an NP will miss the zebra diagnosis XX% of the time, whereas the FP doctor will catch the zebra diagnosis 100% of the time?

Click to expand...

Yes, exactly why the process is stupid.
Those in practice long enough are aware the brightest can miss the zebra and the less knowledgeable may find by accident.

ghost dog said:

Ok.

Here is where the MDs post some simple clinical questions for the nurse practioners and see if they can answer them. Although a highly artificial situation (as they can look them up at their leisure) , I would be interested in the responses.

An example would be a simple scenario, and the request to back up the response with an appropriate clinical guideline.

I'll start:

A 14 yr old comes in with a sore throat and no cough.

On exam : T = 37 degrees C. No cervical LTathy and no tonsillar exudate. Ears and chest normal.

What is the diagnosis ?

What is your treatment ?

What guideline would you like to follow?

Click to expand...

Hey, GD. Question. Would you diagnose someone over the Internet with the information you provided? Just wondering. Will patiently await your response.

I'm a 4th year med student and I've seen this treated 3 different ways by three different MDs. I've never rotated with a noctor.

ghost dog said:

However, if a person were to send me an email asking about a particular problem of theirs, I would reply that I am ethically not able to address their situation.

Click to expand...

Dude, you are cracking me up. ARE YOU SERIOUS? I cannot put in to words how asinine your original post and (more so) your responses are. Are your REALLY an attending? Seriously?

Why was the "Calling out Doctors", thread closed an not this one? Well you could say because it mocks your thread...thats exactly what you are doing to np's. Did you actually think anyone would reply to this thread? I have a feeling regardless of what any response was you'd ridicule it.

Im one to agree I loathe nps, but there is a niche for them but they shouldnt have independent practice rights etc. But by the way you are showing you a** it seems you are trying your hardest to close the gap.

PS funny how you posted your disclaimer on the "Calling out Doctors" thread as if he wad actually seeking help with your thought provoking question, because he was actually mocking you.

Please refrain from posting intentionally inflammatory/ call-out threads.

closing.