Cecil's Medicine question

[russianbear]

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Hello everybody. I am an RN preparing to begin an NP program in the fall. I am gathering some books for reference. I have Harrison's, but it reads too much like an encyclopedia. What is the difference between Goldman Cecils Medicine and Andreoli and Carpenter's Cecils Medicine.

Also, opinion on Guyton and Hall Medical Physiology and Robbins Pathologic Basis of Disease (we will be using a different patho book).
Thank you all very much.

 

[Mad Jack]

http://forums.studentdoctor.net/threads/cecil-vs-harrison.452758/

Robbins is the book for pathology, there's just no way around that.

 

[russianbear]

Thank you, I will definitely get Robbins.

http://forums.studentdoctor.net/threads/cecil-vs-harrison.452758/

Robbins is the book for pathology, there's just no way around that.

 

[Mad Jack]

As an addendum, you might want to hold off on Robbins just yet- many schools provide free electronic copies to their students (my medical school does, for instance). And once you've got an electronic copy, the physical copy serves as little more than an overpriced doorstop.

 

[russianbear]

As an addendum, you might want to hold off on Robbins just yet- many schools provide free electronic copies to their students (my medical school does, for instance). And once you've got an electronic copy, the physical copy serves as little more than an overpriced doorstop.

I've never been big on using electronic versions of books. I prefer to read a paper book than on a computer screen. Not sure why. What is the difference between Andreoli and Carpenter and Goldman?

 

[Mad Jack]

I've never been big on using electronic versions of books. I prefer to read a paper book than on a computer screen. Not sure why. What is the difference between Andreoli and Carpenter and Goldman?

Cecil's Essentials is what we call baby Cecil's- it's a quick and dirty version of Cecil's Internal Medicine that is much smaller in size and scope, but adequate for most clinical practice. I believe Andreoli and Carpenter is Essentials, while Goldman is the real deal.

 

[russianbear]

Cecil's Essentials is what we call baby Cecil's- it's a quick and dirty version of Cecil's Internal Medicine that is much smaller in size and scope, but adequate for most clinical practice. I believe Andreoli and Carpenter is Essentials, while Goldman is the real deal.

So I want Goldman then, thank you.

 

[ortnakas]

"Baby Robbins" aka "Pocket Companion to..." is life. "Baby Guyton" is also handy.

You should be able to get the old edition for pretty cheap-- unfortunately there is no 9th edition yet.

 

[Microshaft]

came in expecting NP vs MD thread

not disappointed

 

[libraryismyhome]

came in expecting NP vs MD thread

not disappointed

So OP, do you think its safe for patients to be treated by you and other NPs without physician supervision?

 

[W19]

Pathoma > Baby Robbins > Everything else

 

[Psai]

I stay away from textbooks if I can help it. Too long, too dense and not enough retention.

 

[russianbear]

So OP, do you think its safe for patients to be treated by you and other NPs without physician supervision?

There have been several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs. Even in critical care units. Thank you for being very mature and derailing my thread and assuming that I would not seek out more knowledgeable practitioners, NPs and MDs alike, during my practice.

 

[bashwell]

I prefer Costanzo for physiology (big and BRS). Costanzo isn't as comprehensive, but it is much more concise and clear on what it does cover.

IMO, Boron is the best if you only want a single textbook, but it's definitely overkill. Far too much info, far too in-depth.

Guyton is good for certain things like cardio. Lilly for cardio and also pathophys of cardio. West for pulm. Rennke for nephro. Etc.

 

[Psai]

There have been several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs. Even in critical care units. Thank you for being very mature and derailing my thread and assuming that I would not seek out more knowledgeable practitioners, NPs and MDs alike, during my practice.

MDs are not "practitioners". They are physicians. And I haven't seen a single study that wasn't garbage. Have you read any of them or do you just eat up all the np propaganda that's force fed to you?

 

[bashwell]

There have been several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs. Even in critical care units. Thank you for being very mature and derailing my thread and assuming that I would not seek out more knowledgeable practitioners, NPs and MDs alike, during my practice.

The unfortunate truth is there are some or maybe many nurses including NPs who think they are equal to doctors in nearly every respect.

I'm not necessarily saying this is true of you, OP, or of most nurses. But just that there sure are a lot of nurses who think this way. Not sure why nurses can't just be content to be nurses because nurses provide a crucial role in healthcare as well.

Instead, it's almost as if some or many nurses want to be accorded the status of a physician, but without what it takes to get there.

Welp, they don't know what they don't know, as is often said.

 

[bashwell]

There have been several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs. Even in critical care units. Thank you for being very mature and derailing my thread and assuming that I would not seek out more knowledgeable practitioners, NPs and MDs alike, during my practice.

By the way, just wondering, if it's true there are "several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs," then why "seek out...MDs"? If true, this statement proves too much.

 

[russianbear]

MDs are not "practitioners". They are physicians. And I haven't seen a single study that wasn't garbage. Have you read any of them or do you just eat up all the np propaganda that's force fed to you?

Damn, you're bitter.

prac·ti·tion·er
prakˈtiSH(ə)nər/
noun

1. a person actively engaged in an art, discipline, or profession, especially medicine.
   "patients are treated by skilled practitioners"
   
   Yes, I have read the studies. Maybe you should. Or at least have some evidence to back up your point or are you not only not a practitioner, but also not a scientist?

 

[russianbear]

By the way, just wondering, if it's true there are "several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs," then why "seek out...MDs"? If true, this statement proves too much.

The unfortunate truth is there are some or maybe many nurses including NPs who think they are equal to doctors in nearly every respect.

I'm not necessarily saying this is true of you, OP, or of most nurses. But just that there sure are a lot of nurses who think this way. Not sure why nurses can't just be content to be nurses because nurses provide a crucial role in healthcare as well.

Instead, it's almost as if some or many nurses want to be accorded the status of a physician, but without what it takes to get there.

Welp, they don't know what they don't know, as is often said.

Could you please quote me and highlight the part where I said NPs are equal to MDs? I won't wait, because you cannot do that. I said patient outcomes are the same. And that is what is important, not who is better. It's not a contest. It's about helping people ge back to previous level functioning and encouraging healthy behaviors

 

[russianbear]

By the way, just wondering, if it's true there are "several reputable longitudinal studies that show the outcomes of patients treated by NPs is equal to those of patients treated by MDs," then why "seek out...MDs"? If true, this statement proves too much.

I'm not sure I understand the hostility on this site toward an honorable profession. It's more sad than funny to me.

 

[bashwell]

Could you please quote me and highlight the part where I said NPs are equal to MDs? I won't wait, because you cannot do that. I said patient outcomes are the same. And that is what is important, not who is better. It's not a contest. It's about helping people ge back to previous level functioning and encouraging healthy behaviors

I'm not sure I understand the hostility on this site toward an honorable profession. It's more sad than funny to me.

Could you please quote me and highlight the part where I said I am hostile toward nurses? I won't wait, because you cannot do that. What I said was simply a matter of logic. If your premise is true, then your conclusion follows.

Indeed, I explicitly stated this wasn't directed at you, OP, or most nurses. What's more, I explicitly stated "nurses provide a crucial role in healthcare".

Besides, if "this site" is as "hostile" toward nurses as you claim, then would we take the time to help answer your questions about recommended books and resources?

 

[NickNaylor]

Could you please quote me and highlight the part where I said NPs are equal to MDs? I won't wait, because you cannot do that. I said patient outcomes are the same. And that is what is important, not who is better. It's not a contest. It's about helping people ge back to previous level functioning and encouraging healthy behaviors

All of the data that I've seen are pretty weak in and of themselves (e.g., measurements of BPs demonstrating similar pressures in patients with hypertension [newsflash: an MS4 can do that, doesn't mean they're ready to practice medicine], measurements of blood glucose in patients with diabetes [newsflash: an MS4 can do that, doesn't mean they're ready to practice medicine]). And regardless, it's not just about outcomes. Midlevels are billed as a means by which costs can be reduced. If that doesn't actually bear fruit - the studies I've seen generally show either no or minimal decreases in cost - then what's the point?

 

[russianbear]

Could you please quote me and highlight the part where I said I am hostile toward nurses? I won't wait, because you cannot do that. What I said was simply a matter of logic. If your premise is true, then your conclusion follows.

Indeed, I explicitly stated this wasn't directed at you, OP, or most nurses. What's more, I explicitly stated "nurses provide a crucial role in healthcare".

Besides, if "this site" is as "hostile" toward nurses as you claim, then would we take the time to help answer your questions about recommended books and resources?

The tone of your post is one of extreme hostility. Becoming very defensive over the term practitioner, which an MD in fact is. Referring to propaganda. You're a mean person who fails to respect the value of ALL members of the healthcare team. Do you think patients heal and recover simply because physicians exist? Then we do not need nurses, nurse practitioners, reapiratory staff, PT/OT, speech, etc. get rid of them all. We only need MDs.

 

[russianbear]

All of the data that I've seen are pretty weak in and of themselves (e.g., measurements of BPs demonstrating similar pressures in patients with hypertension [newsflash: an MS4 can do that, doesn't mean they're ready to practice medicine], measurements of blood glucose in patients with diabetes [newsflash: an MS4 can do that, doesn't mean they're ready to practice medicine]). And regardless, it's not just about outcomes. Midlevels are billed as a means by which costs can be reduced. If that doesn't actually bear fruit - the studies I've seen generally show either no or minimal decreases in cost - then what's the point?

The issue has been studied for over 30 years. There are a lot of studies on this including intensive care units.

 

[NickNaylor]

The issue has been studied for over 30 years. There are a lot of studies on this including intensive care units.

Yes, thank you, and the revenue findings I'm mentioning are based on a Cochrane review that includes quite a few studies, some of which are a bit old. Point to some actual outcomes studies if you have them. I've done my own work at looking at them, and the overwhelming majority of them are complete crap from which only people with a barely functioning brain would actually agree demonstrate complete parity in outcomes.

 

[russianbear]

Yes, thank you, and the revenue findings I'm mentioning are based on a Cochrane review that includes quite a few studies, some of which are a bit old. Point to some actual outcomes studies if you have them. I've done my own work at looking at them, and the overwhelming majority of them are complete crap from which only people with a barely functioning brain would actually agree demonstrate complete parity in outcomes.

I'm not in a position right now to do that. Maybe later, when I'm at home and have access to research databases, if I feel inclined to do the research for you, since we know physicians are not capable of doing simple research, I may post some studies for you.

 

[NickNaylor]

I'm not in a position right now to do that. Maybe later, when I'm at home and have access to research databases, if I feel inclined to do the research for you, since we know physicians are not capable of doing simple research, I may post some studies for you.

I've done the research (quite a bit, actually), which I am happy to share with you. However, since you're making a claim, you should post the evidence for your claim. I am more than happy to read studies. Making vague claims is not helpful if your goal is to convince someone of a viewpoint.

 

[russianbear]

I've done the research (quite a bit, actually), which I am happy to share with you. However, since you're making a claim, you should post the evidence for your claim. I am more than happy to read studies. Making vague claims is not helpful if your goal is to convince someone of a viewpoint.

YOU guys started this LOL. I posted a question to improve myself so that I can provide the best care possible to my patients. You nurse haters hijacked the thread.

 

[NickNaylor]

I should add that while there are occasional studies do intermittently demonstrate "superiority" of APNs in some areas (most commonly patient satisfaction, also in cost though these results are less reproducible), most of the studies that I've seen are methodologically questionable. And I've looked at a lot of them. I was doing an informal lit review of NP vs. physician studies to see what the literature said and found roughly 30-40 articles and reviewed roughly half of them before I ran out of stamina. Most studies way overreached in their conclusions - as I said above, BPs over 6 months were equivalent between NPs and physicians, ergo they are the same - and some were dubious from a methods perspective. The AANP and similar organizations also have such a strong bias to produce positive results given their continued waging of the licensing battle across multiple states that it makes me question any study, even if the disclosed methods are viable.

I also just have a fundamental reaction to the assertion that NP training and physician training result in the same outcomes simply because the differences in the length of training are so drastically different. Anecdotally, it just doesn't make sense. Unless NP curriculum designers are closet geniuses that have figured out the way to fast-tracking medical education - I'm skeptical - then by necessity there is some sacrifice in quality by shortening the training. There are no shortcuts. Now it very well may be that in 90% of cases it doesn't matter, particularly in a primary care setting, but I think we can do better than that. Ultimately if APNs want to practice independently, fine - pass the same licensing credentials that are required of physicians. Have an apprenticeship period that is more than optional (it's interesting to me that the AANP emphatically states that "fellowships" akin to residency should not be in any way required for practice) to ensure that you're learning clinical medicine in a meaningful way beyond showing up at a random practice for a week and doing next to nothing (not to say that all NP training programs are like this, but I've heard this anecdote enough that there's at least a kernel of truth to it).

But regardless, this is off-topic. Best of luck.

 

[Psai]

Could you please quote me and highlight the part where I said NPs are equal to MDs? I won't wait, because you cannot do that. I said patient outcomes are the same. And that is what is important, not who is better. It's not a contest. It's about helping people ge back to previous level functioning and encouraging healthy behaviors

If you've actually read the studies, you'll see that the outcomes measured are very limited in scope and duration. It includes things like HgA1c control over 6 months or blood pressure measurements over 3 months in outpatient settings. No randomized control trials, no blinding, mostly retrospective chart reviews with outcomes obviously set to show no difference. Studies run by nurses, paid for by nursing organizations with a pro nurse agenda from the start and yet they take noninferiority in incredibly limited settings to mean "just as good or even better". How this equates to the same patient outcomes is beyond me. What matters is how the information is spun, not what the data actually shows or what common sense dictates. The wording in your posts show that you buy into this mindset.

If you want to provide the best possible care for your patients, go to medical school. The education and mindset that medical school provides is not even comparable to the garbage that is put out by nurse practitioner schools currently.

 

[W19]

NP ia a joke... PA is legit though.

 

[russianbear]

If you've actually read the studies, you'll see that the outcomes measured are very limited in scope and duration. It includes things like HgA1c control over 6 months or blood pressure measurements over 3 months in outpatient settings. No randomized control trials, no blinding, mostly retrospective chart reviews with outcomes obviously set to show no difference. Studies run by nurses, paid for by nursing organizations with a pro nurse agenda from the start and yet they take noninferiority in incredibly limited settings to mean "just as good or even better". How this equates to the same patient outcomes is beyond me. What matters is how the information is spun, not what the data actually shows or what common sense dictates. The wording in your posts show that you buy into this mindset.

If you want to provide the best possible care for your patients, go to medical school. The education and mindset that medical school provides is not even comparable to the garbage that is put out by nurse practitioner schools currently.

Go to medical school? So I can be an arrogant ass? I don't think so.

 

[Psai]

Go to medical school? So I can be an arrogant ass? I don't think so.

Feel free to take your noninferiority elsewhere thanks

 

[russianbear]

Feel free to take your noninferiority elsewhere thanks

Feel free to kiss my ass.

 

[W19]

Feel free to kiss my ass.

So original and childish!

 

[russianbear]

So original and childish!

Thank you.

 

[sloop]

To the original point, straight up reading Harrison's is a fool's errand for most causes. It is ridiculously lengthy and emphasizes a lot of minutiae. It's an excellent reference if you have to do a presentation on a topic or if you need more information on a specific topic. I feel the same way about it as I do about big Robbins.

As to the NP vs MD stuff, this stuff is so old. All I'll say is that ultimately medical care exists on a continuum of competency. What is adequate depends a lot on the severity of your condition, your resources/options, and your perspective on the relative value of health care in your life. I'm an MS3 and we have to spend some time at some free clinics where we are basically treated as and precepted like residents. We create the analysis and plan, decide on lab orders/treatment and have the attending sign off on the plan and sign the scripts. I actually think we do a good job and I'm proud of the work I do there. I think the patients are better off than the alternative of getting no treatment. On the other hand, there's no way I'd allow a family member to be treated there (but again, they have more options).

 

[russianbear]

To the original point, straight up reading Harrison's is a fool's errand for most causes. It is ridiculously lengthy and emphasizes a lot of minutiae. It's an excellent reference if you have to do a presentation on a topic or if you need more information on a specific topic. I feel the same way about it as I do about big Robbins.

As to the NP vs MD stuff, this stuff is so old. All I'll say is that ultimately medical care exists on a continuum of competency. What is adequate depends a lot on the severity of your condition, your resources/options, and your perspective on the relative value of health care in your life. I'm an MS3 and we have to spend some time at some free clinics where we are basically treated as and precepted like residents. We create the analysis and plan, decide on lab orders/treatment and have the attending sign off on the plan and sign the scripts. I actually think we do a good job and I'm proud of the work I do there. I think the patients are better off than the alternative of getting no treatment. On the other hand, there's no way I'd allow a family member to be treated there (but again, they have more options).

Thank you for your input. I think I'll probably still buy Cecil's. I see a new two volume edition has come out. I'm in the process of moving so I'll order it on amazon once the move is complete.
I agree with the second part of your post. I think there is room for a wide variety of people in healthcare and the most important thing is the people in the beds.

 

[bashwell]

The tone of your post is one of extreme hostility. Becoming very defensive over the term practitioner, which an MD in fact is. Referring to propaganda. You're a mean person who fails to respect the value of ALL members of the healthcare team. Do you think patients heal and recover simply because physicians exist? Then we do not need nurses, nurse practitioners, reapiratory staff, PT/OT, speech, etc. get rid of them all. We only need MDs.

You obviously have me confused with someone else. I wasn't "hostile" toward you, I wasn't "defensive" about the term "practioner," I didn't refer to "propaganda," etc. Unfortunately, the fact that you mistakenly attribute these to me is an indication of poor reading comprehension as well as a lack of critical detachment. Yet these are basic competencies a nurse (among others) should possess. In short, I'd implore you to please stop reacting emotionally and start thinking rationally if you wish to act like a healthcare professional.

 

[libraryismyhome]

Go to medical school? So I can be an arrogant ass? I don't think so.

You are not good enough to get into medical school. Thats why you are a NP.

YOU guys started this LOL. I posted a question to improve myself so that I can provide the best care possible to my patients. You nurse haters hijacked the thread.

We will ensure that you and other parasites wont succeed. It would be us eliminating you or you frauds eliminating us. It would be pretty funny to see a first world country without doctors though. Lets see which group has more man power, more money, and better brains. My goal is to make every doctor considering NPs as their enemy. I think i did a pretty decent job on this thread by revealing your true color.

 

[Winged Scapula]

Since the OP has been removed from SDN, the petty bickering and insults can stop.