DNPs will eventually have unlimited SOP

[45408]

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Correct me if I'm wrong, I'm only a lowly 3rd year, but from what I've seen, most of the time physicians are basically working off of lab values and certain stereotypical findings using algorithms. Computers are extremely good at doing exactly this. I know, because I used to be a programmer. Also, computers have instant access to every algorithm and every piece of information in the medical literature, which no human being can ever have.

This is where it gets tricky. The physical exam as it relates to your specialty is a very finely honed skill. Yes, you can teach someone to do a physical exam, but the way a surgeon examines an abdomen or the way a physiatrist/orthopedist examines a joint are not easily attained. You can't have a midlevel doing an exam and punching it into a computer. It won't be worth that much, and we all know that algorithms are only as good as the data going into them. Garbage in, garbage out.

I often don't work off lab values that much, and most diseases don't present with "stereotypical findings," because those findings were only stereotypical when you let a disease progress to an advanced state so that Dr. Grey Turner without a CT scanner could finally figure out that his patient with ecchymotic flanks had severe pancreatitis.

 

[45408]

But clearly eventually the computer will be superior, especially for non-standard diseases/presentations (because a computer doesn't forget a nonclassical presentation of a disease that only affects one out of ten million people).

I don't think that will really help that much, except for quirky autoimmune disorders. Non-classical presentations are extremely classic situations. People show up in the ED with chest pain and think they're dying of a heart attack, only to find out it's their gall bladder.

As much as I love sci-fi, quit derailing the thread with your pointless AI doom-mongering.

 

[xenotype]

I don't think that will really help that much, except for quirky autoimmune disorders. Non-classical presentations are extremely classic situations. People show up in the ED with chest pain and think they're dying of a heart attack, only to find out it's their gall bladder.

I don't think it will help in diagnosis of rare autoimmune disorders. A family medicine attending told me of a case several weeks ago that multiple midlevels had marked off as major depression and treated with SSRIs. A woman's life had fallen apart and she was chronically tired. He spent 35min with her, asked extremely detailed questions in the history, and figured out that her fatigue was related to exercise. He then suspected a very rare muscular autoimmune disease that was entirely treatable with steroids. Turns out he was right. There is no way Watson and a midlevel could have figured that out, because they never would have known what questions to ask.

 

[ArcGurren]

I don't think it will help in diagnosis of rare autoimmune disorders. A family medicine attending told me of a case several weeks ago that multiple midlevels had marked off as major depression and treated with SSRIs. A woman's life had fallen apart and she was chronically tired. He spent 35min with her, asked extremely detailed questions in the history, and figured out that her fatigue was related to exercise. He then suspected a very rare muscular autoimmune disease that was entirely treatable with steroids. Turns out he was right. There is no way Watson and a midlevel could have figured that out, because they never would have known what questions to ask.

Yup. I've seen a doc diagnose someone with lupus on a gut feeling even though the lady didn't have the malar rash or discoid rash or other "classic" lupus signs - just persistent arthralgias and fatigue which was nonresponsive to any conventional treatment. Did ANA - positive, anti-smith positive. Boom, lupus. Started on hydroxychloroquine, arthralgias improve. Good luck getting any AI to replace intuition.

 

[link2swim06]

Remember, we still dont "trust" the EKG machine readout without it being signed off by an MD. And that is a very "objective" result.

Careers replaced (not just enhanced) by AI before physicians:

1. Accountants
2. Teachers
3. Construction workers/ any manual labor
4. Airline pilots and air traffic controllers
5. Post office workers and DMV employees
6. Prostitutes
7. Soldiers
8. Every employee in retail and restaurants

When these are 100% replaced by AI (as in, those careers don't exist anymore) then we can talk about physicians have to worry.

 

[88845]

Remember, we still dont "trust" the EKG machine readout without it being signed off by an MD. And that is a very "objective" result.

Careers replaced (not just enhanced) by AI before physicians:

1. Accountants
2. Teachers
3. Construction workers/ any manual labor
4. Airline pilots and air traffic controllers
5. Post office workers and DMV employees
6. Prostitutes
7. Soldiers
8. Every employee in retail and restaurants

When these are 100% replaced by AI (as in, those careers don't exist anymore) then we can talk about physicians have to worry.

[YOUTUBE]http://www.youtube.com/watch?v=hY-M300XzlE[/YOUTUBE]

Even if Kurzweil's theories are overly optimistic and Utopian, I welcome the incoming technological singularity. As long as this AI isn't called Skynet....

 

[TooMuchResearch]

Yup. I've seen a doc diagnose someone with lupus on a gut feeling even though the lady didn't have the malar rash or discoid rash or other "classic" lupus signs - just persistent arthralgias and fatigue which was nonresponsive to any conventional treatment. Did ANA - positive, anti-smith positive. Boom, lupus. Started on hydroxychloroquine, arthralgias improve. Good luck getting any AI to replace intuition.

Qualitative data are quantifiable. The end is nigh!

 

[link2swim06]

[YOUTUBE]http://www.youtube.com/watch?v=hY-M300XzlE[/YOUTUBE]

Even if Kurzweil's theories are overly optimistic and Utopian, I welcome the incoming technological singularity. As long as this AI isn't called Skynet....

His theories are based on exponential growth/change. This isn't true.

Raw computing power can grow at exponential rates...the rest of the world doesn't. This is especially true in medicine...we are rate limited by clinical trials. It takes a minimum of 6-20 years from idea to implementation in medicine.

Considering most of us will retire when we are ~60yo (40 years from now). They would have to have it perfected and as "good as a physician" for clinical trials in a couple of decades.

 

[peteB]

Oh and one other point.

It seems like if you could build an AI to replace all aspects a physician care for then wouldn't the same level of technology be able to find a cure to every disease known to man and essentially make us immortal? (half-way serious question)...

Yes, a very advanced AI could one day perform research the way humans do and maybe find cures to diseases- but this is not likely to make us immortal because the number of diseases isn't static and diseases themselves aren't either. As we find cures for diseases we will see the diseases evolving into other forms that are resistant to our cures, and we will see new diseases that may actually be occuring as a result of our cures.

Also, no I am not pre-clinical. I'm an MS3.

 

[peteB]

Remember, we still dont "trust" the EKG machine readout without it being signed off by an MD. And that is a very "objective" result.

Careers replaced (not just enhanced) by AI before physicians:

1. Accountants
2. Teachers
3. Construction workers/ any manual labor
4. Airline pilots and air traffic controllers
5. Post office workers and DMV employees
6. Prostitutes
7. Soldiers
8. Every employee in retail and restaurants

When these are 100% replaced by AI (as in, those careers don't exist anymore) then we can talk about physicians have to worry.

@ number 6.

As for the other ones, software and robotics have actually impacted all of these in major ways. Accounting software nowadays does the majority of work that accountants used to do by hand. Most manual labor in factories is done by machines nowadays. The post office also uses lots of machines including very complex sorting machines that sort millions of pieces of mail that used to be done by humans. Retail has largely moved online over the past decade.

The reason that these careers won't be 100% replaced by machines anytime soon is because the cost of developing and maintaining these machines is actually more than the cost of hiring people to do these jobs. That's not true for physicians. Physicians make many times as much as all the jobs on this list. So there's a lot of money to be saved by developing technology that can reduce the number of physicians needed as much as possible. I don't think anyone's talking about replacing physicians altogether, but reducing physicians by bringing in other people (midlevels) or technology to handle a large portion of their work. What's great about that is then the physician deficit turns into a physician surplus and you can get a physician much cheaper.

We can't completely replace all jobs with machines, because people are used to having humans do things for them, like human waiters and human teachers. But in a few decades time maybe people will be so comfortable with machines, and the machines will be so human-like, that they won't feel a difference between the two. I actually think this would be really awesome and great for the world. If any of you have seen Star Wars, you'll remember that all the "doctors" are robots 🙂 If we can eventually have doctor robots, then it would no longer take a decade to create a doctor, which would mean that no one would go without a doctor (assuming we have enough material to build these robots from)

 

[45408]

@ number 6.

As for the other ones, software and robotics have actually impacted all of these in major ways. Accounting software nowadays does the majority of work that accountants used to do by hand. Most manual labor in factories is done by machines nowadays. The post office also uses lots of machines including very complex sorting machines that sort millions of pieces of mail that used to be done by humans. Retail has largely moved online over the past decade.

And yet, there aren't scores of unemployed accountants and huge grocery stores sitting vacant on every corner. Interesting.

The reason that these careers won't be 100% replaced by machines anytime soon is because the cost of developing and maintaining these machines is actually more than the cost of hiring people to do these jobs. That's not true for physicians.

What exactly is the cost of developing a machine to replace a physician? Real numbers, please.

We can't completely replace all jobs with machines, because people are used to having humans do things for them, like human waiters and human teachers.

We can replace physicians because people won't mind seeing a robot, but we can't replace waiters. Do you realize how stupid this sounds?

And teachers will all be replaced by Rosetta Stone.

If any of you have seen Star Wars, you'll remember that all the "doctors" are robots 🙂

They also had light sabers, a clone army, and a pseudo-deity that could shoot lightning bolts from his hands. When I see all of those, I'll look for the robot doctors.

 

[peteB]

We can replace physicians because people won't mind seeing a robot, but we can't replace waiters. Do you realize how stupid this sounds?

It sounds stupid to you because you didn't understand the point I was making at all. I don't know where you even got that.

My point was that one of the barriers to using machines to interact with human patients/clients/customers/whatever, is that today's people are not comfortable interacting with robots and machines as much as they are with human beings. But as time goes on people will encounter more and more technology and will be much more comfortable interacting with a machine as opposed to a human, whether that be a waiter or a doctor.

 

[ArcGurren]

It sounds stupid to you because you didn't understand the point I was making at all. I don't know where you even got that.

My point was that one of the barriers to using machines to interact with human patients/clients/customers/whatever, is that today's people are not comfortable interacting with robots and machines as much as they are with human beings. But as time goes on people will encounter more and more technology and will be much more comfortable interacting with a machine as opposed to a human, whether that be a waiter or a doctor.

You know the human brain actually has a defense mechanism which causes utter and total revulsion against something which tries to poorly imitate humanity right?

http://en.wikipedia.org/wiki/Uncanny_valley

Either way this is the weirdest nonsense I've ever heard. A machine cannot physically replace human intuition and probably won't be able to until we start making Replicants/Cylons. And **** at that point I'd be worried about far bigger things.

 

[peteB]

And yet, there aren't scores of unemployed accountants and huge grocery stores sitting vacant on every corner. Interesting.

They also had light sabers, a clone army, and a pseudo-deity that could shoot lightning bolts from his hands. When I see all of those, I'll look for the robot doctors.

Yeah there aren't "scores of unemployed accountants" or "huge vacant grocery stores" TODAY, but you are extremely naive if you think that what you see today is going to remain the same forever. Technology is developing at a rapid rate and changing the way the world operates, and deskilling is a major part of it. Doctors are not some sort of wizards or Gods. They're just as susceptible to deskilling as any other job. I've outlined why in my previous posts.

LOL at your second comment. What does that even mean? That star wars reference was a JOKE.

 

[peteB]

A machine cannot physically replace human intuition and probably won't be able to until we start making Replicants/Cylons. And **** at that point I'd be worried about far bigger things.

Are we relying on intuition now in medicine? or evidence. I was pretty sure that we were going with evidence. Computers are very good when dealing with numbers, facts, and logic. My understanding is that medicine is supposed to be practiced based on those things, not intuition or guesswork or anecdotes.

 

[ArcGurren]

Are we relying on intuition now in medicine? or evidence. I was pretty sure that we were going with evidence. Computers are very good when dealing with numbers, facts, and logic. My understanding is that medicine is supposed to be practiced based on those things, not intuition or guesswork or anecdotes.

Medicine is equally an art and a science; if you haven't gotten that after being in medical school for (I don't know how long) then you kinda missed out

 

[peteB]

You know the human brain actually has a defense mechanism which causes utter and total revulsion against something which tries to poorly imitate humanity right?.

The human brain also has an evolved defense mechanism which causes revulsion against humans that are significantly different in appearance. It's the biological basis of racism. However, most of us seem to have overcome that due to exposure.

 

[peteB]

Medicine is equally an art and a science; if you haven't gotten that after being in medical school for (I don't know how long) then you kinda missed out

This idea of medicine being an 'art' is simply romantic rhetoric. I've been in med school 3 years and what I've realized is that people love to make their career out to be bigger than it is.

 

[link2swim06]

Yeah there aren't "scores of unemployed accountants" or "huge vacant grocery stores" TODAY, but you are extremely naive if you think that what you see today is going to remain the same forever. Technology is developing at a rapid rate and changing the way the world operates, and deskilling is a major part of it. Doctors are not some sort of wizards or Gods. They're just as susceptible to deskilling as any other job. I've outlined why in my previous posts.

LOL at your second comment. What does that even mean? That star wars reference was a JOKE.

Nobody is saying stuff will not change. Here are the fallacies of many "futurists":

1. They make everything over-simple. Medicine is very complex, there are very few guaranteed "if, then" statements in medical practice.

2. They think everything will happen faster than it does. Just because CPU speed is increasing exponentially doesn't apply to the rest of the entire world.

3. They think everything will happen "because it can" and forget money is required to develop anything new. Something like this would only be developable by tens of thousands of people and a billion dollar budget (this isn't getting made in a college dorm room).

4. People forget we will be dead in ~70 years from day. To me something invented 1 year vs 10,000 years after I die is all the same.

One last thing, if an AI does all careers, how will we make money?

 

[peteB]

Nobody is saying stuff will not change. Here are the fallacies of many "futurists":

1. They make everything over-simple. Medicine is very complex, there are very few guaranteed "if, then" statements in medical practice.

2. They think everything will happen faster than it does. Just because CPU speed is increasing exponentially doesn't apply to the rest of the entire world.

3. They think everything will happen "because it can" and forget money is required to develop anything new. Something like this would only be developable by tens of thousands of people and a billion dollar budget (this isn't getting made in a college dorm room).

4. People forget we will be dead in ~70 years from day. To me something invented 1 year vs 10,000 years after I die is all the same.

One last thing, if an AI does all careers, how will we make money?

The anti-futurists are guilty of the exact opposite of everything you said. They always underestimate the capability of everything. If you look at the last few decades, they have been proven wrong far more often than the futurists. The truth is that reality is somewhere between the two, and as of late we have seen it favoring the futurists.

As for your other question, when technology deskills a career, new careers emerge. For example someone has to design and build these machines, and maintain them and update them.

As for Point 3, you should read about Watson being applied to healthcare. There are already lots of people working on it and lots of money going into it. There are even simple prototypes that are being deployed: http://money.cnn.com/2011/09/12/technology/ibm_watson_health_care/index.htm

I agree that none of us will probably see this type of technology overtaking our jobs in our lifetime. But that doesn't mean it's not possible and can never happen, as many people here have suggested.

 

[cbrons]

Wow

To try and get the thread back on track...

Does anyone know what the difference in post-graduate training is between an NP and PA? So far as I can tell PA school is only 2 years... then what? Do they have any sort of probationary period or do they just start practicing? Same with NPs. What is the "residency" requirement and who is charge of them?

 

[peteB]

Wow

To try and get the thread back on track...

Does anyone know what the difference in post-graduate training is between an NP and PA? So far as I can tell PA school is only 2 years... then what? Do they have any sort of probationary period or do they just start practicing? Same with NPs. What is the "residency" requirement and who is charge of them?

There's no residency requirement for PAs that I'm aware of. After graduation (2 years in school), they take a licensing exam, and then start practicing. That's what I've heard from my PA friends. There are residency training programs available, but they are not mandatory.

 

[link2swim06]

Wow

To try and get the thread back on track...

Does anyone know what the difference in post-graduate training is between an NP and PA? So far as I can tell PA school is only 2 years... then what? Do they have any sort of probationary period or do they just start practicing? Same with NPs. What is the "residency" requirement and who is charge of them?

NP don't always do post-nursing training in clinical medicine. I have encountered a few who just took online classes on healthcare management issues and were essentially "upgraded" from a nurse to a NP.

Which is the equivalent of giving a floor nurse a medical license. They came up with some "interesting" diagnoses to say the least.

 

[link2swim06]

The anti-futurists are guilty of the exact opposite of everything you said. They always underestimate the capability of everything. If you look at the last few decades, they have been proven wrong far more often than the futurists. The truth is that reality is somewhere between the two, and as of late we have seen it favoring the futurists.

As for your other question, when technology deskills a career, new careers emerge. For example someone has to design and build these machines, and maintain them and update them.

As for Point 3, you should read about Watson being applied to healthcare. There are already lots of people working on it and lots of money going into it. There are even simple prototypes that are being deployed: http://money.cnn.com/2011/09/12/technology/ibm_watson_health_care/index.htm

I agree that none of us will probably see this type of technology overtaking our jobs in our lifetime. But that doesn't mean it's not possible and can never happen, as many people here have suggested.

My last reply on this topic.

I am so glad everyone has flying cars now in the year 2012......wait.....

 

[peteB]

My last reply on this topic.

I am so glad everyone has flying cars now in the year 2012......wait.....

Also my last reply- yeah every single thing hasn't happened, obviously. but hundreds, if not thousands of things that were predicted did come true, including the computer and internet you're using to have this argument right now. you ignored all of that and pointed out one thing that didn't. bravo. by the way, there are flying cars- they're just not available for everyone yet, and even when they become better and cheaper, they wont' be widespread not because of the technology but because of the fact that most people won't be intelligent enough to understand how to operate them without killing people. your comment is not funny, it's just stupid. people like you laughed off pretty much every piece of technology that we enjoy today at some point. "no way we'll ever have flying machines, what a joke" well guess what we have airplanes now. people laughed off the idea of the internet, too. Now we realize how dumb these people were.

I don't even know why I'm having this discussion with people who don't even understand what I'm talking about. So I'm done with this topic.

 

[deleted6669]

"Does anyone know what the difference in post-graduate training is between an NP and PA? So far as I can tell PA school is only 2 years... then what? Do they have any sort of probationary period or do they just start practicing? " -CBRONS

optional pa specialty residencies:
www.appap.org
most pa's today learn on the job with physician mentors with graduated autonomy based on performance. a new grad pa (in addition to whatever prior experience they have had) has essentially completed the ms3 yr. at my program taught at a medical school ms3 and pa2 students were scheduled interchangeably on rotations, took the same call and had the same responsibilities and expectations. experienced pa's may qualify to take a certificate of added qualifications exam in a number of specialties after a physician in that specialty has signed off on procedures logs, case requirements, time in practice, etc . this is the closest thing pa's have to board certification at this point.
info on available caq's here:http://www.nccpa.net/specialtycaqs.aspx
I think eventually these(both residencies and caq's) will become a requirement to practice in specialties.

 

[Bacchus]

This idea of medicine being an 'art' is simply romantic rhetoric. I've been in med school 3 years and what I've realized is that people love to make their career out to be bigger than it is.

Wrong. You haven't been on the wards long enough to see enough idiosyncrasies to know it is an art. This is all multifactorial. Our intuition, our knowledge leads us down the right path. Frankly, there's too much deviation from the norm to replace us.

 

[Bacchus]

Wow

To try and get the thread back on track...

Does anyone know what the difference in post-graduate training is between an NP and PA? So far as I can tell PA school is only 2 years... then what? Do they have any sort of probationary period or do they just start practicing? Same with NPs. What is the "residency" requirement and who is charge of them?

Post-grad, I'm not sure. However, the last rotation I was on I was with a DNP student. She had "clinic" one day a week every week versus the PA students that were there everyday (much to their dismay).

 

[deleted6669]

Post-grad, I'm not sure. However, the last rotation I was on I was with a DNP student. She had "clinic" one day a week every week versus the PA students that were there everyday (much to their dismay).

yup, pa is a much more consistent product. I precept both pa and np students. the em rotation for np student s from our local program is 40 hrs scheduled around the students full time work as an rn, basically at their convenience. the pa students do 6 weeks of 50 hrs/week rotating through all shifts (including overnights) and all areas of the dept.(fast track, peds, main, obs unit).
40 hrs isn't a rotation, it's an orientation.

 

[Bacchus]

yup, pa is a much more consistent product. I precept both pa and np students. the em rotation for np student s from our local program is 40 hrs scheduled around the students full time work as an rn, basically at their convenience. the pa students do 6 weeks of 50 hrs/week rotating through all shifts (including overnights) and all areas of the dept.(fast track, peds, main, obs unit).
40 hrs isn't a rotation, it's an orientation.

Thank you for making your PA-S do overnights 😉. Rotations were I've coexisted they seem to have a much more glamorous schedule than me which makes me a bit jealous 😉.

 

[ArcGurren]

This idea of medicine being an 'art' is simply romantic rhetoric. I've been in med school 3 years and what I've realized is that people love to make their career out to be bigger than it is.

Pretty much every attending I know would find that statement absurd. Work in an ICU for a couple months and your view on that will change very quickly

 

[link2swim06]

Also my last reply- yeah every single thing hasn't happened, obviously. but hundreds, if not thousands of things that were predicted did come true, including the computer and internet you're using to have this argument right now. you ignored all of that and pointed out one thing that didn't. bravo. by the way, there are flying cars- they're just not available for everyone yet, and even when they become better and cheaper, they wont' be widespread not because of the technology but because of the fact that most people won't be intelligent enough to understand how to operate them without killing people. your comment is not funny, it's just stupid. people like you laughed off pretty much every piece of technology that we enjoy today at some point. "no way we'll ever have flying machines, what a joke" well guess what we have airplanes now. people laughed off the idea of the internet, too. Now we realize how dumb these people were.

I don't even know why I'm having this discussion with people who don't even understand what I'm talking about. So I'm done with this topic.

You must be blind. I clearly already said nobody is debating "if" it will happen...its all about timeline. Since most dead people don't have a 9-5, its a pointless to talk about something that will happen after our lifetime.

And most futurist aren't accurate on their timelines. A quick wikipedia article from the foremost futurist (Ray Kurzweil) shows for 2009 (from 1999):

"Most books will be read on screens rather than paper." -- How many people had an eReader in 2009?
"Most text will be created using speech recognition technology." -- Definitely not most text.
"Intelligent roads and driverless cars will be in use, mostly on highways". -- None in 2009, only in 2011 there was the google prototype for a "driverless car."

So maybe if you add 10-20 years to his predictions they would be accurate.


Oh and my favorite is in 2019 (about 6 years from now) "Virtual artists—creative computers capable of making their own art and music—emerge in all fields of the arts." Looks like lil wayne better hurry up and find a new career. He is about to be replaced a hood-bot (ghetto robot).

 

[cbrons]

NP don't always do post-nursing training in clinical medicine. I have encountered a few who just took online classes on healthcare management issues and were essentially "upgraded" from a nurse to a NP.

Which is the equivalent of giving a floor nurse a medical license. They came up with some "interesting" diagnoses to say the least.

Like what?

 

[link2swim06]

Like what?

Three off the top of my head:

1. A nasty case shingles misdiagnosed by the NP as poison ivy. It was in a perfect dermatome shaped pattern and the pt was in his 70s.

2. 3 week history of new cough, 40 pack year history of smoking, fatigue, and weight loss. NP told him he had either a URI or bronchitis...never got a CXR. Turned out to be metastatic lung cancer.

3. Oh and my favorite. Very healthy pt is admitted to the hospital by a NP for a very small cellulitis. Turns out the NP never even tried to I&D it...which is all it needed. This was benign enough for an urgent care let alone an ER... admitting him to hospital was beyond ridiculous.

 

[Akali]

This is where it gets tricky. The physical exam as it relates to your specialty is a very finely honed skill. Yes, you can teach someone to do a physical exam, but the way a surgeon examines an abdomen or the way a physiatrist/orthopedist examines a joint are not easily attained. You can't have a midlevel doing an exam and punching it into a computer. It won't be worth that much, and we all know that algorithms are only as good as the data going into them. Garbage in, garbage out.

I often don't work off lab values that much, and most diseases don't present with "stereotypical findings," because those findings were only stereotypical when you let a disease progress to an advanced state so that Dr. Grey Turner without a CT scanner could finally figure out that his patient with ecchymotic flanks had severe pancreatitis.

Why even use a human middle man? Have you see the **** those Japanese robots can do these days? It's cray.

 

[Evil_Abed]

Three off the top of my head:

1. A nasty case shingles misdiagnosed by the NP as poison ivy. It was in a perfect dermatome shaped pattern and the pt was in his 70s.

2. 3 week history of new cough, 40 pack year history of smoking, fatigue, and weight loss. NP told him he had either a URI or bronchitis...never got a CXR. Turned out to be metastatic lung cancer.

3. Oh and my favorite. Very healthy pt is admitted to the hospital by a NP for a very small cellulitis. Turns out the NP never even tried to I&D it...which is all it needed. This was benign enough for an urgent care let alone an ER... admitting him to hospital was beyond ridiculous.

Holy ****!! 😱

Those are things I would expect an M1 to be able to pick up, especially that second one. How can you not even consider cancer with that history?! Wow.

 

[cbrons]

Three off the top of my head:

1. A nasty case shingles misdiagnosed by the NP as poison ivy. It was in a perfect dermatome shaped pattern and the pt was in his 70s.

2. 3 week history of new cough, 40 pack year history of smoking, fatigue, and weight loss. NP told him he had either a URI or bronchitis...never got a CXR. Turned out to be metastatic lung cancer.

3. Oh and my favorite. Very healthy pt is admitted to the hospital by a NP for a very small cellulitis. Turns out the NP never even tried to I&D it...which is all it needed. This was benign enough for an urgent care let alone an ER... admitting him to hospital was beyond ridiculous.

I guess basic science education does matter at least a little bit.

 

[celkon]

I guess basic science education does matter at least a little bit.

At what point do NP start getting sued?

 

[link2swim06]

Holy ****!! 😱

Those are things I would expect an M1 to be able to pick up, especially that second one. How can you not even consider cancer with that history?! Wow.

I have a feeling the NP never even asked about weight loss or the history of smoking (items I obtained in my H&P). My understand from what the patient told me was that the NP didn't ask many/any focused questions besides "what brings you in today."

The only reason we got that patient was because he started to have focal neuro deficits (2/2 to brain mets) and the NP didn't know what to do.

 

[cbrons]

I have a feeling the NP never even asked about weight loss or the history of smoking (items I obtained in my H&P). My understand from what the patient told me was that the NP didn't ask many/any focused questions besides "what brings you in today."

The only reason we got that patient was because he started to have focal neuro deficits (2/2 to brain mets) and the NP didn't know what to do.

wow... was this an NP student or a practicing NP?

 

[link2swim06]

wow... was this an NP student or a practicing NP?

Practicing NP.

One of my internal med attendings put it pretty well...to quote/paraphrase him:
"NPs/PAs have a low training requirement to enter their fields. They can either choose to perform at this level or actively learn about their field/improve their knowledge base. I have seen NPs/PAs perform from the level of a floor nurse to an internist and everywhere inbetween."

 

[cbrons]

Practicing NP.

One of my internal med attendings put it pretty well...to quote/paraphrase him:
"NPs/PAs have a low training requirement to enter their fields. They can either choose to perform at this level or actively learn about their field/improve their knowledge base. I have seen NPs/PAs perform from the level of a floor nurse to an internist and everywhere inbetween."

Heh.... Well how do they even get to that level? If its really possible to develop the skills to perform at the level of an attending without med school, then we have a lot of fluff in our curricula.

 

[cbrons]

At what point do NP start getting sued?

Not sure how their liability works now.

 

[xenotype]

Practicing NP.

One of my internal med attendings put it pretty well...to quote/paraphrase him:
"NPs/PAs have a low training requirement to enter their fields. They can either choose to perform at this level or actively learn about their field/improve their knowledge base. I have seen NPs/PAs perform from the level of a floor nurse to an internist and everywhere inbetween."

Exactly. The problem is quality control. Med school and residency is mostly a lot of quality control to ensure a top rate product comes out. A few midlevels will be about as knowledgeable and capable as many attendings. Most will not, hence why supervision is needed for both NPs and PAs.

For the capable few that want independence and deserve it, they should be forced to take step 1,2, and 3 as well as the board exam in their chosen specialty after having at least as many supervised hours as a new attending following residency. If they can pass all of those, who's to say they haven't earned it?

 

[Rendar5]

Heh.... Well how do they even get to that level? If its really possible to develop the skills to perform at the level of an attending without med school, then we have a lot of fluff in our curricula.

Actually there is a ton of fluff in med school curricula. Reason we're better is the fact that we're trained in a physician-based residency, we're trained to improve ours medical knowledge, and we're trained on more complex cases and on differentials. That's the reason most midlevels can be productive at the level of a PGY-1+ but don't go beyond residency level

 

[peteB]

You must be blind. I clearly already said nobody is debating "if" it will happen...its all about timeline. Since most dead people don't have a 9-5, its a pointless to talk about something that will happen after our lifetime.

And most futurist aren't accurate on their timelines. A quick wikipedia article from the foremost futurist (Ray Kurzweil) shows for 2009 (from 1999):

"Most books will be read on screens rather than paper." -- How many people had an eReader in 2009?
"Most text will be created using speech recognition technology." -- Definitely not most text.
"Intelligent roads and driverless cars will be in use, mostly on highways". -- None in 2009, only in 2011 there was the google prototype for a "driverless car."

So maybe if you add 10-20 years to his predictions they would be accurate.


Oh and my favorite is in 2019 (about 6 years from now) "Virtual artists—creative computers capable of making their own art and music—emerge in all fields of the arts." Looks like lil wayne better hurry up and find a new career. He is about to be replaced a hood-bot (ghetto robot).

OK, fine. I don't care about the timeline, and I don't think it even makes sense for people who aren't involved in developing this technology to be talking about a timeline for it. How are we supposed to know? I just said that none of this is impossible, and it come come much sooner than later. We have no way of knowing that. As for lil wayne, I think he can be replaced today by a babbling monkey and no one would notice the difference.

 

[ArcGurren]

Practicing NP.

One of my internal med attendings put it pretty well...to quote/paraphrase him:
"NPs/PAs have a low training requirement to enter their fields. They can either choose to perform at this level or actively learn about their field/improve their knowledge base. I have seen NPs/PAs perform from the level of a floor nurse to an internist and everywhere inbetween."

Yup I've seen the whole gamut. I remember one of the NPs I worked with in the oncology clinic was probably just as good as the attendings; she was able to pick up small and subtle things about her patients very well. On the other hand I've seen some hospitalist PAs who were... well...

 

[peteB]

Practicing NP.

One of my internal med attendings put it pretty well...to quote/paraphrase him:
"NPs/PAs have a low training requirement to enter their fields. They can either choose to perform at this level or actively learn about their field/improve their knowledge base. I have seen NPs/PAs perform from the level of a floor nurse to an internist and everywhere inbetween."

The whole NP thing makes no sense to me. Throughout history we set a high bar for physicians because we say that we can't risk quality and safety when dealing with people's lives. Then we create another group of people to act as 'physicians' with a very low bar and give them more and more autonomy to the point at which some of them are working completely on their own. We see them pulling out studies to show that the lower bar doesn't matter and the authorities agree with this and give them more autonomy, yet they still expect primary care physicians to jump over the high bar. Am I the only one that doesn't see the contradiction here? How does this kind of stuff even get approved?

 

[SpecterGT260]

And yet, there aren't scores of unemployed accountants and huge grocery stores sitting vacant on every corner. Interesting.


What exactly is the cost of developing a machine to replace a physician? Real numbers, please.


We can replace physicians because people won't mind seeing a robot, but we can't replace waiters. Do you realize how stupid this sounds?

And teachers will all be replaced by Rosetta Stone.


They also had light sabers, a clone army, and a pseudo-deity that could shoot lightning bolts from his hands. When I see all of those, I'll look for the robot doctors.

This. All of this.

 

[peteB]

Pretty much every attending I know would find that statement absurd. Work in an ICU for a couple months and your view on that will change very quickly

Could you give me an example?