NMBE sells out the medical profession to the nurses

[genesis09]

I'm not joking. They, pharmacies and hospitals, are already coming up with formulas for pharmacist service.
Some doctors bill for refill requests or filling out immunization forms.
That's why everyone is having issues with the potential new medicare payment structure. That's why there is the lawsuit barring its implentation. It would require a number of pharmacies to accept payment below true acquistion cost of medicines. It is harder to determine a true cost to a service than to an actual good. I can tell you how much each pill costs a pharmacy. The dispensing fee, for most insurances, is currently about half of the true cost to dispense it. Average fixed cost to dispense a prescription is $8-$10, and average dispensing fee is $3-$5 per prescription.
Like MDs cannot be replace with supercomputers in which you put in all the symptoms and a diagnosis pops out, pharmacists cannot be replace with vending machines. Furthermore, every medicine vending machine for use in a community situation I've ever seen has no more than 100 drugs in unit of use bottles. The states which allow vending machines regulate it must be in unit of use bottles. In Illinois, you can only use the vending machines for refills anyway. If you want a rare drug or rare number of tablets, you can't get it.

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[BMBiology]

That's right folks. Primary care docs not only have to worry about competing with NP's, DNP's, and PA's, but now pharmacists.

You guys should be worried when other healthcare professionals can make a difference:

Regular consults with pharmacists significantly reduces hospitalization rates for people with heart failure, according to an analysis of 12 randomized trials

It is time to hit them books my friends.

 

[BMBiology]

"I recommend Alleve for headaches" to a patient in-store. You really want to bill for that?

"Oh, you want birth control? Here's a prescription for Yasmin". You really want to bill for that?

"Oh, remember to make an appointment in 6 months to get another prescription (so I can bill you again)"

No wonder the FDA is considering BTC medications.

 

[oldManDO2009]

"Oh, you want birth control? Here's a prescription for Yasmin". You really want to bill for that?

"Oh, remember to make an appointment in 6 months to get another prescription (so I can bill you again)"

No wonder the FDA is considering BTC medications.

the reason we have someone comeback in 6 months is to make sure the medication is effective and there are no side effects. Unlike the "Aleve" for your headache - if a patient's CHEF decompensates then we (doctors) need to change or adjust the med. What would the pharmacist do for the decompensation? Most likely wait for the Doctor to evaluate the patient - no wounder we have to see patients every 6 months...

 

[BMBiology]

the reason we have someone comeback in 6 months is to make sure the medication is effective and there are no side effects.

"So, are you pregnant yet? No? the medication is effective". Common sense, buddy.

Really? Physicians don't ask patients to come back just for refills so they can make more money? The greed showed in this thread proves otherwise.

 

[cpants]

"Oh, you want birth control? Here's a prescription for Yasmin". You really want to bill for that?

"Oh, remember to make an appointment in 6 months to get another prescription (so I can bill you again)"

No wonder the FDA is considering BTC medications.

Actually birth control is a lot more complicated than that. First of all there are many different options for birth control (implants, injections, pill, surgery, condoms, rhythm method, etc.). It is important to find a solution that fits a patient's lifestyle and that she can be compliant with. Once you decide to go with the pill are still a lot of different options to consider, and unlike an NSAID it is a hormone which can cause some pretty serious physiological effects. There is a reason why birth control is a controlled medication that requires a physician consultation. Regular follow up with a physician is not only to evaluate for side effects, but also to check for STI's and evaluate other sexual health issues.

 

[BMBiology]

...unlike an NSAID it is a hormone which can cause some pretty serious physiological effects.

Anybody, who thinks birth controls are more dangerous than NSAIDs, don't know his meds too well. How about GI bleeding? Ulceration?

Don't forget about sodium and water retention in CHF, HTN pts and reduce renal blood flow in renal impaired pts. Lets compare the number of deaths caused by NSAIDS vs OCs.

Like I said, it is time to hit them books.

 

[Taurus]

"So, are you pregnant yet? No? the medication is effective". Common sense, buddy.

Really? Physicians don't ask patients to come back just for refills so they can make more money? The greed showed in this thread proves otherwise.

Wow. Are you a premed or some nurse? Anybody who prescribes a new medication and doesn't follow up is asking for a lawsuit. The funny thing is you have no idea why.

 

[BMBiology]

Wow. Are you a premed or some nurse? Anybody who prescribes a new medication and doesn't follow up is asking for a lawsuit. The funny thing is you have no idea why.

I should sue my physician then for prescribing hydrocortisone 2% cream for my allergy and not having me come back and waste my time. The scare tactic strikes again!

 

[Taurus]

I should sue my physician then for prescribing hydrocortisone 2% cream for my allergy and not having me come back and waste my time. The scare tactic strikes again!

If he told you to use it for a few days and stop, then you don't need to come back if you have no problems.

OCP's is a different story because the woman could be on it for years. Just like BP, cholesterol, DM, psych meds. You're monitoring the patients response to the med and looking for side effects.

Go back to allnurses.com you freaking loser. You don't even understand the basic protocol for meds.

 

[BMBiology]

Go back to allnurses.com you freaking loser. You don't even understand the basic protocol for meds.

Name calling will get you nowhere. You have a lot of class, buddy.

 

[zenman]

Wow. Are you a premed or some nurse? Anybody who prescribes a new medication and doesn't follow up is asking for a lawsuit. The funny thing is you have no idea why.

Can't be a nurse; we know better than that!

 

[cpants]

I should sue my physician then for prescribing hydrocortisone 2% cream for my allergy and not having me come back and waste my time. The scare tactic strikes again!

You are being sarcastic, but doctors get sued for stuff like this all the time. You say it is unreasonable and greedy for a doc to want a pt to return to clinic in 6 months after starting oral contraceptive. What would be an appropriate follow up time after this prescription? 1 year? Never? When you get pregnant so you know that it has stopped working, as you suggested above?

Per you, OC is safer than Aleve anyway, so it should probably be OTC with pharmacist advice as needed.

 

[BMBiology]

Per you, OC is safer than Aleve anyway

Per American Gastroenterological Association:

GI complications caused by NSAIDs remain one of the most prevalent drug toxicities in the nation - leading to approximately 76,000 hospitalizations and 7,600 deaths annually -- a mortality rate comparable to that of asthma, cervical cancer or melanoma (skin cancer)

http://www.gastro.org/wmspage.cfm?parm1=398

This is not about OTC NSAIDs. This is about you thinking birth controls are more dangerous than NSAIDs. You are more than welcomed to look up the number of deaths caused by birth controls.

 

[Miami_med]

I should sue my physician then for prescribing hydrocortisone 2% cream for my allergy and not having me come back and waste my time. The scare tactic strikes again!

All over-the-counter medications have potential side effects, and they all come with specific guidelines within which, their use has minimal risk. This includes usually length of use and quantity. (Ex: Take no more than 500 mg every 4-6 hours. If pain persists greater than 15 days, please consult a physician). NSAIDS do have nasty GI side effects, but not usually at the doses and lengths for which they are approved. Do people abuse them? Yep. However, physicians prescribe medications that often have potentially serious side-effects at proper use, and this requires close monitoring.

When a patient comes in for OCPs and the pharmacist prescribes, who is going to take a family history. 21 yo G0P0 can easily become 21 yo with hx of DVT whose mother died of PE and has positive genetic test for Factor V Lieden. How are you going to know that? Are you going to give her OCPs, because I don't know a lawyer who could defend that choice?

For patients that are on NSAIDs chronically and choose to do so against the recommendations without seeing a physician, what are you going to do? Mr. Pharmacist, I've got stomach pain. Are you going to take a full hx? What if it's suspicious for an ulcer, are you going to refer for endoscopy? Do you plan to do the endoscopy? Are you going to consider testing for H.Pylori? What if the stomach pain is from an ulcer, are you sure that the NSAIDs are the only contributing factor? If the patient is older, are you going to consider a more sinister gastric or esophageal neoplasm? What if it's just GERD? Are you going to tell the patient to suck it up and ignore the pain because Motrin might be causing an ulcer and you can't tell? Are you going to spend the time doing this work-up?

I promise that "greed" (The magic code word that anyone who doesn't understand medicine uses whenever they don't understand what the doctor does) has nothing to do with it. Prescription meds are powerful drugs, and patients really shouldn't just be left on them forever without being checked on. Some prescriptions (like the 2% cortisone cream) are of only prescription dubiously, kind of like Motrin 800, I can use over the counter meds to achieve the same effect if I use them improperly. We can argue as to whether these things need to be prescription at all, or if anything needs to be. However, if we claim we need a prescription system for substances with side effect or abuse potential, it makes no sense to say that we shouldn't follow up to look for side effects or abuse.

 

[cpants]

Per American Gastroenterological Association:



http://www.gastro.org/wmspage.cfm?parm1=398

This is not about OTC NSAIDs. This is about you thinking birth controls are more dangerous than NSAIDs. You are more than welcomed to look up the number of deaths caused by birth controls.

I suppose the low mortality and complications associated with birth control use has nothing to do with regular follow up with a qualified physician?

 

[BMBiology]

I am glad you learned something today about NSAIDs.

 

[BMBiology]

21 yo G0P0 can easily become 21 yo with hx of DVT whose mother died of PE and has positive genetic test for Factor V Lieden.

Pharmacists are capable of monitoring someone who's on coumadin but yet, they are lost when it comes to OCs? I hate reposting but I think you need to read this again:

Regular consults with pharmacists significantly reduces hospitalization rates for people with heart failure, according to an analysis of 12 randomized trials

You can thank Taurus for posting the article.

 

[Miami_med]

Pharmacists are capable of monitoring someone who's on coumadin but yet, they are lost when it comes to OCs? I hate reposting but I think you need to read this again:



You can thank Taurus for posting the article.

I am not saying that we should never talk to pharmacists or that they shouldn't exist. I am saying that they don't take patient histories and have no way of interpreting the information, because they DON'T study diagnosis. I'm sure pharmacists know a whole lot more about specific mechanisms of action, drug half lives, etc... than I do, but this has NOTHING to do with knowing what the problem is with the patient. Coumadin monitoring is as easy as following an INR, and we could train a motivated 8th grader to look at the INR and say if the report is high or low. This isn't the same for all drugs. Also, knowing the indications for coumadin doesn't equal knowing if the PATIENT has those indications.

 

[BMBiology]

I am saying that they don't take patient histories and have no way of interpreting the information, because they DON'T study diagnosis.

Coumadin pharmacists don't take a patient history? I guess they blindly tell a patient with a high INR to increase, decrease or stop taking his coumadin.

It's time to catch up with reality:

http://www.usatoday.com/money/industries/health/2007-09-30-pharmacists-clinics_N.htm

 

[cpants]

Regular consults with pharmacists significantly reduces hospitalization rates for people with heart failure, according to an analysis of 12 randomized trials

later on...

The role of the pharmacist varied from trial to trial, but tended to include things such as monitoring patients, and helping them keep on track with their medications.

Sounds like all these studies show is that pharmacists in the traditional role of providing and helping patients with their medication can improve outcome. I don't think many physicians would argue with that. Pharmacists are a valuable resource for sick patients, and can improve patient compliance to their treatment. In no way, however, can they assume the role of the physician.

When one of these patients presents undiagnosed to CVS with dyspnea, edema, and coughing up blood tinged mucus, the pharmacist better send him to see a doctor or even (I can't believe I'm saying this) a nurse practitioner.

 

[Taurus]

If pharmacists were allowed to do primary care, how long do you think it will be before you hear a story about a pharmacist who killed a patient because they were not trained to do full H&P's and diagnose conditions?

What's that saying? The absence of evidence of substandard care by pharms in primary care does not mean that pharms are qualified to diagnose and treat conditions. It's just a matter of letting them loose and waiting for it to happen.

 

[genesis09]

The VA has been using pharmacist based clinics for years. I don't know if they have ever published their data about their use of pharmacists and their prescribing habits. That would give you lots of data to determine efficacy and error rate.

 

[alpha62]

Here is a nice little niche for Nurses and yet another way for them to keep from getting their hands dirty and make $$$ from their home....

H.R. 5719 is trying to insert 3rd party review of dispersement of MY OWN AFTER TAX money in my Health Savings account.

In short, they want to charge me and your patients a 3rd Party fee to review the withdrawal of our own after tax Health Savings account to pay YOUR fees.

That means delays and denials of payments to YOU. This law will likely double monthly HSA administrative fees.

In addition, this new law would:

eliminate the ability to get reimbursed out of your HSA when you want by check or at an ATM.

force submission of your medical receipts to a third party in order for you to utilize the funds in your HSA.

The increase in fees will be for the third party to review your expense receipts.

A corporation that has a patent on part of the process used to review your paper receipts asked Congress to pass this law.

 

[Faebinder]

"So, are you pregnant yet? No? the medication is effective". Common sense, buddy.

Really? Physicians don't ask patients to come back just for refills so they can make more money? The greed showed in this thread proves otherwise.

What an ignorant statement.. but that's okay.. I used to think like that before medical school and then i found out why they actually are PRESCRIPTIONS not over the counter.

Not Pregnant = effective... sure. But lets say she picks up smoking in the last month and she is currently taking the pills and now she is on her way to form a blood clot and a PE or a stroke and end up with a dead lung or dead brain. Oh ya, but lets not check that, after all it's up to the patient to realize that smoking with birth controls might kill them right? That's just ONE side effect... What if she has a blood disease she is not aware of... what if and what if...

Here is a list for possible side effects of oral contraceptives.. most occur in less than 1% of the people out there... that means you are likely to see one after your 100th prescriptions.. feel free to be the sole person responsible for killing/maiming/hurting someone just cause you dont want the physician to see them. Oh and BTW, this list is for the adverse reactions.. not the contraindications... which is another long list.

• abdominal pain
• acne vulgaris
• alopecia
• amenorrhea
• anorexia
• anxiety
• appetite stimulation
• azotemia
• breakthrough bleeding
• breast discharge
• breast enlargement
• candidiasis
• cervical dysplasia
• cholecystitis
• cholelithiasis
• cholestasis
• depression
• diplopia
• edema
• elevated hepatic enzymes
• erythema nodosum
• fluid retention
• galactorrhea
• gingivitis
• headache
• hepatitis
• hepatoma
• hypertension
• jaundice
• keratoconus
• libido decrease
• maculopapular rash
• mastalgia
• melasma
• menstrual irregularity
• migraine
• myocardial infarction
• nausea/vomiting
• optic neuritis
• pancreatitis
• peliosis hepatis
• photosensitivity
• pulmonary embolism
• retinal thrombosis
• secondary malignancy
• stroke
• thromboembolism
• thrombosis
• urticaria
• vaginal bleeding
• vaginitis
• weight gain

 

[soonereng]

Oh ya, but lets not check that, after all it's up to the patient to realize that smoking with birth controls might kill them right?

Wouldn't that be one of the things that the pharmacist should mention in their little white sheet? (not that the pharmacists actually cover all of that info with the pt though) Myabe not, I'm a male, so I have no clue as I've never seen one for oral contraceptives.

 

[soonereng]

H.R. 5719 is trying to insert 3rd party review of dispersement of MY OWN AFTER TAX money in my Health Savings account.

Most of the HSAs that I know of are pretax, but I didn't know that there were after tax HSAs which also weren't also totally tax deductible (remember, after tax =/= no tax implications). I can see where they don't want you buying a flat screen TV with the HSA money.

The part about the company with the patent is rediculous. Just another favor for some buddy somewhere who contributed to a campaign. You are already responsible for audits of HSA spending as it is.

 

[genesis09]

Wouldn't that be one of the things that the pharmacist should mention in their little white sheet? (not that the pharmacists actually cover all of that info with the pt though) Myabe not, I'm a male, so I have no clue as I've never seen one for oral contraceptives.

It should be on the drug information sheet and in the booklet provided with the birth control. Technically, being over 35 and smoking is a relative contraindication for combination birth control pills because of the clotting risk.

 

[BMBiology]

Not Pregnant = effective... sure...Here is a list for possible side effects of oral contraceptives.. most occur in less than 1% of the people out there... that means you are likely to see one after your 100th prescriptions.. feel free to be the sole person responsible for killing/maiming/hurting someone just cause you dont want the physician to see them.

First, I was talking about efficacy, not potential side effects. And yes, it is that simple: not pregnant = birth control is effective. Don't make it harder than it is. If you have a different definition of efficacy for birth control, post it.

Second, less than 1% does not mean 1/100. 1/200, 1/1000, 1/10000 are all less than 1%. Let me also tell you that the FDA requires the pharmaceutical companies to post ALL potential adverse reactions experienced by the patients during clinical trials, whether it is caused by the drug or not so I would take that list with a grain of salt.

Third, the world did not end as the AMA predicted when diphenhydramine went over the counter years ago. Let me return the favor, here's a list of precautions, not adverse effects, of diphenhydramine:

bladder neck obstruction
concurrent MAOI therapy
concurrent use of central nervous system depressants
decreases mental alertness and psychomotor performance
do not use topical form on eyes or eye lids
elderly are more susceptible to the side effects of diphenhydramine
history of bronchial asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease or hypertension
may cause excitation in young children
narrow angle glaucoma
pyloroduodenal obstruction
stenosing peptic ulcer
symptomatic prostatic hypertrophy
use of the topical form on patients with chicken pox, measles, blisters, or large areas of skin unless directed by a physician

 

[Miami_med]

If you're arguing that some drugs that are only available by prescription don't need to be, I won't argue that. However, this has nothing to do with whether pharmacists should be prescribing drugs. You are correct that OCPs have a low risk rate, which is pushed lower by the fact that it is rarely distributed outside of oversight. However, I can buy the argument that maybe OCPs shouldn't be by prescription only. This has NOTHING to do however with the need for a pharmacist. We can write directions on the package.

There is value to clinical pharmacy, but that value is not to be another wannabe physician. Having someone on top of patient's polypharmacy does improve outcomes, but that doesn't necessarily mean that the same person should be writing the prescriptions or removing meds without consulting the person who wrote the prescription in the first place. I spent multiple rotations and parts of rotations at the VA hospital, and I've worked with many clinical pharmacists with variable results. The good ones are valuable. They come to interdisciplinary meetings once a week and review medications, indications, and possible interactions. They do not however write orders for different meds on the floor.

 

[core0]

Coumadin pharmacists don't take a patient history? I guess they blindly tell a patient with a high INR to increase, decrease or stop taking his coumadin.

It's time to catch up with reality:

http://www.usatoday.com/money/industries/health/2007-09-30-pharmacists-clinics_N.htm

Actually Coumadin Pharmacists don't take a patient history at all. They are there to adjust the medication. We work with several of these clinics. After a medical provider makes the diagnosis and does any testing needed, they are started on an initial dose and referred to the Coumadin clinic with a target INR rate. The pharmacists reviews the testing and changes the rate within the protocol developed by the medical director of the clinic to achieve the target INR. There is no history, no diagnosis because pharmacists are not trained to diagnose medical problem. DM clinic is the same way. After insulin is initiated the patient monitors their glucose and sees the pharmacist to adjust their insulin dose. They can call and suggest a new regimen ie. adding Lantus, but in the end its the providers decision.

Same for antibiotics. I write the initial dose and then write pharmacokinetics per pharmacy. They order the peaks and troughs per a protocol devised by the medical director and adjust the dose appropriately. If Pharmacists want to take over any more uncompensated portions of my job they are welcome to them.

David Carpenter, PA-C

 

[BMBiology]

Actually Coumadin Pharmacists don't take a patient history at all. They are there to adjust the medication.

If a patient comes to the coumadin clinic with a sudden high INR, how does the pharmacist adjust his therapy without taking his history? Pharmacists do not start a patient on coumadin but they certainly need to take and understand a patient history in order to adjust his regimen.

 

[deleted6669]

If a patient comes to the coumadin clinic with a sudden high INR, how does the pharmacist adjust his therapy without taking his history? Pharmacists do not start a patient on coumadin but they certainly need to take and understand a patient history in order to adjust his regimen.

if someone is supposed to have an inr of 2 and they have an inr of 5 the pharmacist tells them to hold their dose and calls their pcp for direction on when to resume and at what dose.
I work with 2 of these clinics as well.

 

[Taurus]

Pharms who think that they are qualified to do primary care are in lala land. First, pharms aren't trained to diagnose. Second, pharms are entering into a very crowded field with physicians, PA's, and NP's. That's why the realistic pharm profs know the odds are heavily stacked up against them. Better look for other fertile ground before you get paid next to nothing to fill a prescription.

 

[BMBiology]

if someone is supposed to have an inr of 2 and they have an inr of 5 the pharmacist tells them to hold their dose and calls their pcp for direction on when to resume and at what dose.
I work with 2 of these clinics as well.

I wish every pharmacists do that. It would make things much easier. Just like some PCPs refer their patients to specialists so they dont have to deal with it.

 

[oldManDO2009]

"So, are you pregnant yet? No? the medication is effective". Common sense, buddy.

Really? Physicians don't ask patients to come back just for refills so they can make more money? The greed showed in this thread proves otherwise.

It is not as simple as that.

What about increased risk for P/E, what about other health problems such as HTN where it may require a medication change.

So unlike the vending machine dispensing a medication - what a physician does can not be replaced with such a device. We have to evaluate all health risks a patient has and determine the best course of action and follow that patient to make sure there are no complications.

 

[oldManDO2009]

Per American Gastroenterological Association:



http://www.gastro.org/wmspage.cfm?parm1=398

This is not about OTC NSAIDs. This is about you thinking birth controls are more dangerous than NSAIDs. You are more than welcomed to look up the number of deaths caused by birth controls.

I think he is pre-pharm..and seems to think complications/deaths such as a PE or HTN will always be associated to BCP

 

[genesis09]

I've found most physicians will require a patient to come back for refills if it has been an extended period of time since the last visit, and I don't mind that. Drugs need to be re-evulated at appropriate intervals. The right drug 18 months ago, might not be the right drug today.

 

[BMBiology]

It is not as simple as that.

What about increased risk for P/E, what about other health problems such as HTN where it may require a medication change.

a future MD doesn't think so:

I can buy the argument that maybe OCPs shouldn't be by prescription only.

 

[BMBiology]

-

 

[Faebinder]

a future MD doesn't think so:

That's cause he hasnt been called at 3 am in the morning about his patient whom he prescribed OCs and is now in the ER having a PE/Stroke cause he's not a resident/attending yet.

 

[cpants]

This patient has a PE! Page the pharmacist!

 

[Taurus]

I think he is pre-pharm..and seems to think complications/deaths such as a PE or HTN will always be associated to BCP

I agree he doesn't know what he's talking about. Just spouting off nonsense like a fool.

 

[BMBiology]

That's cause he hasnt been called at 3 am in the morning about his patient whom he prescribed OCs and is now in the ER having a PE/Stroke cause he's not a resident/attending yet.

She was prescribed an OC but she still got PE? That really supports the argument that physicians monitor patients on OC.

 

[BMBiology]

This patient has a PE! Page the pharmacist!

Just don't page the guy aka cpants who thinks OCs are way more dangerous than NSAIDs! She is having GI bleeding...must be the OCs!!!

 

[oldManDO2009]

it is really about relative risk. I would have a greater index of concern if the pt told me he had PUD or GERD - then I may consider monitoring his condition and the prescription for an NSAID - I may have him come back in THREE months instead of six - just to make sure I have his best interest in mind. The most a pharmacist could do is read from a paper "oh NSAID are contradicted - I am sorry you can't take them" When he could with appropriate supervision (physician)

As for BCPs - again relative to the risk - if there is a history of coagulopathy, cancer, metabolic derangements, etc all would be taken into account during the HPI (which a pharmacist would not do) and a determination there would be made as to risk v. benefits.

I just don't get how a pharmacist would be qualified to do this - you can review the contradictions but in no way assess the patient and determine if they are relative.

Why do you as a pharmacist to be (assumed by your previous post hx) need to write scripts for meds - do you think it makes your job more respectable, or do you see this part of a physicians job as "easy" and anybody could do it?

I have a great deal of respect for the clinical pharmacist I interact with - they are able to help me determine the risk v. benefit profile for a drug. When a weird "one off" condition arises and I am just not sure I look to them for help in finding the answer. They help initiate therapy with some of the most toxic drugs to the human body - chemo drugs...the list goes on and on. So why do you feel that you need to do what has been traditionally my job (or soon will be)?

 

[cpants]

Just don't page the guy aka cpants who thinks OCs are way more dangerous than NSAIDs! She is having GI bleeding...must be the OCs!!!

Dude, I am aware that NSAIDs can cause GI bleeds. I am aware that more people (total incidence) suffer from NSAID side effects than OC side effects. This is not equivalent to NSAIDs are more dangerous than OC. Many, many more people take NSAIDs on a regular basis than take OC. More people die in car accidents every year than die from skydiving accidents. This does not mean skydiving is safer than driving a car. Get it?

You don't seem to be aware that oral contraceptives can have serious side effects and contraindications, and hence should be prescribed by and monitored by a physician.

 

[oldManDO2009]

This thread has illuminated the opinions of many other professionals as it relates to the practice of medicine. It seems that some people see us as overpaid and over-valued for our hard won skills. Does it look that easy - a few pills here and there and a few illegible notes in a chart?

I was in surgery today assisting (if you can call it that - mostly holding the arm) on a proximal humerus fracture. As they tried to figure out the right angle I realized just how many problems there are with this surgery to include neurovascular compromise, including loss of motor and sensory function, poor mobility post reduction, and a host of other problems that just makes the surgery very difficult.

I could not do that surgery without proper training and it seems that other professionals look at primary care as an unskilled area of medicine. There seems to be a lack of understanding about the true complexities involved in diagnosis and management of disease. I think it is all very complex and underestimating the difficulty will lead to increased mortality and or morbidity.

The incision and closure today was no more difficult than any other I have observed this last month. The true skill was in the management of the fracture - the reduction. The true skill in primary care is the management - the understanding of all the complexities of the disease process and how to manage it. Not some recipe for CHF - everybody gets diuresed, a dash of beta-blocker and a sprinkle of anti-hypertensive. What about high-output failure - does the same recipe apply? of course not, but then when you just learn about how to treat a disease and not why the disease happens then you cannot consider the alternative.....

rant done.

it just seems crazy that people undervalue the contributions of a physician...

 

[BMBiology]

I know you guys have worked hard to become a physician and it is too bad that your profession has let you down but the reality is:

(1) Nurses are taking over primary care

(2) Salary for physicians in primary care will go down.

(3) Pharmacists are not going into primary care because nurses are better trained in primary care (and they dont cost $55/hr).

(4) The FDA will create BTC medications.

I know it is getting tougher but don't let your disappointment turn into bitterness. Primary care used to belong to physicians but your profession created this demand for affortable and accessible health care. The nursing profession would not have this opportunity if your profession had not created it.

 

[oldManDO2009]

I am not bitter....I am making a specific point that you are trained in a specific field and if nurses were all the sudden dispensing medication and could do it cheaper would that make it better. I am sure you would have an argument or two.

Nurses are not qualified to provide care at even close to the level of a physician and for now patients will have a choice. Who would you take you sick family member to - a doctor or a nurse?

It is not bitterness - I do not plan to pursue family practice but realize these are dangerous inroads that will not stop with just primary care and requires our action now.

I think pharmacy techs should be allowed to dispense meds. I mean how hard is it to apply a computer generated label that cross checked all contradictions and possible side effects?