The apple cider vinegar is just good old fashioned pseudo science, a favorite of chiropractors and naturopaths and the like. To my knowledge, it’s never been subject to any adequate study and the entire concept makes no sense either. That said, arguably the best reflux treatment we often forget about given the ubiquity of PPIs is lifestyle modification, weight loss, treatment of underlying sleep apnea, etc.
As for the NP thing, the further I get into training, the more I see a number of NPs who are a LOT better clinicians than many MDs and who I would much prefer by my side when s—t goes down. I know that’s somewhat anathemous to say, but it’s true. Obviously there are others who are absolutely abysmal. Same goes for MDs of course, but there are far more hurdles to weed out terrible doctors than there are to weed out NPs. My sense is that less desirable places will pull less desirable NPs the same way they get less desirable MDs. If you hit up a minute clinic in some backwater town, your NP experience will be vastly different than in a major center which cherry picked its staff.
Malpractice probably won’t be much of an issue for independent NPs. Remember that “standard of care” is based on what other clinicians with similar training background and experience would do. If they miss an occasional tough diagnosis or mismanage a more nuanced condition, I think a plaintiffs attorney would have a hard time showing that most nurses would have done better. This is the same legal standard, for example, that protects many MDs who offer cosmetic surgical procedures despite absolutely no formal training to do so.
Going forward, I think the best thing for patients is advocating that independent advanced practice nurses be required to undergo some sort of basic competency exams akin to the usmle and a minimum number of years in supervised practice either under an MD or a qualified NP. They should also be subject to comparable CME requirements.
