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No one is belittling nurses. Nurses as a whole are excellent. We are belittling nurse practitioners and doctor
of nurse practitioners.NPs can now do dermatology residencies
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No one is belittling nurses. Nurses as a whole are excellent. We are belittling nurse practitioners and doctor
of nurse practitioners.
The truth comes out... you think you could've been a physician, but the solar alignment was such that it wasn't to be your destiny. Now you're trying to rationalize why you are at least the equivalent of physician.
If the solar alignment did favor medical school, though, I'm sure you could've went straight to MD just like every other college pre-med.
NP's are trained to diagnose as much as PA's are. You are right the primary role of the nurse is not to diagnose, and I never go above what my scope of practice is. If you think we do not take patho or learn about any disease process, you are wrong. You think I don't think of other things that the patient who presented like this could have? Guess what, I work in a very high acuity hospital, and almost every time what I think the problem is happens to be right. I challenge you to do triage in a busy, high acuity ER one day. I bet you will mistriage most of your patients. That is what establishes those who know and those who don't have a clue. Coming up with an idea of what the diagnosis would be and assigning a level appropriately is much more difficult than you think. The attendings and residents that have been working with me trust my judgement, and if I call them and tell them I think xyz is going on, they believe me. I have had instances where interns blew me off and said the patietn was fine. Guess what. The last one that did that to me got reamed out by his attending. This patient that was "fine" wound up spending 2 weeks in the ICU for exactly what I said he had. This has happened many times. The resident learned, and now I know they will never make the same mistake again. Remember, your attendings, program directors and chairmen/vice chairmen were once med students and residents with me. They know and trust me. They do not know you yet. You bet they are going to take my word over yours until they get to assess the situation themself.
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The truth comes out... you think you could've been a physician, but the solar alignment was such that it wasn't to be your destiny. Now you're trying to rationalize why you are at least the equivalent of physician.
If the solar alignment did favor medical school, though, I'm sure you could've went straight to MD just like every other college pre-med.
Where have I EVER said in any of my posts that I am the equivant of an MD???? Find it and quote it.
I didn't think about going to med school until after I started working as a nurse. I thought about, and realized that what I want to do doesn't require an MD degree, and to put myself in debt for it isn't worth it to me.
There are reasons why people don't choose to go to MD based on life circumstances. Some people have to work to help their family, cant do that in med school.
Nurses are not as smart as doctors just as doctors are not as smart as astrophysicists. I'm not sure why you think this implies nurses are stupid.
All docs are smart? All docs are smarter than all nurses? Come on now. Make sure that you let all your program directors know how stupid you think the nurses are when you are interviewing. I'm sure they will agree with you and rank you high on the list.
It's obvious that his ego could not handle not being as smart as a doctor and being ordered around by a doctor.
"Woe is me," said nurse practitioner Gator. "Why do doctors not treat me as an equal? I am just as smart as they am and know just as much as them."
"I know, maybe I should go to medical school! Then I can show them! No...that will be another 8 to 10 years and I don't know if I would be able to handle medical school. Plus I just wasted the last 10 years of my life becoming a nurse practitioner."
"Yes, I can become a doctor of nurse practitioner. Let me take these couple of online courses completely unrelated to the practice of medicine." *Clicks button on computer* "Here, I can sign up for this one month residency. I am now doctor and a dermatologist!"
Sounds like you're a great nurse. It's a shame you'll be moving to greener pastures.
As for your challenge, you think pretty highly of yourself... what with being able to outwit an intern and all. I'm also sure you've never been wrong by the fact that no one has rubbed your errors in your face. Such a shame, too, as humility seems to be your strong point.
Watch out interns, super nurse is here to save the day! Equipped with decades of experience in triage and a new found appreciation for basic pathophysiology, super nurse will protect your patients from the untoward care of novice physicians everywhere!
NO.
NO
But these two questions are beside the point he was making, which is:
Is the average MD smarter than the average nurse?
The answer to this is Yes. And that's clearly what the post you were responding to was implying. However, your attempts at deflection are admirable.
That's exactly what I said... every single physician in existence is smarter than every single nurse. Let's disregard general truth and highlight outlying exceptions. You pinned me good!
And I'm not a medical student, so sorry you can't pull that card against me.
My purpose is not to outwit anyone. In my hospital, our residents and attendings are not too arrogant as to listen to and take into consideration what I think is going on with the patient or what we should do about it. Have I been wrong about my assessment of the situation? Sure, of course I have. But instead of being arrogant pr*cks, they take the time to explain why I was wrong and they teach me how they got to the conclusion they did. Residents are there to learn. If you think the only people who will teach you about medicine is other doctors, than you really have to open your eyes. You will see when you get there how much you really don't know. If you are open to the input of nurses who have been in the game a while, you will learn more than you ever thought you could from us. Like I said before, go right to your attending/program director and tell them that I suggested to you a diagnosis for the patient and that I am overstepping my boundaries. I am not the type of person to sit there and let the resident F up. I just hope that they learn something from the situation.
D
DNPgator
This is my last entry. I am sure you all will applaud. I really do wish you all the best of luck in your chosen fields. Passion is needed to survive in this world and you all certainly have that. Don't let the reality of the health care industry beat you down as it has many doctors and nurses.
This is a story of a young man with dreams of playing in the NFL. At 6'3" 265 pounds with sub 5 40 speed and a max bench of 385 pounds he had earned a division one scholarship to a major university and was enjoying his senior season.😀
That was until he was speared in the lower back, breaking the transverse processes on L3, L4, and L5 and rupturing discs at the levels of L2 to S1.😱
As he layed paralyzed on the field, he knew all his dreams were over. The ortho and neuro surgeons put him back together as best they could. With the help of months of physical therapy, he walked again, but his spirit was broken.🙁
The NP at the orthos office touched this kids life. She helped him to understand his limitations and potentials. In his follow-up appointments over the next 18 months, he began to have hope that he still had a future.
This story was mine. I was the football player. I knew I wanted to be like the person who had given me back hope. I loved my surgeons and to this day I am thankful for their expertise. But, 21 years later, I still send my NP a Christmas card and thank her for saving my life. She sends me one too.
You can be senical, rude, or dismiss this as nonsense if you want, but some of us NP's actually chose this field. We weren't all forced into it because of a lack of work ethic or intelligence as some have suggested.
Good luck to you all and God Bless.🙂
This is a story of a young man with dreams of playing in the NFL. At 6'3" 265 pounds with sub 5 40 speed and a max bench of 385 pounds he had earned a division one scholarship to a major university and was enjoying his senior season.😀
That was until he was speared in the lower back, breaking the transverse processes on L3, L4, and L5 and rupturing discs at the levels of L2 to S1.😱
As he layed paralyzed on the field, he knew all his dreams were over. The ortho and neuro surgeons put him back together as best they could. With the help of months of physical therapy, he walked again, but his spirit was broken.🙁
The NP at the orthos office touched this kids life. She helped him to understand his limitations and potentials. In his follow-up appointments over the next 18 months, he began to have hope that he still had a future.
This story was mine. I was the football player. I knew I wanted to be like the person who had given me back hope. I loved my surgeons and to this day I am thankful for their expertise. But, 21 years later, I still send my NP a Christmas card and thank her for saving my life. She sends me one too.
You can be senical, rude, or dismiss this as nonsense if you want, but some of us NP's actually chose this field. We weren't all forced into it because of a lack of work ethic or intelligence as some have suggested.
Good luck to you all and God Bless.🙂
From my state medical university's FNP curriculum. Pathophys - 3 lecture hours. Pharm - 4 lecture hours. Clinical assessment and reasoning - 2 lecture hours and one practical hour each for child and adult. There is then a bunch of BS classes like health systems and a bunch of "Advanced Care Management" which add up to 22 hours total. My path class was 8 hours, my pathophys/clinical assessment was 18 hours, and my third year clinicals alone were 48 hours of credit (over twice what you would get) which excludes a further 16 hours of required courses 4th year and another 16 hours of electives. That doesn't even get me to residency where if we assume working 48 weeks at 65 hours/week for 3 years we end up with about 10,000 hours. Those 4 weeks off and those 65 hour weeks and the 3 year estimate is about the easiest schedule you can get. Most are more. I don't doubt you do take the same general subjects, but not all of them and certainly not at our depth.
I'm going to be flippant, but mainly because I'm about to be an intern. Holy ****, you caught an intern being wrong! Stop the f-ing presses. Guess what, that happens with some frequency. Interns are sleep deprived, overwhelmed, and are just getting used to actually having responsibility. They also tend to have limited time to make assessments as their other 20-30 patients need attention as well. Did the intern you caught being wrong look tired? Had he/she been up the previous 29 hours? Were they even on their own service or were they a rotater? I've seen 3rd year medical students catch interns unaware because the students (like many nurses) have more time to spend with a patient and thus pick up more information in many cases. I'm glad you and others like you are their to catch anything we might miss, but that doesn't mean we're equals.
As for doing triage in a busy high acuity ER... guess what, most of us do just that. My first month in residency has me in the ER. Want to bet whether or not I can catch an MI too?
Sorry that was a little harsh, but when you bragged on getting an intern yelled at that just pushed my buttons.
This is the dumbest **** I have read in this entire thread.
Go write a letter to home and garden magazine or something.
Don't forget to send us a thank you card when we successfully get neuronal stem cells to work. Then you can break your back all you want, we'll still fix it for ya.
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I am sorry you got hurt playing football and didn't get to reach your dream. But some(by far not all) NP's/PA's are damn right dangerous. I have a horror story about myself that involved one that almost cost me my life(still have and will have problems) that an Attending caught.
I almost wanted to be a NP but wanted to be a P.A. instead because I believe in our training as well as the relationships with the Docs.
So remember for your heart warming story there are many horror stories such as mine.
Cheers.
PS- I have seen a PA miss an obvious appendicitis in a 20 y.o. so I stick by my saying that there are dangers in all fields and MLP's should not be called Doctor in clinical practice. Academics on the other hand is fine IMHO. Also anyone with/wanting a DNP should suck it up and GO TO MEDICAL SCHOOL.
Don't misquote me. I never said we were equals. I wasn't trying to get an intern or resident yelled at. I would rather help the intern or resident learn something. Many times I will help the resident fix what they did wrong so the attending doesn't even have to get involved. The attending got involved because the patient continued to deteriorate despite the resident being called multiple times to come see the patient and I why I thought xyz was happening. The resident told me that the patient had anxiety and not to bother him about this patient again. He ignored my efforts to get the x-ray tech down there, draw abg, whatever he thought we could do right now to figure out the problem or to help the patient. He finally agreed to the x-ray, which didn't show much, but I told him in my experience pts with ths type of problem don't always show anything on x-ray until a later time, but the symptoms added up to what I thought was going on. He told me I was wrong and stormed off. Shortly after, the patient crashed and was intubated. The attending who intubated the pt called the attending of this resident. The patient's attending came down and asked what happened, and when he found out the story from us, and the attending who intubated, he was pissed. This patient spent 2 weeks in the ICU. If the resident would have at least considered that maybe I was onto something, maybe this situation could have been avoided. I know this resident will remember this situation, and it will teach him that in real life, diag tests and what you read in the textbooks is not always what you will see when a patient is sick. Sometimes the diagnostic tests are normal but the patient is not well. I know this resident. He was on his own service and he was not post call. I think he is a good doc, but he let his arrogance get in the way, and it almost cost him the patient's life.
In ER many things are not straight foward and it takes time to see things over and over again before you will really get it. That is why we are supposed to help you figure out what is wrong with the patient by offering input from prior experience. Take it or leave it, but I think it would be smart to at least take what I say into consideration. If you don't think my point is valid, than that is your decision to make. It all comes down to this: If you have a sick patient, and I am telling you what I think the problem is, listen to what I have to say. Are you willing to risk the patient's life and not do what I am suggesting just to try to prove me wrong?
That's fair, and you certainly won't see me advocating for us to completely ignore the advice y'all give us.
Wow, disappear for a few days and look what comes crawling out of the woodwork.
If you really want to go down that road -- just know your place. You're not a dermatologist. Not even close, really -- and I really like NP's/PA's and appreciate their utility in the system -- much to the dismay of many of my colleagues. I have long advocated for the widespread utilization of mid-levels (and that is what you are in the healthcare team -- and does not change with the addition of a "D") in healthcare. A midlevel's only advantage is their lower cost basis -- they constitute cheap(er) labor. That's it. You're not a BC dermatologist -- and, while I would place your command of dermatology up against any non dermatologist, any DNP/PA/NP would likely not fare so well when compared to the "standard". I would tread lightly on the self assigned pretension -- especially in light of the "I am not claiming, nor do I want to be a surgeon, cardiologist, endocrinologist, or any one of the many specialists who provide comprehensive care to moderate and high acuity patients." comment that denotes a fundamental failure in comprehension on the breadth and difficulty of cutaneous disease. Utter failure, actually, which only strengthens the argument against your "brethren".... the best measure of a great clinician is in the understanding of what they do not know.
You really should neither speak nor type when angry unless you have thoroughly thought your position through, as it generally makes one look like an ass.... and only leads to back peddling that undermines any legitimate argument you may otherwise have made.
I do not blame you or your colleagues for the self-advocacy push; nor would I really expect you to understand our position for you really have not had the opportunity -- or the pleasure -- of having your teeth kicked down the back of your throat for years on end, while paying dearly for the opportunity to do so... culminating in hundreds of thousands of debt... followed by the opportunity to go further in debt to start a practice (or have a senior member front your money, which is taken out on the back end -- either way, same net result).... only to find yourself on the public enemies list and have any returns on your efforts undermined via public policy. There is precious little for the indebted healthcare provider to rejoice in given the current environment.
Wow you are cocky. This is just getting embarrassing now. Do you triage a patient and then go back and check that every single patient had what you thought? I have been in several busy EDs and I have never seen triage so good that they are getting the diagnosis right "almost every time" as thats not even really the point of triage. I remember one night working in the minor care area when I had a heat stroke and a AAA back to back that were both triaged as the least urgent complaint (and I'll just say that they weren't triaged by MDs). Now maybe you are just that awesome, but from your posts you sound more narcissistic. Everyone, even the greatest medical provider in the world, has there fair share of stories about being wrong. If you don't you are either lying or God. The hospital is a complex place, and chances are that intern who doesn't come right down when you call is taking care of 10-70 patients, any of whom may have pressing issues of their own.
If you're going to throw us primary care physicians under the bus you surely ain't gonna get our to support to prevent DNPs in subspecialties...
Bad call dude! 👎
One of the lessons in this thread is that nurses should not post on physician forums. It's just a set up for flame wars. Whether a nurse starts out nice or antagonistic makes no difference, because in the end, both are going to get flamed.
What doctors think and how they behave are different. I think many midlevels and nurses who have worked with doctors for a long time tend to forget this.
What doctors think and how they behave are different. I think many midlevels and nurses who have worked with doctors for a long time tend to forget this.
I start my FM residency in 1 month, so I'm not throwing primary care under the bus. I'm just stating how things are. NPs are practicing independently and it would be almost impossible for us to change that at this point. This is somewhat true even in my state which expresses states that NPs/PAs must be supervised by a physician. NPs are "supervised" by an MD/DO that stops by 1-2X/month and reviews a few charts. Otherwise, they're on their own.
Find what your state law allows and don't let it get any worse, but the independent NP is basically here and not going anywhere barring a massive effort that we as physicians just aren't capable of.
This is the dumbest **** I have read in this entire thread.Originally Posted by DNPgator
This is my last entry. I am sure you all will applaud. I really do wish you all the best of luck in your chosen fields. Passion is needed to survive in this world and you all certainly have that. Don't let the reality of the health care industry beat you down as it has many doctors and nurses.
This is a story of a young man with dreams of playing in the NFL. At 6'3" 265 pounds with sub 5 40 speed and a max bench of 385 pounds he had earned a division one scholarship to a major university and was enjoying his senior season.😀
That was until he was speared in the lower back, breaking the transverse processes on L3, L4, and L5 and rupturing discs at the levels of L2 to S1.😱
As he layed paralyzed on the field, he knew all his dreams were over. The ortho and neuro surgeons put him back together as best they could. With the help of months of physical therapy, he walked again, but his spirit was broken.🙁
The NP at the orthos office touched this kids life. She helped him to understand his limitations and potentials. In his follow-up appointments over the next 18 months, he began to have hope that he still had a future.
This story was mine. I was the football player. I knew I wanted to be like the person who had given me back hope. I loved my surgeons and to this day I am thankful for their expertise. But, 21 years later, I still send my NP a Christmas card and thank her for saving my life. She sends me one too.
You can be senical, rude, or dismiss this as nonsense if you want, but some of us NP's actually chose this field. We weren't all forced into it because of a lack of work ethic or intelligence as some have suggested.
Good luck to you all and God Bless.🙂
Go write a letter to home and garden magazine or something.
Don't forget to send us a thank you card when we successfully get neuronal stem cells to work. Then you can break your back all you want, we'll still fix it for ya.
Rabbit Hole, really,
The only common ground we can find is one based on truth in education. DNPs, NPs, PAs are not trained for independent practice - the model you should advocate is one that's based on the actual training you've received.
Murse Gator,
You shoulda married her/him (I don't know where you stand on that and I don't want to exclude any options).
Thank zod for the nurse whose sweet words healed your back. Forget the guys who actually operated on it.
I have had to actively restrain myself from participating in the recent discourse on this thread for a number of reasons:
1. I have a personal policy in general against back-and-forth exchanges with militant nurses. It serves no purpose. They are indefatigable in their ignorance and fools are generally insufferable to me.
2. I have a tendency to go from zero to 60 in a matter of milliseconds so it's not always the best idea for me to get involved in a discussion that I'm intensely passionate about.
In the interest of what is best for the patient (not my wallet, as some nincompoop stated) suffice it to say I will remain a strong opponent of the independent practice of midlevels. However many alphabets you tag behind your name, regardless of how well starched your white coat is, you remain underqualified to assume full responsibility for the care of a patient.
Those passive docs of the yester years have all but retired now. Some of us, I believe some numbskull nurse recently referred to us as "younglings", are hell bent on challenging the legacy (of unchecked midlevel encroachment, independent practice of the underqualified) they bequeathed to us.
You shoulda married her/him (I don't know where you stand on that and I don't want to exclude any options).
Thank zod for the nurse whose sweet words healed your back. Forget the guys who actually operated on it.
I have had to actively restrain myself from participating in the recent discourse on this thread for a number of reasons:
1. I have a personal policy in general against back-and-forth exchanges with militant nurses. It serves no purpose. They are indefatigable in their ignorance and fools are generally insufferable to me.
2. I have a tendency to go from zero to 60 in a matter of milliseconds so it's not always the best idea for me to get involved in a discussion that I'm intensely passionate about.
In the interest of what is best for the patient (not my wallet, as some nincompoop stated) suffice it to say I will remain a strong opponent of the independent practice of midlevels. However many alphabets you tag behind your name, regardless of how well starched your white coat is, you remain underqualified to assume full responsibility for the care of a patient.
Those passive docs of the yester years have all but retired now. Some of us, I believe some numbskull nurse recently referred to us as "younglings", are hell bent on challenging the legacy (of unchecked midlevel encroachment, independent practice of the underqualified) they bequeathed to us.
Being that we are on a computer system, I can look at the charts and see if I was right or wrong. If the case was in interesting one, I will follow up on it with the residents/attendings upstairs. This ED is notorious for being crazy. The news have been here several times as an example of a busy, high acuity ER.
If you have new grad or lazy nurses who treat triage like a registration process, than of course you will have someone triaged to the wrong area. I have recieved patients like that several times. The point of triage is to recognize, in a short period of time, sometimes even without any info at all, that the patient is sick and to start treatment ASAP. If you don't know how to put the pieces together to come up with what the diagnosis MIGHT be, than you can't triage. That is contradictary to what some people here are saying that nurses cannot make decisions or think for themselves. I have had disagreements with MD's about patients I have upgraded. Sometimes I am wrong, but the many (not all, like you claim I am saying) times I have been right, they have come to me and thanked me for bringng it to their attention. The attendings and senior residents know me well enough that if I think a patient is sick, they probably are.
The attendings are not hung up on trying to prove something, so they are not as likely to push off the experienced nurses as residents are. Ask any ER attending who trained at a busy place what the nurses taught them during residency. If you can't work as a team with us you will not make it through residency.
We do not do formal evaluations of residents, but we are asked by the program director and chairman about how the residents are doing. They take this seriously, and if a resident is nasty or is deemed incompetent by the nurses, they will take that into consideration when doing evaluations. This is becoming more and more common, so don't think that this is just one facility that does this. On the other hand, the nurses quite often shoot an email to the chairman and program director when a resident is really doing a good job. I like working with residents, and its so nice to see that transition from intern to 2nd year, and then how much they have grown by the time they graduate. The intern who's patient we shared on the first day who asked me to get a diet history on the patient because the stool smelled so bad (it was melana) is now one of the best attendings we have. Things like this are what you don't learn from the textbooks, but what you will learn by working as a team with us.
If you're right then NP independent practice is here to stay and arguing against independent DNP dermatology practitioners is a moot point
If you're going to mount a fight where you abandon the interests of primary care physicians, because you feel the fight "is almost impossible" don't expect much support from PCPs to prevent subspecialists from going down... 🙄 👎
I am not anti-MD at all, but you are obviously anti-nurse. Maybe arrogant docs are nasty to nurses, but it doesn't take a rocket scientist to figure out if someone is just being nice to you because they have to, or if they actually do see you as a respected member of the team. I am invited to lectures, they offer to let me attend rounds, and have offered to precept me when I get to clinicals. These are attendings, some with over 20 years in practice. I'll tell you that they complain about "dumb" residents just as often as you complain about "dumb" nurses.
I thought we could have open dialogue about issues that effect both nursing and medicine. There are things like healthcare reform, the increasing control of healthcare by lawyers and other things that we should be teaming up to fight against instead of arguing with each other.
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You seem to be confused. I am going to be a PCP (again, I start a Family Medicine residency in 38 days) so why would my own area of practice not helping the subspecialists bother me? I'll repeat that as you might be a little slow. In about 3 years, barring anything unforeseen, I will be a family medicine attending. Why should I care whether the AAFP supports specialists?
Now, of course I care. I'm against independent NPs. The problem is, lots of states allow it. Mine does not. I'll happily give money to prevent that from happening here but it will be pointless to try and take that away from states where it is allowed.
That being said, find me one example in recent history where organized medicine has been able to decrease nursing's scope. Restricting CRNAs from pain medicine doesn't count as they never really had that. Seriously, find me a case where we've managed to convince a state legislature to take away something that nurse's had been doing (ie. find a state where NPs were independent and now they're not). For all intents and purposes, getting that to actually happen is impossible barring a massive, statewide issue caused by lack of training.
Despite that, it is very possible to prevent further expansion. However, that cannot be accomplished by the state boards of medicine. It has to happen in the state law since the BOMs have no jurisdiction over nursing scope unless the law says they do.
Dermatologists do not diagnose skin cancer. They "highly suspect" it, and then send a specimen to the PATHOLOGIST, who then is the one who makes the diagnosis.
Very small percentage of dermatologists actually look at their stuff under the microscope.
Um ... touche? Jesus Christ man, stay on topic.
You absolutely cannot be serious. You guys are screwing with me right? This is a joke???
Again ... Jesus H. Christ.
I can't even break this story down. I'm just glad you're gone and still plan on using your hot-headed posts to invigorate more physicians and physician advocate groups.
Actually I think this is the plot for a new sit-com. This fall, on NBC....
I was just making an observation that SDN is not a friendly place for nurses to post, as good as your intentions may be. I actually welcome your perspective FWIW. I didn't want to suggest that I don't want you or other nurses to post, just that most nurses here get belittled and flamed eventually.
When I hit 6,400 posts like you (which I won't, because I am not an internet-*****), then I will hopefully have a better grasp of forum-etiquette.
You replied me within 2 minutes, so I have reason to believe you spend way too much time here. But if one of your goals in life is becoming a legend on this forum, then more power to you.
Gee, you're right.... I guess, then a Internist never diagnoses thyorid cancer. They simple biopsy the nodule and send it to a pathologist (without any thought or insight).... no hx of exposures or a physical exam of the nodule ... cause those things really mean nothing, right?🙄....
From now on, all physicians only suspect things.
Your logic could be extrapolated into forever. And then the only diagnostician among us is pathologists.
What a ridiculous statement
I can take the heat, I enjoy a healthy debate. I just can't stand when people make ignorant statements. I don't categorize all docs in one group, I don't think its fair to say all NP's or RN's are the same. Trust me, if you worked with me you would appreciate this attitude. I like to use it when family members of patients are nasty to you/annoying you, or if nurses I can't stand are giving you a hard time. If its an attending I know well and they are yelling at you because we were caught up with our patient, I'll put the blame on myself that I needed you here, and that has not failed me yet in getting them to stop yelling
As long as the new docs realize that SDN is not the real world. They cannot go into the hospital and act the way they do here. Most docs really don't feel the hatred towards nurses that it seems to be here. accepting it anymore. The hospitals are no longer tolerating abusive behavior between care providers. Attendings are losing privledges, residents will be kicked out, nurses will be fired for being disrespectful and nasty. I think the most abuse goes on between senior residents and attendings toward other less senior residents. I know the residents don't say anything about that, but that should not be allowed either.
Serious question. Could you give me an example of when you've taken the mind, spirit, and body into consideration when treating a patient?
Listen SLOPO, focus!
Whatever it is you will be an attending in 3 years don't mean jack
If we don't do this together we will go down divided
This ain't about regulating midlevel independent practice in non-primary specialties only,
dis is bout regulatind de practice of MEDICINE of midlevels!
Comprende? 👎
You can argue back and forth all you want, I DON GUT TINE FOR DIS!! 😎
dnpgator is funny, just because they did an easy laid back "doctorate" they think their education is up to par with that of medicine!! wow. And I thought this thing was scary, but reading the nurses posts makes it even scarier.
And about noctor shelby, cry me a river!!!
And about noctor shelby, cry me a river!!!
does studies that you mention have been shown to have huge errors and are bias. Really, a nurse up to par to a board certified attending. The healthcare of america is in problems, very big problems!!!
For real. I'd like to see what is involved in this DNP program for instance. What in it earns the 'Doctoral' part. I admit I do not know.
I'm not sure why masters, then 'residency' type training is all one wouldn't need to practice as an independent Nurse dermatologist...that is, unless people feel the need to call a program a 'doctorate' program so they might be able to tell others to refer to them as 'Doctor'.
Again, I am not aware of whatever national or state requirements exist, or what the program entails, but..yeah.
I'm not sure why masters, then 'residency' type training is all one wouldn't need to practice as an independent Nurse dermatologist...that is, unless people feel the need to call a program a 'doctorate' program so they might be able to tell others to refer to them as 'Doctor'.
Again, I am not aware of whatever national or state requirements exist, or what the program entails, but..yeah.
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deleted6669
at the most basic level if someone with a masters does more structured academic and clinical training they expect a doctorate.
whether or not the education deserves a doctorate is another conversation.
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Wow. I merely stated one fact (Pathologists diagnose skin cancer...which is true by the way). And you are making it out as if I said Pathologists diagnose everything and internests diagnose nothing??
Sure internests can make diagnoses (CHF, COPD, IDDM, etc), but they can't diganose "skin cancer" nor can they diagnose "thyroid cancer" as you pointed out in your poor excuse of an example. They can make the diagnosis of "skin lesion" or "thyroid nodule" but not cancer, and you might be aware of this if you had ever taken the time to look under a microscope.
I didn't say anything about the H&P not meaning anything, it is. But good luck differentiating a benign and malignant (hence, the diagnosis of cancer or carcinoma in this case) thyroid nodule based on your H&P. Perhaps the surgeon should send the nodule to you intraoperatively, and let you feel it with your hands, and then you make the determination whether or not the entire thyroid needs to be removed.
Bottom line, I didn't say Pathologists diagnose everything, nor did I say Internests diagnose nothing. You said I did. Therefore not only are you a FutureDoc, but you are also a PresentTool.
I was merely pointing out the idiocy of your posts. That you cannot make a diagnosis of skin cancer without a pathologist to look at it under a microscope.
Any good dermatologist can look at a lesion and pick out a melanoma, basal cell, or squamous cell pretty easily. Are there exceptions? Sure. But, the notion that you always need the pathologist to make the Dx is ridiculous. You do the biopsy and send it off to confirm your suspicion and grade the lesion. Your comment most definitely seemed like an insult to Derms.
Same thing with the "thyroid nodule".... does it move when the patient swallows? Is it midline? Is it solo? Do they have a hx of radiation exposure? Is there a Hx of endocrine abnormalities? The list goes on and on.
The purpose to sending your biopsy to the pathologist is to confirm a dx based on your differential.
Maybe you just blindly biopsy and send things off to be viewed under the microscope. But, some of us actually think about what we're doing. Which seems to be going the way of the dinosaur in this profession.
Btw, I know your not an "internet *****"... so why don't you just do us a favor and stay off of this thread.
Any good dermatologist can look at a lesion and pick out a melanoma, basal cell, or squamous cell pretty easily. Are there exceptions? Sure. But, the notion that you always need the pathologist to make the Dx is ridiculous. You do the biopsy and send it off to confirm your suspicion and grade the lesion. Your comment most definitely seemed like an insult to Derms.
Same thing with the "thyroid nodule".... does it move when the patient swallows? Is it midline? Is it solo? Do they have a hx of radiation exposure? Is there a Hx of endocrine abnormalities? The list goes on and on.
The purpose to sending your biopsy to the pathologist is to confirm a dx based on your differential.
Maybe you just blindly biopsy and send things off to be viewed under the microscope. But, some of us actually think about what we're doing. Which seems to be going the way of the dinosaur in this profession.
Btw, I know your not an "internet *****"... so why don't you just do us a favor and stay off of this thread.
Besides which, several, if not most, dermatopathologists are BC dermatologists.
Probably most as DermPath fellowships tend to strongly favor Derm applicants over Path applicants. A small minority are double-boarded.🙂
Probably most as DermPath fellowships tend to strongly favor Derm applicants over Path applicants. A small minority are double-boarded.🙂
No, the percentage is not small... a minority, maybe, but not small. You do realize that a sizable portion of the dermatopathologists in the workforce are dermatologists, right? And then there are the Mohs guys... and the wannabe's in the "Mohs society"... so, really, your assessment is a touch inaccurate.
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