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[SleepIsGood]

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http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html

 

[Bertelman]

I don't think it's that outrageous. Depending on how you interpret their suggestions, I think many of the healthcare services missing for the uninsured could be served by non-physicians.

There was a recent article in the NYT about post-d/c f/u of CHF patients, and how routine nursing care can prevent readmission. If you've done an intern year, you understand how frustrating it is to take care of these Pts. Although Medicare doesn't reimburse for this service, it routinely prevented readmission of a significant number of these Pts.

 

[neuroride]

Minute clinics are crap in my opinion in anything other than the simplest problems. Had a 7 yr old girl go into a minute clinic 5 times in 2 days for SOB/cough. No CXR was taken and only after the 5th time to the clinic did the mom come to the ER and found that the kid had a huge empyema and Strep A. in the blood by that time. And this is not the only case that I have seen.

 

[Impromptu]

While anecdotes are nice for emotionally convincing people to one's point of view, the author makes some good arguments. Perhaps midlevel providers can do more, leaving medical doctors to focus on more complex medical issues. There are some nice algorithms out there, some so easy that we can leave out the RNs entirely and simply let the sick folks type it into a computer.

What really bothers me about algorithm based medicine is that algorithms often break down on individuals. You need to know much more than the single page algorithm to understand those outliers and when to refer to someone with more expertise than yourself, and midlevel providers usually don't have the knowledge base and training to identify the outliers.

Take the 2007 AHA/ACC cardiac preoperative evaluation guidelines. There is a nice 1 page algorithm, yet the description of that algorithm takes over 80 pages, and those 80 pages require a deeper level of understanding that is not easily learned.

 

[2win]

I don't think it's that outrageous. Depending on how you interpret their suggestions, I think many of the healthcare services missing for the uninsured could be served by non-physicians.

There was a recent article in the NYT about post-d/c f/u of CHF patients, and how routine nursing care can prevent readmission. If you've done an intern year, you understand how frustrating it is to take care of these Pts. Although Medicare doesn't reimburse for this service, it routinely prevented readmission of a significant number of these Pts.

So you suggest a different standard of care - one for the insured and the other one for the uninsured - " I think many of the healthcare services missing for the uninsured could be served by non-physicians.". I don't agree - the article is part of the movement that want to replace physician with "middle level" "providers".
The author is earning his bread masturbating with non senses - bought easily by dreamers of a "new society". I bet as any advocate of mid level practitioners that he will be the first one to look for "the beat doctor" when him or somebody form his family are sick. The ugliness in his attitude is so obvious and I understand why the article was published by CNN.
"There is new technology that makes it easier for non-anesthesiologists to administer conscious sedation, for example, allowing procedures such as colonoscopies to be done under the supervision of just the endoscopist and a nursing team. By removing anesthesiologists from the equation, these procedures can be performed in a clinic setting rather than in hospitals."
The guy is nuts,
"Professor Christensen is committed to both community and church. In addition to his stint as a White House Fellow, he was an elected member of the Belmont Town Council for 8 years, and has served the Boy Scouts of America for 25 years as a scoutmaster, cub master, den leader and troop and pack committee chairman. He also worked as a missionary for the Church of Jesus Christ of Latter-day Saints in the Republic of Korea from 1971 to 1973, speaks fluent Korean, and is currently a leader in his church. He and his wife Christine live in Belmont, MA. They are the parents of five children, and have three grandchildren."
He is part of t he movement (sect) who's knocking to my door promising that if I join his church I will have my own planet....
In the same line his article is garbage!

 

[coprolalia]

There is new technology that makes it easier for non-anesthesiologists to administer conscious sedation, for example, allowing procedures such as colonoscopies to be done under the supervision of just the endoscopist and a nursing team. By removing anesthesiologists from the equation, these procedures can be performed in a clinic setting rather than in hospitals.

Bullsh*t. This guy doesn't know what the f*ck he is talking about. Period. The modality he is referring to here simply does not work (i.e., might be "safer" but onset lag-time makes the procedure take longer, patients aren't as reliably optimized for the procedure, most "positive" studies are published in Gastroenterology journals and not Anesthesiology journals, etc.). So, his is but one opinion. And, at least on this issue, a wrong one.

People want to see the doctor. I've got a plethora of anecdotes, too. But, instead look at another opinion...

http://drugmonkey.blogspot.com/2009/03/nurse-practitioners-all-attitude-of.html

-copro

 

[coprolalia]

I don't think it's that outrageous.

Don't kid yourself, Bert. They want to remove doctors from the equation altogether. This is a prescription for one big social experiment. The margin of safety will substantially decrease - and ensuing horror stories of missed diagnoses with subsequent terrible outcomes will skyrocket- if they get their way.

-copro

 

[Bertelman]

Don't kid yourself, Bert. They want to remove doctors from the equation altogether. This is a prescription for one big social experiment. The margin of safety will substantially decrease - and ensuing horror stories of missed diagnoses with subsequent terrible outcomes will skyrocket- if they get their way.

-copro

I'm not agreeing part and parcel with the article. I am just saying that many of the holes in care that many patients fall through, which of course mostly centers around the uninsured, can be served by midlevels. Even if that midlevel serves only to triage a patient to the appropriate provider, which is possibly a physician, it beats another trip to the ED.

I don't agree with the author's assertion that most of doctor's every day work can be replaced by other providers, but I also don't think the suggestion of increasing midlevel involvement should be dismissed just because he presents some outlandish fantasies and outright ignorance.

I understand this is an open wound in this forum, but if you take the balance of how MD/DOs and CRNAs exist in anesthesia today, it seems to be a pretty nice model. I think a similar model could be used for the primary care fields. Any expansion would require oversight by physicians to work well.

 

[Bertelman]

So you suggest a different standard of care - one for the insured and the other one for the uninsured

There's already a different standard of care. When I need to see a doctor, I choose my provider and select a convenient appointment. Not the same for the millions of uninsured. I'm merely suggesting a better standard of care.

 

[jetproppilot]

I understand this is an open wound in this forum, but if you take the balance of how MD/DOs and CRNAs exist in anesthesia today, it seems to be a pretty nice model. I think a similar model could be used for the primary care fields. Any expansion would require oversight by physicians to work well.

 

[jtn]

The way to lower healthcare cost in this country is to give everyone in the hospital a long white coat that says "Dr." in front of their name and that will increase supply immediately...oh wait, it happening now. Look at around your hospital...everyone is wearing a white coat. From the RNs to the case managers to the equipment technicians to the PAs to the NPs to even people how don't even have patient contact at all. I can't even tell whose a real doctor or not.

I'm telling you...the sacred and respected profession of medicine is being invaded and taken over by everyone in the name of "cost savings". It's because we doctors are so stupid and allowing it to happen. An M.D. degree will eventually be worthless in the future as the government/policy makers view us as "technicians". Do you think the nurses would allow CNAs to invade their field? Of course not.

On another note, I just found out the other day that D.O.'s can apparently convert their D.O. into an M.D. by taking a course or two in certain states. How ridiculous is that? Their argument is that patients and the public discriminate them because of their D.O. degree so by switching it into an M.D., it would take away the distraction and allow them to better take care of their patients.

If that's the case, they should have gone to an allopathic school in the first place and not an osteopathic school. What's next, a P.A. or N.P. can convert their degree into a D.O. and then to a M.D.?!?!?! Or a CNA can convert their degree to an R.N.? We doctors are so clueless/careless and allowing this to happen. We need to snip the problem NOW before it grows and blows up and is too late.

How pathetic that we are the ones allowing this to happen to our OWN profession. Why? Because we are so busy and worn out sacrificing our life to taking care of patients. We are so busy spending the majority of our prime life training to become the best we can be. Yes, we dedicated our lives to the humble profession of medicine...but we need to also protect it and prevent others from trying pass off as "doctors" the short cut way.

 

[jtn]

.

 

[OB1🤙]

On another note, I just found out the other day that D.O.'s can apparently convert their D.O. into an M.D. by taking a course or two in certain states. How ridiculous is that? Their argument is that patients and the public discriminate them because of their D.O. degree so by switching it into an M.D., it would take away the distraction and allow them to better take care of their patients.

If that's the case, they should have gone to an allopathic school in the first place and not an osteopathic school. What's next, a P.A. or N.P. can convert their degree into a D.O. and then to a M.D.?!?!?! Or a CNA can convert their degree to an R.N.? We doctors are so clueless/careless and allowing this to happen. We need to snip the problem NOW before it grows and blows up and is too late.

I agree with your general sentiment, but this silliness about DOs is just...

 

[Arch Guillotti]

On another note, I just found out the other day that D.O.'s can apparently convert their D.O. into an M.D. by taking a course or two in certain states.

This is nonsense. Prove me wrong and provide some evidence to back this up.

 

[ozzie20]

jtn back up your statements about DO's being able to "take some courses" to become an MD.

Otherwise STFU