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To answer the thread’s header, is SDN overblowing midlevel encroachment? Having a bit of experience with the system now, I can pretty confidently say no. It’s pretty on point with what’s out there in the real world. Some on this thread may be more insulated (to no fault of their own) than others depending on where they’re training but in private practice that employs NPPs to maximize profits outside of academia the situations look quite ugly. One example off the top of my head was an NP diagnosing a patient with AF and starting anticoagulants and then the physician co-signing the note 10 days later (to bill). There was only PACs and I called the physician and he confirmed the patient should be off anticoagulants at an outpatient follow up.
Unfortunately the way the medical system works allows PAs/NPs to hide from their incompetence. Big medical errors aren’t usually caught on the day they happen to allow all parties involved to realize what happened. The only major immediate incidents are allergies and we have fail safes for that built into the EMR to avoid that. When we bring patients in, put them in little heuristic boxes, and employ mindless algorithms to them, and write ****** documentation so no one can actually realize what happened, it’s really hard to spot medical errors right away. If you really care about the situation though and stop viewing patients as drug-seekers, gomers, etc. and reference things like the MAR and vitals instead of the notes, you start picking up terrifying things and realize how badly some in medicine (especially PAs/NPs) are harming patients. They basically epitomize the robotic, thoughtless, and frankly near-sociopathic practice of medicine where they cut every corner, provide bad care, and know they can get away with it because hospital administrators accept their lie-ridden documentation so long as it pays the bills. The worst part and why I call it near sociopathic is because they know the care they provide is terrible, but know they can get away with it because they’re caring for the most vulnerable patients who wouldn’t even know where to start with figuring out which provider messed them up…Most hospitalized patients are already circling the drain to begin with, what’s throwing on an unnecessary anticoagulant going to do for that? No one’s going to realize the mistake because hardly anyone is going to track the MAR, look for the tele strip, and the best part is even if their error is discovered, it’s the Cardiologist who co-signed their note 10 days later to bill who’s getting the liability…
Unfortunately the way the medical system works allows PAs/NPs to hide from their incompetence. Big medical errors aren’t usually caught on the day they happen to allow all parties involved to realize what happened. The only major immediate incidents are allergies and we have fail safes for that built into the EMR to avoid that. When we bring patients in, put them in little heuristic boxes, and employ mindless algorithms to them, and write ****** documentation so no one can actually realize what happened, it’s really hard to spot medical errors right away. If you really care about the situation though and stop viewing patients as drug-seekers, gomers, etc. and reference things like the MAR and vitals instead of the notes, you start picking up terrifying things and realize how badly some in medicine (especially PAs/NPs) are harming patients. They basically epitomize the robotic, thoughtless, and frankly near-sociopathic practice of medicine where they cut every corner, provide bad care, and know they can get away with it because hospital administrators accept their lie-ridden documentation so long as it pays the bills. The worst part and why I call it near sociopathic is because they know the care they provide is terrible, but know they can get away with it because they’re caring for the most vulnerable patients who wouldn’t even know where to start with figuring out which provider messed them up…Most hospitalized patients are already circling the drain to begin with, what’s throwing on an unnecessary anticoagulant going to do for that? No one’s going to realize the mistake because hardly anyone is going to track the MAR, look for the tele strip, and the best part is even if their error is discovered, it’s the Cardiologist who co-signed their note 10 days later to bill who’s getting the liability…
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