Spoke with a DNP Student Today..

[Coastie]

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DNP student is an older man with many years of experience as an ARNP, and about to graduate in August. For his, um, "specialty", he is far beneath even a junior resident in knowledge. However, this gentleman claims equivalency with MD/DO's. Furthermore, he told me that DNP's get alot of training in "health policy", which will help them "shape their profession and the face of medicine on a macro level". I asked him about DNP's future, and he said the fight at the highest levels (of which he has been a part of/active in for many years) is for active withdrawal of medicare funds from residency slots in order to form "DNP residency slots". He hopes that the DNP's will continue to "expand into all medical specialties", and yet when confronted, told me that they only want to do "simple surgeries, such as carpal tunnel release, hand surgeries, and dermatological procedures".

He was very positive about the DNaP (CRNA "doctorate"), and claims that within 5 years 200 DNP programs will be in place. He claims it "definitely increases" his scope of practice "clinically", and that within 20 years, the DNP will overwhelm MD/DO in sheer numbers as to force "residency slots to be created".

Did I mention he said most people take the DNP courses online for 1.5 years, followed by 1.5 years of "clinicals", which, by the way, have fewer requirements and hardships than even a PA curriculum?

 

[toughlife]

DNP student is an older man with many years of experience as an ARNP, and about to graduate in August. For his, um, "specialty", he is far beneath even a junior resident in knowledge. However, this gentleman claims equivalency with MD/DO's. Furthermore, he told me that DNP's get alot of training in "health policy", which will help them "shape their profession and the face of medicine on a macro level". I asked him about DNP's future, and he said the fight at the highest levels (of which he has been a part of/active in for many years) is for active withdrawal of medicare funds from residency slots in order to form "DNP residency slots". He hopes that the DNP's will continue to "expand into all medical specialties", and yet when confronted, told me that they only want to do "simple surgeries, such as carpal tunnel release, hand surgeries, and dermatological procedures".

He was very positive about the DNaP (CRNA "doctorate"), and claims that within 5 years 200 DNP programs will be in place. He claims it "definitely increases" his scope of practice "clinically", and that within 20 years, the DNP will overwhelm MD/DO in sheer numbers as to force "residency slots to be created".

Did I mention he said most people take the DNP courses online for 1.5 years, followed by 1.5 years of "clinicals", which, by the way, have fewer requirements and hardships than even a PA curriculum?

Well he is not lying.

http://www.asahq.org/news/asanews062807.htm

 

[Coastie]

Oh yeah, I almost forgot! He was telling the young 3rd year med student that "Nurses perform surgeries in Germany and Britain, so why not do it here in America?" I mean, honestly, how can someone say this stuff with a straight face?

 

[BLADEMDA]

Well he is not lying.

http://www.asahq.org/news/asanews062807.htm

Tough,

Remember this statement:

All of Medicine is under seige; but, we are in the FRONT LINES.

Blade

 

[proclivity]

DNP student is an older man with many years of experience as an ARNP, and about to graduate in August. For his, um, "specialty", he is far beneath even a junior resident in knowledge. However, this gentleman claims equivalency with MD/DO's. Furthermore, he told me that DNP's get alot of training in "health policy", which will help them "shape their profession and the face of medicine on a macro level". I asked him about DNP's future, and he said the fight at the highest levels (of which he has been a part of/active in for many years) is for active withdrawal of medicare funds from residency slots in order to form "DNP residency slots". He hopes that the DNP's will continue to "expand into all medical specialties", and yet when confronted, told me that they only want to do "simple surgeries, such as carpal tunnel release, hand surgeries, and dermatological procedures".

He was very positive about the DNaP (CRNA "doctorate"), and claims that within 5 years 200 DNP programs will be in place. He claims it "definitely increases" his scope of practice "clinically", and that within 20 years, the DNP will overwhelm MD/DO in sheer numbers as to force "residency slots to be created".

Did I mention he said most people take the DNP courses online for 1.5 years, followed by 1.5 years of "clinicals", which, by the way, have fewer requirements and hardships than even a PA curriculum?

200 DNP programs????......that is about as optimistic as a a nurse can get.


This guy is the epitome of disgrace.


i am embarrassed by the fact that this 'nurse' is even mentioning that a portion of the degree is online........Online degrees are about as bull**** as the African country money scandal e-mails!!!!!!!

 

[Coastie]

It's pretty hilarious. If this is what we have to fight against in Medicine, things may not be so bad after all, eh Blade? You're right, though: All lines are under assault, but Anesthesiology is definitely one of the front lines.

 

[Coastie]

200 as in the NP programs converting to DNP by 2015. He made that point very clear.

200 DNP programs????......that is about as optimistic as a a nurse can get.


This guy is the epitome of disgrace.


i am embarrassed by the fact that this 'nurse' is even mentioning that a portion of the degree is online........Online degrees are about as bull**** as the African country money scandal e-mails!!!!!!!

 

[CremeSickle]

I would have laughed at him.

He is clearly delusional.

 

[OB1🤙]

When I was a 3rd year student on family med, an woman came into clinic to be seen. She was visibly upset when I, ridiculous-short-white-coat-wearing-minion that I was, went to go talk to her, but using my Jedi powers of interpersonal communication, she softened up a little and eventually started talking.

Turns out she was a neonatal NP, and she was a doctoral candidate for a DNP. Cool, I said. So what's your doctorate thesis going to be?

"I'm studying the effects of prayer on mortality in the NICU." Uhhhh, woah. OK. How's that, uh, how's that working out for you then? "Our results so far have been inconclusive." Mmm hmm. So what's your methodology then? "We round with the chaplain and the families and pray for half the babies in the unit, and compare outcomes."

Riiiiiiiiiiiiiiiight. Way to advance the art and science of neonatology. No disrespect intended to those who believe in the healing power of prayer, but that's another discussion for another forum. Clearly though, this was a ridiculous premise on which to base a Doctorate degree.

As far as I'm concerned, these people are totally delusional. The woman I met and guy from Coastie's story both envision themselves as complete academic equals. As has been said before, the problem is that they don't know what they don't know. That, boys and girls, is dangerous. Very, very dangerous.

 

[CremeSickle]

Having said that, i watched a surgeon pray in the OR that the surgery would go well, i wanted to jump out of my own skin. There is no place for religion in the OR or in medicine (IMHO).

 

[Monty Python]

DNP's get alot of training in "health policy", which will help them "shape their profession and the face of medicine on a macro level".

I don't know which is more appropriate: or

He was very positive about the DNaP (CRNA "doctorate"), and claims that within 5 years 200 DNP programs will be in place.

Did I mention he said most people take the DNP courses online for 1.5 years?

Let's see, how is "fluff" defined in Webster's?

 

[Coastie]

Wow, I'm a Christian, and I find that thesis a) hilarious and b) borderline offensive. Conflicted!

When I was a 3rd year student on family med, an woman came into clinic to be seen. She was visibly upset when I, ridiculous-short-white-coat-wearing-minion that I was, went to go talk to her, but using my Jedi powers of interpersonal communication, she softened up a little and eventually started talking.

Turns out she was a neonatal NP, and she was a doctoral candidate for a DNP. Cool, I said. So what's your doctorate thesis going to be?

"I'm studying the effects of prayer on mortality in the NICU." Uhhhh, woah. OK. How's that, uh, how's that working out for you then? "Our results so far have been inconclusive." Mmm hmm. So what's your methodology then? "We round with the chaplain and the families and pray for half the babies in the unit, and compare outcomes."

Riiiiiiiiiiiiiiiight. Way to advance the art and science of neonatology. No disrespect intended to those who believe in the healing power of prayer, but that's another discussion for another forum. Clearly though, this was a ridiculous premise on which to base a Doctorate degree.

As far as I'm concerned, these people are totally delusional. The woman I met and guy from Coastie's story both envision themselves as complete academic equals. As has been said before, the problem is that they don't know what they don't know. That, boys and girls, is dangerous. Very, very dangerous.

 

[rmh149]

Having said that, i watched a surgeon pray in the OR that the surgery would go well, i wanted to jump out of my own skin. There is no place for religion in the OR or in medicine (IMHO).

What if your patient asked you to pray before going under. I had that happen several times....and I am not a religous guy...AT ALL. It was hard, but I spoke a few words...."oh heavenly father...please be with us today as Mr. X goes through this trying time...etc etc etc". I dont have the slightest clue how to pray out loud, it is a very strange thing to do with someone you dont know while the OR staff is watching. But how could you say no? How would the patient feel if they thought the guy putting them to sleep doesnt believe in God. Not that I am saying that...I just dont pray out loud.

However, I do pray when the sheit hits the fan! I pray OUT LOUD to GOD and JESUS CHRIST himself.

 

[Coastie]

Nothing wrong with praying with a patient if they ask you to. Christians practice medicine, Muslims do too, as well as Atheists. Each one needs to use discretion and wisdom at keeping a balance between their application of religion in their daily lives with the desires and comfort levels of each patient.

 

[Taurus]

His bubble will burst when he starts to look for a job and can't find anything but being a nurse.

 

[BLADEMDA]

What if your patient asked you to pray before going under. I had that happen several times....and I am not a religous guy...AT ALL. It was hard, but I spoke a few words...."oh heavenly father...please be with us today as Mr. X goes through this trying time...etc etc etc". I dont have the slightest clue how to pray out loud, it is a very strange thing to do with someone you dont know while the OR staff is watching. But how could you say no? How would the patient feel if they thought the guy putting them to sleep doesnt believe in God. Not that I am saying that...I just dont pray out loud.

However, I do pray when the sheit hits the fan! I pray OUT LOUD to GOD and JESUS CHRIST himself.

To borrow a line from Alec Baldwin you might want to pray for a REAL BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST to help you. That AND J.C. would go a long way.

Blade

 

[Coastie]

Where is MacGuyver and his profile quote? We're talking about DNP's AND Alec Baldwin, and he's not here?

To borrow a line from Alec Baldwin you might want to pray for a REAL BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST to help you. That AND J.C. would go a long way.

Blade

 

[rmh149]

To borrow a line from Alec Baldwin you might want to pray for a REAL BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST to help you. That AND J.C. would go a long way.

Blade

LOL, I honestly thought about puttin something to that effect on my post..... 🙂

Hell, when I have to pray.....I pray for anyone to come help...and yes! if a BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST walked in I certainly wouldnt kick him out.

 

[deleted50478]

I searched on yahoo for dnp anesthesia. The first thing that came up was UT Memphis which had the following:
"The DNP program is web-enhanced (primarily online, with required on-campus component)...Students are required to be on campus four times yearly, at the start and end of each term. Each on-campus time is typically one week (Monday-Friday).
no dissertation requirement"

I had no idea how ridiculous it was. I mean I knew the notion of doctor-nurse was idiotic, but I didn't know how minimal the 'doctoral level' training is.

 

[toughlife]

I searched on yahoo for dnp anesthesia. The first thing that came up was UT Memphis which had the following:
"The DNP program is web-enhanced (primarily online, with required on-campus component)...Students are required to be on campus four times yearly, at the start and end of each term. Each on-campus time is typically one week (Monday-Friday).
no dissertation requirement"

I had no idea how ridiculous it was. I mean I knew the notion of doctor-nurse was idiotic, but I didn't know how minimal the 'doctoral level' training is.

It's a doctorate for idiots--those idiotic enough to believe it is a real doctorate.

 

[CremeSickle]

Look up PT and OT Doctorates, even worse.

 

[Coastie]

Bingo!

It was, according to him, "one of the firsts", and is a "leader in DNP education".

"One week of very intense classes, four times a year".

I searched on yahoo for dnp anesthesia. The first thing that came up was UT Memphis which had the following:
"The DNP program is web-enhanced (primarily online, with required on-campus component)...Students are required to be on campus four times yearly, at the start and end of each term. Each on-campus time is typically one week (Monday-Friday).
no dissertation requirement"

I had no idea how ridiculous it was. I mean I knew the notion of doctor-nurse was idiotic, but I didn't know how minimal the 'doctoral level' training is.

 

[jwk]

Having said that, i watched a surgeon pray in the OR that the surgery would go well, i wanted to jump out of my own skin. There is no place for religion in the OR or in medicine (IMHO).

Sorry Creme, you're WAY off base. Just because you don't share someone's faith doesn't mean you should be ridiculing it. That's patently offensive to many of us.

Virtually every hospital in the country has a chaplain, or even several chaplains of different faiths. Many patients have their pastor/rabbi/priest with them prior to surgery. Every patient that is admitted to the hospital as an inpatient or for surgery is asked if they have a religious preference and some will ask if they would like their pastor/rabbi/priest kept in the loop should the need arise. Although not all that common in our hospital, we have several surgeons that will pray with their patients prior to surgery if requested or as part of their usual routine.

I'm curious - do you laugh at or criticize Jewish doctors that wear their yarmulke's in the hospital? Oh - and do you gladly take the day off on Christmas? Hey - no place for religion in the OR or medicine, right?

 

[Trisomy13]

if a BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST walked in I certainly wouldnt kick him out.

well... you couldn't

 

[Fastrach]

Here's how my patient-requested OR prayer session went during my MAC case the other day:

Pt: "Can we say a prayer before I go to sleep?"
Me: "Sure."
Pt: "Heavenly father..."
Me: <pushing 50 of Propofol> "Amen."
Pt: "zzzzz"
Surgeon: "I believe!"

I think that's about as far as it should go, otherwise, it just gets annoying.

 

[Trisomy13]

Here's how my patient-requested OR prayer session went during my MAC case the other day:

Pt: "Can we say a prayer before I go to sleep?"
Me: "Sure."
Pt: "Heavenly father..."
Me: <pushing 50 of Propofol> "Amen."
Pt: "zzzzz"
Surgeon: "I believe!"

I think that's about as far as it should go, otherwise, it just gets annoying.

Try starting with something like "Oh Satan, my Dark Prince..." and see if you can calm the patient with the power of prayer.

i.e. religion is diverse and personal and one should not be expected to pray for a patient. and if they ask, go for it. "Hail Xenu, may this patient persevere the surgery and emerge Thetan Operational Level 8". well, that might fly in Clearwater...

 

[rmh149]

well... you couldn't

Yes I could...you had to go there didnt you. I am not supervised....but they are in the hospital (different group). I would never turn down help if it hit the fan....as I am sure they would not turn me down if I walked in.

 

[Noyac]

Yes I could...you had to go there didnt you. I am not supervised....but they are in the hospital (different group). I would never turn down help if it hit the fan....as I am sure they would not turn me down if I walked in.

You continue to show just how delusional you really are. If you were in trouble as a nurse and you "kicked out" a doctor that was coming to help you, you would be looking for a job so fast your head would spin. No hospital would keep a nurse around that thought they couldn't benefit from a real physician. And if you walk in to help out one of those physicians in the "different group" and they told you to get lost I would doubt that anyone would have a problem with it much less blame the real physician.

 

[BlackSails]

I read an interesting study dealing with prayer and post-op healing in a psych textbook. There were 4 groups in the study: Control, Secret Prayer, Prayer and False Prayer. The control was just normal. The secret prayer was praying for patients, but not telling them they were being prayed for. The prayer group was telling and praying for patients, and the false prayer was telling them, but not praying for patients. They found that the patients who are told they are being prayed for did worse on average than the others. The difference between secret prayer and control was not significant.

 

[Stimulate]

Try starting with something like "Oh Satan, my Dark Prince..." and see if you can calm the patient with the power of prayer.

i.e. religion is diverse and personal and one should not be expected to pray for a patient. and if they ask, go for it. "Hail Xenu, may this patient persevere the surgery and emerge Thetan Operational Level 8". well, that might fly in Clearwater...

Two approaches to the prayer situation:
1) You can combine it with the time-out..."Dearly Beloved, We are Gathered Here Today to Replace the Left Knee of Mr. X. If You Have Any Objections Speak Now or Forever Hold Your Peace"
2) Push your induction dose of propofol and whisper in their ear "Stay away from the light" (just kidding of course!!)

 

[amyl]

I have a story about NP vs med student.
for those of you that are not interested...ignore.
when i was a second year medical student, a friend calls me up and says he doesn't feel well. he has been vomiting since yesterday early evening and thinks he has food poisoning...the last thing he ate was a sandwich from the grocery store at about noon. he doesn't sound right though, mild distress i guess. he wants to go see someone locally and doesn't have insurance, so he ignores my advice to go to the ER which i argue with him for awhile and then I have to go to class.
he calls my mother in law, an NP, DBA with almost 30 years experience and says she will get him in today. at the time, she and i would pimp each other with patients and presentations in a nice way...if i would send her a patient i would tell her what i thought it was and what tests i would order etc. and see if i was right later. so I call her and and leave a message on her cell phone that this guy is coming to see her. he is claiming its food poisoning and just wants to stop throwing up. i didn't see him only talked to him on the phone but i tell her i think it is something more...the timing just isn't right for food poisioning, he sounds minorly in respiratory distress besides he is slightly overweight but no family hx of DM but still i think its got to be on the list so at least do a urine dipstick.
my friend calls me up at like 10pm that night. as a second year med student I had never heard Kussmaul's before but i knew it when i heard it anyways. I asked him what my MIL said and did for him. she gave him an anti-emetic and told him to drink lots of fluids. she didn't get my message.
i told him you have to go to the ER right now...right now...this time he listened. his blood sugar was 1200. he was admitted to the ICU where he spent quite some time and ran up a $100,000 bill (very little of which he actually paid but that is a discussion for another time) and he almost died.

i like to tell this story when people say we need mid-levels to save money.

how much does a urine dipstick test for glucose cost?

now maybe it was beginners luck... but diagnosed over the phone by a second year medical student....missed in person by an EXPERIENCED NP...
Before this happened I looked at her as my superior in medicine...someone that had so much experience over me that it would take me years to catch up... that a few years of medical school couldn't compete with 30 years of experience... But I guess it can.
There really is no substitute for the real thing.

 

[CremeSickle]

*sigh*

Talking to the chaplain prior to the Op is one thing, praying in the OR is a whole different story. Im not going to do it for a patient or anyone else.

We have muslim and jewish employees at the hospital and they wear their religious garb. That dosent bother me at all nor does it impinge on anyone else to do so.

I dont personally feel that a physicians religious or political doctrine has any place in medicine under any circumstance (in the hospital). You dont have to like it, thats why its a free country.

PS I have worked every Xmas that I can remember in recent history so that others can be with their families.

Sorry Creme, you're WAY off base. Just because you don't share someone's faith doesn't mean you should be ridiculing it. That's patently offensive to many of us.

Virtually every hospital in the country has a chaplain, or even several chaplains of different faiths. Many patients have their pastor/rabbi/priest with them prior to surgery. Every patient that is admitted to the hospital as an inpatient or for surgery is asked if they have a religious preference and some will ask if they would like their pastor/rabbi/priest kept in the loop should the need arise. Although not all that common in our hospital, we have several surgeons that will pray with their patients prior to surgery if requested or as part of their usual routine.

I'm curious - do you laugh at or criticize Jewish doctors that wear their yarmulke's in the hospital? Oh - and do you gladly take the day off on Christmas? Hey - no place for religion in the OR or medicine, right?

 

[jwk]

I dont personally feel that a physicians religious or political doctrine has any place in medicine under any circumstance (in the hospital). You dont have to like it, thats why its a free country.

Since we're way off topic anyway 😉 ... Based on religious beliefs,

Should an OB refuse to perform an abortion, or an anesthesiologist refuse to provide anesthesia for one?

Should a pharmacist refuse to fill a prescription for a morning-after pill?

Should a patient be able to demand or refuse a specific anesthesia provider based on the patient's or the provider's religious beliefs, gender, race, sexuality, etc.?

Just some philosophical / hypothetical questions - not yanking your chain anymore.

 

[proclivity]

To borrow a line from Alec Baldwin you might want to pray for a REAL BOARD CERTIFIED PHYSICIAN ANESTHESIOLOGIST to help you. That AND J.C. would go a long way.

Blade

I saw malice for the first time last week....it was pretty darn entertaining, albeit disturbing at times.

 

[fval28]

Since we're way off topic anyway 😉 ... Based on religious beliefs,

Should an OB refuse to perform an abortion, or an anesthesiologist refuse to provide anesthesia for one?

YES- I have refused to take place in any elective AB's since training and have not done one (that I know of). I am not a profoundly religious person but I find the whole notion of elective abortion to be something that I cannot logically or morally come to grips with. In fact I think if a provider has such strong objections and feels that those feelings may compromise patient care, one has an obligation to recuse him/herself from the case and prompt the woman to find what she wants elsewhere

 

[rmh149]

You continue to show just how delusional you really are. If you were in trouble as a nurse and you "kicked out" a doctor that was coming to help you, you would be looking for a job so fast your head would spin. No hospital would keep a nurse around that thought they couldn't benefit from a real physician. And if you walk in to help out one of those physicians in the "different group" and they told you to get lost I would doubt that anyone would have a problem with it much less blame the real physician.

Noyac...not delusional. Why do you get so offended? I have asked an anesthesiologist nicely to leave during a difficult case. Not because I didnt want an anesthesiologist there, but because he tried to take over the anesthetic management. I owned the case...cant have two captains. If I start it, I stay with it till the end. I already had plenty of help anyway and he was more in the way than being helpful. I needed his advice and ideas, not for him to just take over. Thank goodness it has only happened once.

YES- I have refused to take place in any elective AB's since training and have not done one (that I know of). I am not a profoundly religious person but I find the whole notion of elective abortion to be something that I cannot logically or morally come to grips with. In fact I think if a provider has such strong objections and feels that those feelings may compromise patient care, one has an obligation to recuse him/herself from the case and prompt the woman to find what she wants elsewhere

BRAVO! Same here.

 

[me454555]

Since we're way off topic anyway 😉 ... Based on religious beliefs,

Should an OB refuse to perform an abortion, or an anesthesiologist refuse to provide anesthesia for one?

IMO, no. There are parts of everyones job that they don't like but if you chose to practice OB or anesthesia, you're going to be confronted with these types of dilemmas. If you have a problem, don't go into it.

Should a pharmacist refuse to fill a prescription for a morning-after pill?

No. Same premise as above, if you have a moral objection, don't become a pharmacist.

Should a patient be able to demand or refuse a specific anesthesia provider based on the patient's or the provider's religious beliefs, gender, race, sexuality, etc.?

This depends. If the person is a cash only pt then yes, it's their dime, they should get what they want. Unless of course its an emergency and there's no one else. If this is a medicare pt or a no pay patient then no b/c they are not paying for the procedure so they don't get a choice. HMOs grey area b/c the pt is paying for it but they're alos not. I'd tend to side with no here though if I had to give a definative answer.

Just some philosophical / hypothetical questions - not yanking your chain anymore.

In the first 2 situations, the pt is the one asking for the procedure. Their rights must be respected and there becomes a slippery slope when you start denying treatments for religious reasons. What if a JW physician is asked to give blood? Should they be allowed deny doing it b/c it's against their religion? If you can't handle these aspects of medicine then medicine is not the right job for you, or at the very least, you shouldn't be in OB or anesthesia. It always bugs me when a physician institutes their beliefs on another pt. It's their bodies, not ours and we should always respect their rights to choose.

 

[proclivity]

I have a story about NP vs med student.
for those of you that are not interested...ignore.
when i was a second year medical student, a friend calls me up and says he doesn't feel well. he has been vomiting since yesterday early evening and thinks he has food poisoning...the last thing he ate was a sandwich from the grocery store at about noon. he doesn't sound right though, mild distress i guess. he wants to go see someone locally and doesn't have insurance, so he ignores my advice to go to the ER which i argue with him for awhile and then I have to go to class.
he calls my mother in law, an NP, DBA with almost 30 years experience and says she will get him in today. at the time, she and i would pimp each other with patients and presentations in a nice way...if i would send her a patient i would tell her what i thought it was and what tests i would order etc. and see if i was right later. so I call her and and leave a message on her cell phone that this guy is coming to see her. he is claiming its food poisoning and just wants to stop throwing up. i didn't see him only talked to him on the phone but i tell her i think it is something more...the timing just isn't right for food poisioning, he sounds minorly in respiratory distress besides he is slightly overweight but no family hx of DM but still i think its got to be on the list so at least do a urine dipstick.
my friend calls me up at like 10pm that night. as a second year med student I had never heard Kussmaul's before but i knew it when i heard it anyways. I asked him what my MIL said and did for him. she gave him an anti-emetic and told him to drink lots of fluids. she didn't get my message.
i told him you have to go to the ER right now...right now...this time he listened. his blood sugar was 1200. he was admitted to the ICU where he spent quite some time and ran up a $100,000 bill (very little of which he actually paid but that is a discussion for another time) and he almost died.

i like to tell this story when people say we need mid-levels to save money.

how much does a urine dipstick test for glucose cost?

now maybe it was beginners luck... but diagnosed over the phone by a second year medical student....missed in person by an EXPERIENCED NP...
Before this happened I looked at her as my superior in medicine...someone that had so much experience over me that it would take me years to catch up... that a few years of medical school couldn't compete with 30 years of experience... But I guess it can.
There really is no substitute for the real thing.

Once again i am ashamed for the NP......i am glad your friend survived. It sounds like he didn't have very much time left. Probably would have been in a coma in less than 24 hours. Go to sleep and never wake up probably.

I have seen the outcomes of a DKA coma in the SICU, it is not a pretty sight.

 

[rmh149]

In the first 2 situations, the pt is the one asking for the procedure. Their rights must be respected and there becomes a slippery slope when you start denying treatments for religious reasons. What if a JW physician is asked to give blood? Should they be allowed deny doing it b/c it's against their religion? If you can't handle these aspects of medicine then medicine is not the right job for you, or at the very least, you shouldn't be in OB or anesthesia. It always bugs me when a physician institutes their beliefs on another pt. It's their bodies, not ours and we should always respect their rights to choose.

An EAB is "elective". Whats wrong with ellecting not doing the anesthesia? They can go somewhere else.

 

[CremeSickle]

Well...

Should an OB refuse to perform an abortion, or an anesthesiologist refuse to provide anesthesia for one?

I will say this. Personally, i feel that refusing care to anyone based on YOUR personal beliefs is unethical. I personally feel that if someone has these "religious" dilemmas they should reconsider the profession they have chosen, which is an unbiased PATIENT centered and NON-JUDGMENTAL profession.

Now, realistically, I have no problem switching rooms with someone who may have some 'religious' objections, as a personal courtesy and when resources permit. However, to refuse anyone care based on ones own personal beliefs is certainly unethical.

Should a pharmacist refuse to fill a prescription for a morning-after pill?

If i felt that drinking alcohol was "wrong" i wouldnt work at a liquor store or one which sells alcohol. I dont see any difference here.

Should a patient be able to demand or refuse a specific anesthesia provider based on the patient's or the provider's religious beliefs, gender, race, sexuality, etc.?

Absolutely. Medicine, regardless of what individuals may think, is a service industry. Patients always choose what they want regardless of their reasons why and we should respect that choice.

 

[proclivity]

If i felt that drinking alcohol was "wrong" i wouldnt work at a liquor store or one which sells alcohol. I dont see any difference here.

that is one damn valid point......👍

 

[jetproppilot]

Sorry Creme, you're WAY off base. Just because you don't share someone's faith doesn't mean you should be ridiculing it. That's patently offensive to many of us.

Virtually every hospital in the country has a chaplain, or even several chaplains of different faiths. Many patients have their pastor/rabbi/priest with them prior to surgery. Every patient that is admitted to the hospital as an inpatient or for surgery is asked if they have a religious preference and some will ask if they would like their pastor/rabbi/priest kept in the loop should the need arise. Although not all that common in our hospital, we have several surgeons that will pray with their patients prior to surgery if requested or as part of their usual routine.

I'm curious - do you laugh at or criticize Jewish doctors that wear their yarmulke's in the hospital? Oh - and do you gladly take the day off on Christmas? Hey - no place for religion in the OR or medicine, right?

I was very similar to Creme in the beginning of my career.

Until I was witness to a cuppla cases....call them miracles if you want....that convinced me how not-in-control I am of....life.....which includes patient outcomes.

I posted that case in detail quite a while ago....wonder if somebody could find that post.

Trinity probably remembers that case....an early 40s dude who came crashing through the OR doors straight from cath lab....CPR in progress, blue as a Smurf......yeah, T Mack the heart surgeon did his heart surgery thing, and I did my anesthesiologist thing....but our actions didnt save this guy....I believe God did.

Dude walked outta the hospital and continues to live a normal life.

I'm not the bible-pushing type.

But I do believe in God. And prayer.

As far as I'm concerned, I'm just an instrument.

 

[me454555]

An EAB is "elective". Whats wrong with ellecting not doing the anesthesia? They can go somewhere else.

They elected to have you do their surgery and chose you as the anesthetist not the other way around. We provide a service and shouldn't turn people down based on race, gender, sexual orientation, or beliefs. As I've said before it's a slippery slope once you start talking about turning down cases for "moral" reasons. Ultimately, I feel you should look at yourself before you go into medicine and examine these questions, not after. People need to realize that part of being a health care provider is that you will have to make decisions like this. If you're not comfortable with it pick a different field. Many people chose not to go into medicine b/c they can't deal with blood and guts or other aspects of the job, why should this be any different?

 

[rmh149]

They elected to have you do their surgery and chose you as the anesthetist not the other way around. We provide a service and shouldn't turn people down based on race, gender, sexual orientation, or beliefs. As I've said before it's a slippery slope once you start talking about turning down cases for "moral" reasons. Ultimately, I feel you should look at yourself before you go into medicine and examine these questions, not after. People need to realize that part of being a health care provider is that you will have to make decisions like this. If you're not comfortable with it pick a different field. Many people chose not to go into medicine b/c they can't deal with blood and guts or other aspects of the job, why should this be any different?

I dont totally disagree with you. What I do is stay away from institutions where EAB's are performed....very few do. So far I have not been presented with this problem.

 

[DOAnestMan]

They elected to have you do their surgery and chose you as the anesthetist not the other way around. We provide a service and shouldn't turn people down based on race, gender, sexual orientation, or beliefs. As I've said before it's a slippery slope once you start talking about turning down cases for "moral" reasons. Ultimately, I feel you should look at yourself before you go into medicine and examine these questions, not after. People need to realize that part of being a health care provider is that you will have to make decisions like this. If you're not comfortable with it pick a different field. Many people chose not to go into medicine b/c they can't deal with blood and guts or other aspects of the job, why should this be any different?

That argument has always puzzled me. As a provider, I would not be "forcing" my personal belief by refusing to take part in an EAB. A similar argument is not made for euthanasia. If a patient came in asking his/her death to be hastened, I imagine a large majority of providers would refuse to assist with this. Would such a provider then be guilty of forcing their beliefs on the patient? Just because an individual is comfortable or does not find anything immoral about EABs does not mean that someone who personally objects is unprofessional in any sense of the word. Some providers who believe a fetus is a living human being and do not want to take part in what they see as infanticide should not be judged by a more "progressive" provider who views themself as superior simply because they take part in a procedure like an EAB.

 

[johankriek]

Since we're way off topic anyway 😉 ... Based on religious beliefs,

Should an OB refuse to perform an abortion, or an anesthesiologist refuse to provide anesthesia for one?

YES- I have refused to take place in any elective AB's since training and have not done one (that I know of). I am not a profoundly religious person but I find the whole notion of elective abortion to be something that I cannot logically or morally come to grips with. In fact I think if a provider has such strong objections and feels that those feelings may compromise patient care, one has an obligation to recuse him/herself from the case and prompt the woman to find what she wants elsewhere

i wish i could morally refuse to take care of anyone who smokes and is obese..

 

[Trisomy13]

Yes I could...you had to go there didnt you. I am not supervised....but they are in the hospital (different group). I would never turn down help if it hit the fan....as I am sure they would not turn me down if I walked in.

I'd like to visit your world. This whole "reality" thing is a drag, man.

 

[Taurus]

I have asked an anesthesiologist nicely to leave during a difficult case. Not because I didnt want an anesthesiologist there, but because he tried to take over the anesthetic management. I owned the case...cant have two captains. If I start it, I stay with it till the end. I already had plenty of help anyway and he was more in the way than being helpful. I needed his advice and ideas, not for him to just take over. Thank goodness it has only happened once.

If you just need an anesthesiologist around so that you can get some freebie advice when you're in over your head, then the anesthesiologist would be wise to not give you any advice in the first place. After he leaves because there can't be "two captains" (who's the other other captain besides the anesthesiologist guy?) and the **** hits the fan because you screwed up, guess who's gonna get named in a lawsuit?

 

[rmh149]

If you just need an anesthesiologist around so that you can get some freebie advice when you're in over your head, then the anesthesiologist would be wise to not give you any advice in the first place. After he leaves because there can't be "two captains" (who's the other other captain besides the anesthesiologist guy?) and the **** hits the fan because you screwed up, guess who's gonna get named in a lawsuit?

You know, when we are taking care of people we don’t think about "freebie advice". Two...three....four...etc. heads are always better than one, even when a CRNA walks in to help an anesthesiologist. It does happen.

The **** hits the fan for many reasons.....I fix it just like any other anesthesia provider. It’s what we do.

Taurus, your post does not offend me because I know it is way too early in your quest toward anesthesia to understand what exactly it means when 'the **** hits the fan" or what is considered "over my head". I will never put a patient under that is over my head. I know my limitations. And problems occur it doesn’t mean I am immediately over my head. It doesn’t necessarily mean I screwed up. The suggesting that the **** hits the fan because I screwed up coming from someone who has not even started their anesthesia residency is truly laughable.

I know you think just because one is an anesthesiologist as soon as they walk in the room they are in charge. That’s not how it works everywhere.

Now, please, don’t run with this and start a bunch of crap about CRNA's vs MD/DO's. We are not equal...board certified anesthesiologists as a whole are superior. I know that and agree with it.

 

[me454555]

That argument has always puzzled me. As a provider, I would not be "forcing" my personal belief by refusing to take part in an EAB. A similar argument is not made for euthanasia. If a patient came in asking his/her death to be hastened, I imagine a large majority of providers would refuse to assist with this. Would such a provider then be guilty of forcing their beliefs on the patient? Just because an individual is comfortable or does not find anything immoral about EABs does not mean that someone who personally objects is unprofessional in any sense of the word. Some providers who believe a fetus is a living human being and do not want to take part in what they see as infanticide should not be judged by a more "progressive" provider who views themself as superior simply because they take part in a procedure like an EAB.

To my knowlege, euthenasia is illegal in most states so this becomes a legal argument rather than a moral one. My personal beliefs in this situation are irrelevant. EAB OTOH is a perfectly legal procedure. 1 person refusing to perform an EAB isn't too big a deal but if enough people refuse to do perform it then this can certainly interfere w/a patients right to chose. I feel that my responsability is toward the pt and I put my own beliefs aside when I'm working with a patient.