Taking Umbrage at the "If a CRNA had been there..." Idiocy

[BuzzPhreed]

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Hey, genius (yeah, you - bomoss). Did you even read the case I posted?

The CRNA claimed respondeat superior in the case and the surgeon's liability - for this CRNA's SOLO AND WITHOUT HELP GROSS NEGLIGENCE - was $800,000!

If an anesthesiologist had been there, the surgeon's liability would have most likely been significantly less -- and probably would have been $0.00.

Captain of the ship! It applies. I don't care how much case law you have accumulated. The fact is that this particular CRNA - whether you like it or not - successfully used it as a defense tactic and to share liability!

 

[deleted171991]

So with that ive done all i needed to do.

The truth is that, in most states, a surgeon with an independent CRNA in the room may and will probably be treated as captain of the ship, until new legal precedent is created. The doctrine is not changing as fast as the AANA would like us to believe.

Please give us examples where the surgeon was not significantly liable (in a jury decision) for the anesthesia errors committed by an independent CRNA.

 

[deleted171991]

Regardless, the case law does not lie and neither do actuaries.

Only the AANA.

If actuaries don't lie, please explain us why CRNA malpractice insurance premiums are few times lower than anesthesiologists', even in independent practice states? Is there no relationship to the fact that there are zero cases we know about where a CRNA was judged to be the sole provider responsible for an anesthesia error? Really?

 

[PlutoBoy]

It's a shame that we need to resort to "MDA" to refer to anesthesiologists (if I'm getting it right). In my book there is only one kind of anesthesiologist (and they do not pad their credentials by adding letters to their professional degree).

What's next? A CRNI (Certified AAAAAND REGISTERED nurse INTENSIVIST)?

 

[Baller MD]

It's a shame that we need to resort to "MDA" to refer to anesthesiologists (if I'm getting it right). In my book there is only one kind of anesthesiologist (and they do not pad their credentials by adding letters to their professional degree).

What's next? A CRNI (Certified AAAAAND REGISTERED nurse INTENSIVIST)?

Don't forget these as well: John/Jane Doe RN, BSN, MSN, DNP, CRNA, CRNI, DNAP, ROFL, etc.

 

[BLADEMDA]

You might want to actually read the newsletter bub. It talks about surgeon liability with CRNAs in general and RARELY mentions MDAs. Regardless, the case law does not lie and neither do actuaries.

Not that I expect people with tunnel vision and a chip on their shoulders to change their opinion in the face of evidence, that would be a Christmas miracle. However, those reading who post or not, are MDAs or not can see the hypocrisy and reality here. So with that ive done all i needed to do.

Your view of the legal world is just that...your AANA view. In the Optho case above if there had been an Anesthesiologist like myself there would have been NO BAD OUTCOME and if there was a bad outcome I would have taken the heat, all the heat.

Again, why is it a million dollar liability policy for a CRNA is $5K while an Anesthesiologist pays $20K? The answer is because lawyers like to sue the DOCTOR involved in the case. CRNAs are not sued or are co-defendants because they are Nurses. This limits the actual exposure to payouts which is why the actuaries charge 1/4 the amount for the policy.

Plenty of Juries, Judges, Lawyers don't share your B.S. AANA centered view of the law. Instead, they will use the case to show the poor Nurse was just following the doctor's orders.

I agree there are cases where the Surgeon was not held liable for the actions of the CRNA. That said, all medical decisions regarding perioperative care will belong 100% to the surgeon. Anesthesiologists as Medical Doctors share that burden or assume most of it which is why we pay $20K per year for Malpractice.

CRNAs are a liability to the Surgeon but as long as they profit from that liability they will use them. This is why Plastic Surgeons, Gi doctors, Opthalmologists, ASCs choose CRNAs: they profit from the anesthesia revenue so they accept the liability.

When the **** hits the fan in the room the Advanced Practice Nurse will be doing the anesthesia while I do Acute/Critical Care medicine and save the patient's life. Without me the Surgeon must deal with EVERYTHING going on with the patient except the SEVO vaporizer.

 

[BLADEMDA]

Hey, genius (yeah, you - bomoss). Did you even read the case I posted?

The CRNA claimed respondeat superior in the case and the surgeon's liability - for this CRNA's SOLO AND WITHOUT HELP GROSS NEGLIGENCE - was $800,000!

If an anesthesiologist had been there, the surgeon's liability would have most likely been significantly less -- and probably would have been $0.00.

Captain of the ship! It applies. I don't care how much case law you have accumulated. The fact is that this particular CRNA - whether you like it or not - successfully used it as a defense tactic and to share liability!

Exactly. Your post shows the AANA doesn't allow other legal cases into the discussion. Anything which goes against their Propaganda is simply ignored. We need to publish these cases so Surgeons can see there is RISK in using second tier providers who aren't adequately trained to deal with intraop emergencies.

 

[gasdoc1]

All of this stuff assumes we have to convince the public that we are better. We don't. We are doctors. They are nurses. 99.9% of the population doesn't even question whether or not we are better. Trying to convince the public that we provide better care than nurses is like trying to convince them that the sky is blue. If the AANA has such a great PR campaign, how come nobody has ever heard it, other than nurses and us? On the extremely rare occasion that someone asks me if nurse anesthetists are like doctors (maybe twice in my 15 years) I just say, "They are nurses and we are doctors. Who would you rather trust when a loved one is getting something as dangerous as anesthesia?" Thats all it takes. No need to go into details. In fact, arguing further than that just gives them credibility. Like we are in a position where we have to defend ourselves. We don't. We just have to maintain how laughable the question even is, and that 0.1% will come to believe what the other 99.9% already know. That only in some bizarro, alternate universe is a nurse better than a doctor.

 

[BuzzPhreed]

All of this stuff assumes we have to convince the public that we are better. We don't. We are doctors. They are nurses. 99.9% of the population doesn't even question whether or not we are better. Trying to convince the public that we provide better care than nurses is like trying to convince them that the sky is blue. If the AANA has such a great PR campaign, how come nobody has ever heard it, other than nurses and us? On the extremely rare occasion that someone asks me if nurse anesthetists are like doctors (maybe twice in my 15 years) I just say, "They are nurses and we are doctors. Who would you rather trust when a loved one is getting something as dangerous as anesthesia?" Thats all it takes. No need to go into details. In fact, arguing further than that just gives them credibility. Like we are in a position where we have to defend ourselves. We don't. We just have to maintain how laughable the question even is, and that 0.1% will come to believe what the other 99.9% already know. That only in some bizarro, alternate universe is a nurse better than a doctor.

This is exactly the attitude that has gotten us into this mess.

The patient's don't decide who is in the OR giving anesthesia. Administrators do. That's the audience. How do I know this? I regularly meet with some of those administrators.

 

[Spinach Dip]

All of this stuff assumes we have to convince the public that we are better. We don't. We are doctors. They are nurses.

I think the more important question is: Is the public even aware that this is an issue?

Sure, the 99% may already agree that MDAs are superior, but 99% of those don't have any idea what the difference between an MDA and a CRNA is.



Go ahead and conduct a poll. Ask the non-medical population what the difference is. I wager the vast majority would stare at you like you're speaking another language....WHICH IS EXACTLY THE PROBLEM. How can the public think doctors are better when they don't even know there's an issue in the first place?

 

[deleted171991]

This is exactly the attitude that has gotten us into this mess.

The patient's don't decide who is in the OR giving anesthesia. Administrators do. That's the audience. How do I know this? I regularly meet with some of those administrators.

Yep.

As I said before: in the last 5 years, I only remember one person who refused to be administered anesthesia by a CRNA, got dressed and left.

 

[gasdoc1]

This is exactly the attitude that has gotten us into this mess.

The patient's don't decide who is in the OR giving anesthesia. Administrators do. That's the audience. How do I know this? I regularly meet with some of those administrators.

I do as well, and never have they even questioned who is better. If your administrators are questioning it, then your department is doing something differently than mine.

 

[BuzzPhreed]

I do as well, and never have they even questioned who is better. If your administrators are questioning it, then your department is doing something differently than mine.

It's not a question of "better". It's a question of "good enough" + "cheaper" = more shareholder profit.

Our group (predominately physician) survives because we still bring in money AND we provide superior care. This is something that the administrators -- who, much like patients, have no real clue what the difference between an anesthesiologist and a nurse anesthetist is, thanks in no small part to the propaganda (some of which we've seen on this very thread) of the AANA -- need to be constantly reminded of.

 

[gasdoc1]

Yep.

As I said before: in the last 5 years, I only remember one person who refused to be administered anesthesia by a CRNA, got dressed and left.

How are you presenting the anesthesia care to the patient? We introduce our nurse anesthetists basically as "helpers". There is no reason a patient would refuse.

 

[k12balla]

Exactly what buzz said. Logically speaking, I agree, it is stating the obvious to promote our superiority. But this is psychological warfare, and as you can see from this troll, they flood the market with their propaganda, so much so that they actually and truly believe the bs that spews from their mouths.

I would not argue with a troll on this forum because it is irrational to try and rationalize with an irrational individual.

 

[gasdoc1]

It's not a question of "better". It's a question of "good enough" + "cheaper" = more shareholder
profit.

Our group (predominately physician) survives because we still bring in money AND we provide superior care. This is something that the administrators who, much like patients, have no real clue what the difference between an anesthesiologist and a nurse anesthetist is, thanks in no small part to the propaganda (some of which we've seen on this very thread) of the AANA.

Most groups aren't employed by the hospital. At least not in my area. "Cheaper" isn't even a question. It costs the hospital nothing, so of course they want doctors in charge.

 

[BuzzPhreed]

Most groups aren't employed by the hospital. At least not in my area. "Cheaper" isn't even a question. It costs the hospital nothing, so of course they want doctors in charge.

Well, until you start asking for too many subsidies...

 

[gasdoc1]

Well, until you start asking for too many subsidies...

A subsidy would be nice, but I guess not having one does provide me with certain freedoms.

I am not saying that there is no fight to be had. There is certainly one in the political arena. And I guess I will add to that, in the administrative arena, in some cases. But I was speaking in terms of the general public. And I still stand by my post in that respect.

 

[BuzzPhreed]

But I was speaking in terms of the general public. And I still stand by my post in that respect.

The general public gets whatever they get when they come to the hospital. You and I don't make those decisions. We can try to steer them, but we don't make them.

Fact is that there are many patients that call their nurse practitioner "doc" because, "you know, they're nice to me and listen like no other doctors I've seen". Do you think that CRNP is going to correct them? Doesn't matter if they get the worst healthcare advice on the planet.

That's all patients care about. Whomever is nice to them. That, and if the food in the hospital was good, if the lobby had a waterfall and a player piano and marble staircase, and if their hospital room looked more like a hotel room than a hospital room... and that they got "waited on" whenever they had a problem or concern.

That's the truth. I've heard patients say things like, "I just listened to my nurse because I couldn't understand a word the doctor was saying... and I don't think he was right anyway."

So, any propaganda -- any propaganda -- whether it be in the form of the near-meaningless Press-Ganey reports to informal surveys funded and published by specific special-interest groups are used as ammo by people forwarding their own agenda. And, if that agenda includes a substantial cost-savings to the healthcare system and increased profits for the shareholders of a corporation, you'd better have your own propaganda to battle it. Fiercely. Vociferously. And relentlessly.

 

[gasdoc1]

I think the more important question is: Is the public even aware that this is an issue?

Sure, the 99% may already agree that MDAs are superior, but 99% of those don't have any idea what the difference between an MDA and a CRNA is.



Go ahead and conduct a poll. Ask the non-medical population what the difference is. I wager the vast majority would stare at you like you're speaking another language....WHICH IS EXACTLY THE PROBLEM. How can the public think doctors are better when they don't even know there's an issue in the first place?

I agree with the first part of what you are saying. They don't know. When someone doesn't know, I think the best response is that anesthesiologists are doctors, and nurse anesthetists are nurses that assist the anesthesiologist. I think that is the logical conclusion that people readily accept. I don't think highlighting our differences helps us any more than that. Alerting them to the controversial stuff, only helps the CRNAs. It leads them to inquire further and makes it more likely to come across some of this BS propaganda that the AANA puts out. All they have to do is a google search. My response, pretty much shuts that down. Nurses assist doctors. That is what they are there for. Everybody knows that. End of discussion.

 

[deleted171991]

How are you presenting the anesthesia care to the patient? We introduce our nurse anesthetists basically as "helpers". There is no reason a patient would refuse.

The patient had OSA. The moment he walked in, he asked to be taken care of by an MD in the OR. When he was told that, in that place, it was not an option, he walked out. It was non-negotiable (he wanted the MD to be present all the time), and I respected him for that.

 

[deleted171991]

That's all patients care about. Whomever is nice to them. That, and if the food in the hospital was good, if the lobby had a waterfall and a player piano and marble staircase, and if their hospital room looked more like a hotel room than a hospital room... and that they got "waited on" whenever they had a problem or concern.

Absolutely true. This is why patients are less likely to sue doctors they like, despite bad medical care, and the opposite.

Most patients seem to appreciate a warm blanket more than surviving GA.

I remember a case from my intern year, when an elderly wealthy lady was brought in emergently by ambulance to my community hospital. She was used to her regional hospital, located 2o miles away, in a wealthy area, and looking like a 4-star hotel. This while ours looked like the cookie-cutter functional industrial assembly-lane place. The moment her family arrived they started complaining about the lack of carpets etc., and how they were donors at the other hospital and they wanted a transfer. The lady was in a bad shape, so that was out of the question. When she walked out the doors about a week later, she thanked us profusely, because she had never gotten such great medical care in the other place. But it took about 4-5 days to really convince the family that we were as competent, if not better, than their "hotel".

 

[656844]

When I had a colonoscopy done about 7 years ago, a CRNA did it. It didn't take much effort at all, just a simple IV sedation. Now if this was general surgery, I would have had a problem with that. I would want a fully licensed anesthesiologist M.D. doing anything to me in the OR.

 

[k12balla]

We are still referred to as Anesthesia by many in the OR, called MDAs on our own thread by RNs and our own brethren, and barely recognized as physicians in our own hospitals.

Next week, the ASA is sponsoring "Physician Anesthesiologists Week"...as if there is more than one kind of Anesthesiologist

"I would want a fully licensed anesthesiologist M.D. doing anything to me in the OR" This is also redundant....or are you implying that you are opposed to fully licensed D.O. Anesthesiologists?

For those who use care4 or similar EMRs when accessing a patient, you must assign a role: Attending Physician, Consulting Physician, or Anesthesiologist.

If you don't believe we are losing the PR campaign, you are in denial.

 

[BuzzPhreed]

In our EHR there is an option when reviewing documents to choose "anesthesiologist" in lieu of "consulting physician".

 

[IlDestriero]

EHRs are complicated. There may be a lot of reasons for a separate anesthesia designation. I don't want to get admit/dc and tranfer of care reminders, etc.
Our anesthesia system is heavily customized.
And I couldn't care less about that.

 

[BuzzPhreed]

EHRs are complicated. There may be a lot of reasons for a separate anesthesia designation. I don't want to get admit/dc and tranfer of care reminders, etc.
Our anesthesia system is heavily customized.
And I couldn't care less about that.

This is true. Valid point.

Still doesn't take away from the "no respect" part though.

It's funny. The surgeon's I regularly work with and do the bulk of the cases are awesome. They treat our group great. It's always the ones that bring next to zero business to the hospital, you know, like 1 case/every 2 months that are always the biggest pains in the ass.

There's a lot to be said about rapport. And that's the first thing that goes when you hire a big AMC with their rotating-door of providers. (You listening AMC lurkers? Incentivize physicians, and CRNAs for that matter, to stay.)

 

[GA8314]

This is true. Valid point.

Still doesn't take away from the "no respect" part though.

It's funny. The surgeon's I regularly work with and do the bulk of the cases are awesome. They treat our group great. It's always the ones that bring next to zero business to the hospital, you know, like 1 case/every 2 months that are always the biggest pains in the ass.

There's a lot to be said about rapport. And that's the first thing that goes when you hire a big AMC with their rotating-door of providers. (You listening AMC lurkers? Incentivize physicians, and CRNAs for that matter, to stay.)

Indeed. It may be different if a successful PP group sells their practice and negotiates some job security and $/year for x number of years.

But, these low-ball AMC's or even large exploitive PP groups that come in and undercut the existing group, bring in their low-ball anesthesiologists, Locums, whatever... Administrators need to have their head examined if they think that's the way forward.

I've seen enough of this crap happening such that it's becoming VERY clear (even to the most OBTUSE administrator) that this is a losers game. I really feel that these AMC's aren't going to last for too much longer. Sure, there are some with good structures, but "Low-Ball Anesthesia PC"? Their days are numbered, I think.

It's just too costly and overall upsetting to keep making these CHEAPO changes to staff with very little benefit as many hospitals are starting to figure out it seems.

I do believe there's a future for GOOD, local anesthesiologists, who commit themselves to the community, and provide excellent service. I also feel that some of the trends we're seeing will come full circle in due time.

 

[pgg]

That's the truth. I've heard patients say things like, "I just listened to my nurse because I couldn't understand a word the doctor was saying... and I don't think he was right anyway."

This isn't just medicine. It's a cultural shift that has accelerated the last 10-15 years ... it's trendy and cool to dismiss educated people of all kinds, whether it's the doctor with no "common sense" or the engineer who's "never turned a wrench" or the scientist in the "ivory tower". We're just fools who couldn't hack it in the School of Hard Knocks.

It has become socially acceptable to express derision and doubt of ALL highly educated people. We're just near the top of that list.

 

[Spinach Dip]

This isn't just medicine. It's a cultural shift that has accelerated the last 10-15 years ... it's trendy and cool to dismiss educated people of all kinds, whether it's the doctor with no "common sense" or the engineer who's "never turned a wrench" or the scientist in the "ivory tower". We're just fools who couldn't hack it in the School of Hard Knocks.

It has become socially acceptable to express derision and doubt of ALL highly educated people. We're just near the top of that list.

It's called "being in denial", and it has gotten more and more popular in recent years.

Remember, we live in a country where The Learning Channel airs shows like Honey Boo Boo, the History Channel airs shows like Ancient Aliens, and the Discovery Channel airs shows like Amish Mafia.

So go ahead and dismiss any facts that don't jive with your happy place.

 

[criticalelement]

I do believe there's a future for GOOD, local anesthesiologists, who commit themselves to the community, and provide excellent service. I also feel that some of the trends we're seeing will come full circle in due time.

What does that even mean? Every anesthesiologist who has a permanent job commits themselves to the community until they get screwed and have to move.

Thnk about it. Does the ceo care when janitors get replaced? No.

I think the AMCs may become defunct.. but not for the reasons you are talking about.

 

[deleted171991]

It has become socially acceptable to express derision and doubt of ALL highly educated people.

Do you know which countries were famous for their national policies of disrespecting (and downright exterminating) intellectuals? The communist/marxist ones. They also had about the same level of demagoguery and brainwashing one currently sees about doctors in the American media. (For better understanding, I recommend Orwell's Animal Farm.)

As a foreigner raised in the classical respect of smart educated people, I had a cultural shock when immigrating into a society where almost everybody is your equal and treats you as such. This is how aristocracy must have felt historically in the face of revolutions. Except that this country is not supposed to be a marxist one.

 

[BLADEMDA]

Do you know which countries were famous for their national policies of disrespecting (and downright exterminating) intellectuals? The communist/marxist ones. They also had about the same level of demagoguery and brainwashing one currently sees about healthcare in the American media.

As a foreigner raised in the classical respect of smart educated people, I had a cultural shock when immigrating into a society where all the *****s are your equal and treat you as such. This is how aristocracy must have felt historically in the face of revolutions. Except that this country is not supposed to be a marxist one.

Does Obama know we aren't a Marxist country? Or, is that what his transformation of America is all about?

 

[deleted171991]

I will never forget my day as a resident with one of the most respected names in American anesthesia. One of the OR or PACU nurses was speaking to him in such a disrespectful tone that, once he left, I literally burst out at her: "Do you know who this guy is, besides being a professor here?" That was the day I learnt that an anesthesiologist is really nobody.

Blade, this is by far not just about America. There is a strong egalitarian current in modern Western society, which looks down on old-school respect for one's elders and/or "wisers". They call everybody by their first names, even their doctors etc. No Mr. or Ms. or Dr., no Sir or Madam. Everybody has rights, nobody has obligations. Everybody is smart, beautiful and a winner. People are spoiled; there is a reason some draw a parallel with the fall of the Roman empire. The sleep of reason produces monsters.

As a kid, had I disrespected an adult in public, three strangers would have jumped to put me in place. Nowadays, kids are allowed (even encouraged by their "legal rights") to disrespect even their own parents, and nobody says anything. Hence a bunch of entitled generations at maturity. Look at the Millenials; we are just beginning to reap what we sowed.

I feel old.

 

[Ronin2258]

This isn't just medicine. It's a cultural shift that has accelerated the last 10-15 years ... it's trendy and cool to dismiss educated people of all kinds, whether it's the doctor with no "common sense" or the engineer who's "never turned a wrench" or the scientist in the "ivory tower". We're just fools who couldn't hack it in the School of Hard Knocks.

It has become socially acceptable to express derision and doubt of ALL highly educated people. We're just near the top of that list.

That is all I can say about that.

I will never forget my day as a resident with one of the most respected names in American anesthesia. One of the OR or PACU nurses was speaking to him in such a disrespectful tone that, once he left, I literally burst out at her: "Do you know who this guy is, besides being a professor here?" That was the day I learnt that an anesthesiologist is really nobody.

Blade, this is by far not just about America. There is a strong egalitarian current in modern Western society, which looks down on old-school respect for one's elders and/or "wisers". They call everybody by their first names, even their doctors etc. No Mr. or Ms. or Dr., no Sir or Madam. Everybody has rights, nobody has obligations. Everybody is smart, beautiful and a winner. People are spoiled; there is a reason some draw a parallel with the fall of the Roman empire. The sleep of reason produces monsters.

As a kid, had I disrespected an adult in public, three strangers would have jumped to put me in place. Nowadays, kids are allowed (even encouraged by their "legal rights") to disrespect even their own parents, and nobody says anything. Hence a bunch of entitled generations at maturity. Look at the Millenials; we are just beginning to reap what we sowed.

I feel old.

I would have been crucified.

 

[k12balla]

The Dumbing Down of America...Sensational news programming, the decay of our public education system, lower moral and ethical standards, perpetual debt that keeps you in manual labor for eternity, sugar in everything, reality TV where anybody with a hot bod or sassy mouth or sex tape can become a star, gladiator sports and over the top movies that help us to escape from our miserable existence, Sex & consumption...everywhere! All so we can be placated, consumed with irrelevant musings, and not engaged in intellectual discourse aimed at improving our society and humanity.

As FFP said, everyone is equal and everyone is a winner, the world revolves around you, and you deserve the best. So disrespect your teacher, argue with the officer, second guess your physician, demand restitution and denigrate your spouse....because by golly you deserve to be happy.

 

[gasdoc77]

All of this stuff assumes we have to convince the public that we are better. We don't. We are doctors. They are nurses. 99.9% of the population doesn't even question whether or not we are better. Trying to convince the public that we provide better care than nurses is like trying to convince them that the sky is blue. If the AANA has such a great PR campaign, how come nobody has ever heard it, other than nurses and us? On the extremely rare occasion that someone asks me if nurse anesthetists are like doctors (maybe twice in my 15 years) I just say, "They are nurses and we are doctors. Who would you rather trust when a loved one is getting something as dangerous as anesthesia?" Thats all it takes. No need to go into details. In fact, arguing further than that just gives them credibility. Like we are in a position where we have to defend ourselves. We don't. We just have to maintain how laughable the question even is, and that 0.1% will come to believe what the other 99.9% already know. That only in some bizarro, alternate universe is a nurse better than a doctor.

http://www.gomerblog.com/2014/10/nursing-degrees/

 

[BuzzPhreed]

http://www.gomerblog.com/2014/10/nursing-degrees/

Haha. Funny.

You do know that this story is completely fabricated though, right? Just making sure.

(Gomer blog is a medical satire site. It's 'The Onion' for doctors.)

 

[deleted171991]

Haha. Funny.

You do know that this story is completely fabricated though, right? Just making sure.

(Gomer blog is a medical satire site. It's 'The Onion' for doctors.)

Just realized the same thing, but wouldn't shock me even if it were true.

 

[gasdoc77]

Haha. Funny.

You do know that this story is completely fabricated though, right? Just making sure.

(Gomer blog is a medical satire site. It's 'The Onion' for doctors.)

come on guys gimmie a little credit. I know I'm no orthopod but......

 

[G0S2]

Opinion today in NY Post.

http://nypost.com/2015/01/06/when-a-nurse-is-your-health-care-provider-youre-at-risk/

 

[criticalelement]

Finally, someone is writing about this and it had to be the NY POST....

 

[BLADEMDA]

Finally, someone is writing about this and it had to be the NY POST....

On Jan. 1, New York changed the standard for who can practice medicine, putting patients at risk. It became the 19th state to capitulate to aggressive lobbying by nursing groups to let some nurses play doctor without going to medical school.

In these states, nurse practitioners can do everything primary-care doctors do — diagnose, treat, prescribe and even open their own independent practices — once they’ve worked 20 months under a physician’s direction.

That is, “can” legally. That doesn’t mean they have the know-how. And therein lies the danger.

Don’t get me wrong: Nurses are the backbone of the health-care system, and generally they’re better than doctors at educating patients and providing many types of routine care.

But their training is different, and it doesn’t prepare them to do everything doctors do — especially diagnosing less common conditions.

Nurse practitioners are registered nurses who’ve earned an advanced degree. But they’ve never been to medical school; they have half the years of training a doctor gets (generally six years beyond high school, instead of 12), and they don’t take the same state licensing exam as doctors.

So you’ll be fine if you have a urinary-tract infection or a sprain. But don’t assume they have the in-depth knowledge to diagnose an uncommon illness or handle a complex problem.

Indeed, Health Maintenance Organizations cooked up the term “health-care provider” to blur the differences between physicians and less expensive caregivers.

Dr. Sandeep Jauhar, a cardiologist at Long Island Jewish Medical Center, criticized New York’s law when it was enacted last April.

Medical students with “two years of clinical training are not considered fit to practice medicine,” he warned, but in the Empire State “nurse practitioners with perhaps even less clinical education will be allowed to do so.”

Lower cost is why insurers, drugstore chains with walk-in clinics and federal health programs applaud replacing doctors with nurse practitioners. It’s also why the Veterans Administration is considering cutting its backlog by sending vets to nurse practitioners.

But they don’t save money in the long run, Dr. Jauhar suggested, because they tend to order more CAT scans and MRIs than physicians treating similar patients — probably as a crutch to try to get to the right diagnosis.

 

[Pooh & Annie]

Does Obama know we aren't a Marxist country? Or, is that what his transformation of America is all about?

You have to wean yourself from that Fox teet. It makes you sound Ike an ignorant brainwashed person who doesn't know what Marxism is or what Obama might or might not be responsible for.

 

[BuzzPhreed]

You have to wean yourself from that Fox teet. It makes you sound Ike an ignorant brainwashed person who doesn't know what Marxism is or what Obama might or might not be responsible for.

Marxism? Okay that may be a stretch.

Seeing this country converted into a western-European style socialist democracy? That's more to his reality and worldview.

So, maybe you should open your eyes and realize that a lot of those commentators who regularly appear on Fox (and elsewhere) have a point.

http://www.post-gazette.com/opinion...r-historical-parenthesis/stories/201211030149

 

[BLADEMDA]

You have to wean yourself from that Fox teet. It makes you sound Ike an ignorant brainwashed person who doesn't know what Marxism is or what Obama might or might not be responsible for.

I'm fully aware of the difference between Socialism and Marxism. I think Obama would prefer Marxism but will settle for Socialism. But, since he is only President and not Emperor he couldn't get through his entire socialistic agenda for transforming America. But, here is what he did accomplish:

1. Massive Tax hikes
2. ACA/Obamacare with massive govt. subsidies
3. Massive Stimulus bills
4. Record level of disability and permanent unemployment
5. Record level of Food stamps
6. Record level of National Debt
7. Student loan Forgiveness
8. Increase of EPA regulations on Coal
9. Federal Loans/grants for Businesses he likes


Government grows in size and power as the individual shrinks into dependency. Until the tipping point where dependency becomes the new norm -- as it is in Europe, where even minor retrenchment of the entitlement state has led to despair and, for the more energetic, rioting.
Charles Krauthammer

 

[BuzzPhreed]

9. Increase and expansion of the surveillance state (http://www.washingtonexaminer.com/o...ion-of-the-surveillance-state/article/2542550)
10. Continuing and expanding costly secretive "war on terror" with drone strikes via unilateral presidential action -- remember he won the Nobel Peace Prize in 2009 (http://www.huffingtonpost.com/2014/01/23/obama-drone-program-anniversary_n_4654825.html)
11. Repeatedly blocking (and now threatening to veto) the Keystone Pipeline, a baffling move that stifles ongoing energy independence in the U.S.
12. Unilaterally opening a dialogue with Cuba without consulting Congress, which is probably going to fall apart because it was so ill-conceived
13. Worsening sense of national racial divide
14. Catastrophic immigration policy, again including unilaterally and without congressional approval amnesty (yes, that's what it is) for hundreds of thousands of illegal immigrants
15. Falsely creating a deadline for withdrawal from Iraq (and soon Afghanistan) and the subsequent creation of power gulf in that region leading to current massive instability
16. Vladimir Putin - 'nuff said
17. Despite completely getting his ass kicked in the 2014 midterms, he decided to dig his heals in and move even farther to the left

Yeah, with this ***** at the helm the next two years are going to be really productive.

 

[jwk]

You have to wean yourself from that Fox teet. It makes you sound Ike an ignorant brainwashed person who doesn't know what Marxism is or what Obama might or might not be responsible for.

Better wean yourself from that Obama teat.

 

[pgg]

16. Vladimir Putin - 'nuff said

No, say more.

That guy is a hairless cat away from being a James Bond villain (I'm sure he's got a volcano lair somewhere) but he's hardly masterminding Russia to world domination of late.

I'm not Ukrainian and I'm not interested in going to war with Russia over Ukraine. If he really wants to take it and fight a counterinsurgency war there for a while, I don't see a reason for us to get involved.

I think Obama's a bad president but I don't hold Putin against him.

17. Despite completely getting his ass kicked in the 2014 midterms, he decided to dig his heals in and move even farther to the left

People should know when they're conquered.

 

[BuzzPhreed]

No, say more.

First, Obama's brand of self-aggrandizing intellectualism and his "I'm right so why can't people just listen to and agree with me" attitude has lead him to conclude that it's a sense of nationalism and nostalgia for the cold war that has lead Putin to act the way he has.

Wrong.

Here's Obama's interview with Scott Pelley last March.

http://www.politico.com/story/2014/03/president-obama-vladimir-putin-105131.html

(Remember this is the same Obama who called ISIS the "junior varsity" squad of terrorists.)

It's actually a perception that Obama is weak and will not react with a strong stance that has emboldened Putin. Obama has a penchant for completely misjudging these types of situations.

http://www.wsj.com/articles/SB10001424052702304914204579395002605559222

Secondly because Obama continually misjudges this (and other) diplomatic situations, which is his usual M.O. (if you don't want to play my game, I'm gonna take away all my toys), the sanctions have done nothing to move the diplomatic relationship forward and instead has only further pissed-off Putin.

http://www.businessinsider.com/putin-sanctions-law-violate-2014-11

Lastly, putting it all together, Obama still believes that he is "winning" against Putin with his mamby-pamby diplomacy, which has had zero effect on Putin's maneuvering in Ukraine. He believes that non-provocation is "safer" when it actually only emboldens certain strong-arm political leaders around the world.

http://www.washingtontimes.com/news/2014/dec/21/obama-putin-hasnt-rolled-me-economic-sanctions-on-/