What Physicians Do

[mocdoc]

So I have been reading more than I ever wanted to about the difference between nurses and doctors (physicians). It seems that with all the crap with DRNP, CRNA . . . the most important thing physicians do is being over looked. Some nurse was spewing BS about how nurses take care of people on the floors and physicians write H&P's and do dictations, and was trying to explain that nurses are better at X & Y for whatever reason.

As physicians the most important thing we do is make decisions, some are small and a matter of preference and some are life and death. It is this decision making ability that takes 12+ years of post high school education to develop. Otherwise we would be technicians, similar to the nurses.

This is also part of the problem, as there is often little communication between the physicians and the nurses, it can appear that a physician comes to see a patient and does little in the way of decision making when in reality there were numerous silent decisions made every second. This is true for surgeons and family physicians. The decision making process, and the education as well as selection bias (remember that only 1/3 of applicants historically get into medical school) that it depends upon is why nurses should never be able to provide anesthetic care without a board certified anesthesiologist present and why PA's working for a cardiac surgeon should never be permitted to directly enter into a cardiothoracic surgery training program.

Any thoughts?

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[Tired Pigeon]

Agree with above.

Furthermore, I think that lover-level providers can perform about as well on some of the run-of-the-mill, routine things we do as long as nothing goes wrong. But when the unexpected happens - when you have a rare or difficult-to-diagnose disease, when you have an unexpected finding or complications in surgery, when you have a serious reaction to anesthesia - basically, when things go really bad really fast, I want a DOCTOR there. I want the knowledge, I want the experience, and I want the judgment that you only get from that training.

Not trying to start a flame war with other providers, but there's a REASON doctors have longer and more in depth training than any other medical professionals.

 

[mocdoc]

You could put me in at second base for the Chicago Cubs. . . providing nothing goes wrong . . . no difficult ground balls . . . and that I was far enough down in the lineup I promise that no one would know that I have not played baseball since high school. At least for a few innings.

I just thought of a response to the AANA billboard. Show two healthy attractive women, then the signs says "one has HIV, sometimes what you can't see on the surface can hurt you, make sure your anesthesia provider is a physician not a nurse that looks like one" . . . errr or something like that.

 

[urgewrx]

You could put me in at second base for the Chicago Cubs. . . providing nothing goes wrong . . . no difficult ground balls . . . and that I was far enough down in the lineup I promise that no one would know that I have not played baseball since high school. At least for a few innings.

I just thought of a response to the AANA billboard. Show two healthy attractive women, then the signs says "one has HIV, sometimes what you can't see on the surface can hurt you, make sure your anesthesia provider is a physician not a nurse that looks like one" . . . errr or something like that.

I'm glad to know you are not in the marketing field. No offense.

 

[urgewrx]

I think one way to go is getting the general public to help us. For example, take any of these states where CRNA's are lobbying for independence. We can have a campaing explaining people that as population ages and becomes sicker, they need the best medical care availabe. Yet, politicians are considering allowing nurses to practice anesthesia without supervision. Eplain them that they have a say in this, since they are the ones ultimately affected. Urging them to communicate their worries about this to their local legislators.

Radio ad: [pulse ox beep in background] If next time you, or your loved ones, have surgery and want a physician anesthesiologist to overlook your anesthetic care, call your state legislator before it is too late. [pulse ox desating until going into asystole alarms]

Another thing we can do is have the ASA , or AMA, hire an independent trusted company to survey the public regarding being taken care by nurses rather than physicians. We can bring this info to the legislators and let them know what the people they represent really want.
​

 

[mocdoc]

I think one way to go is getting the general public to help us. For example, take any of these states where CRNA's are lobbying for independence. We can have a campaing explaining people that as population ages and becomes sicker, they need the best medical care availabe. Yet, politicians are considering allowing nurses to practice anesthesia without supervision. Eplain them that they have a say in this, since they are the ones ultimately affected. Urging them to communicate their worries about this to their local legislators.

Radio ad: [pulse ox beep in background] If next time you, or your loved ones, have surgery and want a physician anesthesiologist to overlook your anesthetic care, call your state legislator before it is too late. [pulse ox desating until going into asystole alarms]

Another thing we can do is have the ASA , or AMA, hire an independent trusted company to survey the public regarding being taken care by nurses rather than physicians. We can bring this info to the legislators and let them know what the people they represent really want.
​

You are right on the mark. My HIV message above was partially meant to find some humor but also stems from how offensive I find the AANA's message. I am just getting started in this business, but I have yet to be impressed with most nurses, CRNA or otherwise. Granted there are thousands of exceptions, and I don't want to start a fight with that comment.

I think the most important issue is $$. Hitting major markets with radio and or TV propaganda along with a regional or national survey could cost . . . millions? I really have no idea. The AMA slant is a good one, it is broad, and nurses, pseudo-doctor-nurses, and other mid-levels are looking to pose a threat. The survey could be broad enough to benefit everyone, and in turn be paid for by everyone.

Also, old people vote, and more and more have a sense of entitlement to the best health care provided by the best physicians. If politicians feel that their electability depends on keeping the aging happy, they are less likely to open up opportunities for inferiorly trained mid levels to practice without supervision. Never mind the fact that the aging population poses a REAL challenge in taking care of older sicker patients than ever before in the OR.

 

[cfdavid]

You could put me in at second base for the Chicago Cubs. . . providing nothing goes wrong . . . no difficult ground balls . . . and that I was far enough down in the lineup I promise that no one would know that I have not played baseball since high school. At least for a few innings.

I just thought of a response to the AANA billboard. Show two healthy attractive women, then the signs says "one has HIV, sometimes what you can't see on the surface can hurt you, make sure your anesthesia provider is a physician not a nurse that looks like one" . . . errr or something like that.

That's hilarious. I've often reflected on getting thrown into a professional hockey game. I could "look" the part for a quick shift (very quick), but with any significant pressure, it would become blatantly obvious that I was WAY out of my "league"....lol

 

[VolatileAgent]

So I have been reading more than I ever wanted to about the difference between nurses and doctors (physicians). It seems that with all the crap with DRNP, CRNA . . . the most important thing physicians do is being over looked. Some nurse was spewing BS about how nurses take care of people on the floors and physicians write H&P's and do dictations, and was trying to explain that nurses are better at X & Y for whatever reason.

As physicians the most important thing we do is make decisions, some are small and a matter of preference and some are life and death. It is this decision making ability that takes 12+ years of post high school education to develop. Otherwise we would be technicians, similar to the nurses.

This is also part of the problem, as there is often little communication between the physicians and the nurses, it can appear that a physician comes to see a patient and does little in the way of decision making when in reality there were numerous silent decisions made every second. This is true for surgeons and family physicians. The decision making process, and the education as well as selection bias (remember that only 1/3 of applicants historically get into medical school) that it depends upon is why nurses should never be able to provide anesthetic care without a board certified anesthesiologist present and why PA's working for a cardiac surgeon should never be permitted to directly enter into a cardiothoracic surgery training program.

Any thoughts?

great summary.

what i find works and usually do is try to explain to nurses why i'm making a particular decision (outside the OR, of course... i don't have to explain my orders to myself) and i find this little extra effort usually reduces the amount of angst that the nurse has about a particular order, especially if it's something they're not accustomed to doing and/or don't maybe understand. plus, this gives them a little glimpse that you're actually thinking about the problem and not just barking out an order they may not understand the rationale behind.

sometimes i get blank stares. other times, they thank me. occasionally they may tell me something about the patient i didn't know or hadn't considered, and i might change my mind. even other times still, it'll result in an argument or confrontation... which is okay. you just have to be prepared for it, which means being the bigger professional. (somebody adeptly put it on this forum recently that there's a lot of "us" vs. the doctors in the hospital... which is sad, really, but largely our own doing as a profession.)

bottom line is that nurses (and techs) are professionals to... well, most of them. some are even actually quite clever, especially the critical care nurses and ancillary terrorrists... er... therapists with whom we often interact. but, occassionally they may not always understand why you are doing something. unfortunately, the current system has empowered them to say "no" based on their impression as to whether or not it's a legitimate order. this "power diffusion", as i like to call it, is intended to make healthcare delivery safer, but i've noticed that this usually just results in a substantial delay in what was already an effective care plan. they don't always realize that there may be more than one way to skin a cat. still, they should feel empowered to ask for clarification. many don't, and they won't even tell you that they've refused to carry out an order (or changed it, or substituted something else, or acted without an order purportedly under the guise of the patient's best interests, etc.).

the only time i really have a big problem is when they just flat out say "no". in that case (and when you know you're clearly correct), you'd better know how to do whatever it was that you'd asked them to do yourself (draw-up and inject a med, put a Foley in, change the vent settings, etc.)... and be prepared to go to their supervisor.

another word to the wise: if you get in a pissing match, you'd also better go back later and look what was written in the chart. ultimately, it'll be your ass in the hot seat if something goes wrong with that patient, despite what anyone else who tries to make you believe otherwise says. their documentation might sink you. if it's clearly inappropriate, insubordinate, unprofessional, dangerous (etc.), definitely photocopy it and give it to their supervisor.

 

[Lasvegas]

You could put me in at second base for the Chicago Cubs. . . providing nothing goes wrong . . . no difficult ground balls . . . and that I was far enough down in the lineup I promise that no one would know that I have not played baseball since high school. At least for a few innings.

I just thought of a response to the AANA billboard. Show two healthy attractive women, then the signs says "one has HIV, sometimes what you can't see on the surface can hurt you, make sure your anesthesia provider is a physician not a nurse that looks like one" . . . errr or something like that.

Those are flat out the best analogies I have heard regarding the MD / CRNA issue.

Another: I can just see a commercial with some lead singer in a major Rock Band dressed to the nines banging his head and acting the part while the band plays behind – then he runs up stage holding the mic about to launch - opens his mouth to sing - and sounds like Liza Minnelli or Peewee Herman. The camera goes to the audience showing total surprise.

Then the narrator comes on and says – appearances can be deceiving. The next time you need surgery, ask for an anesthesiologist – not a nurse.

 

[lane]

Those are flat out the best analogies I have heard regarding the MD / CRNA issue.

Another: I can just see a commercial with some lead singer in a major Rock Band dressed to the nines banging his head and acting the part while the band plays behind – then he runs up stage holding the mic about to launch - opens his mouth to sing - and sounds like Liza Minnelli or Peewee Herman. The camera goes to the audience showing total surprise.

Then the narrator comes on and says – appearances can be deceiving. The next time you need surgery, ask for an anesthesiologist – not a nurse.

Me an MD?! No, but I did stay in a Holiday Inn Express last night

 

[Lasvegas]

Me an MD?! No, but I did stay in a Holiday Inn Express last night

That is also a really good one – with one edit.

A patient on the table before going under,

‘Are you an anesthesiologist?’ ‘No, I’m a CRNA, but I did stay a Holiday Inn Express last night.’

 

[FSUCRNA]

That is also a really good one – with one edit.

A patient on the table before going under,

‘Are you an anesthesiologist?’ ‘No, I’m a CRNA, but I did stay a Holiday Inn Express last night.’[/quote

Pathetic. Once we get the DNAP degree the field will be leveled. Patients and Surgeons feel comfortable with Nurses. People know we do most of the work and they trust their surgeon. As long as the surgeon okays us with the patient there is no problem. We will step up our ad campaigns as well. Our Doctorate will insure patients have confidence and trust in the Anesthetist at their side.

 

[OB1🤙]

Pathetic. Once we get the DNAP degree the field will be leveled. Patients and Surgeons feel comfortable with Nurses. People know we do most of the work and they trust their surgeon. As long as the surgeon okays us with the patient there is no problem. We will step up our ad campaigns as well. Our Doctorate will insure patients have confidence and trust in the Anesthetist at their side.

Hi, Ether.

 

[FSUCRNA]

Hi, Ether.

Nitecap lives again. The MDA is going the way of the dinosaur. Why pay a Physician to do a Nurses job? The AANA is going to hammer this point all the way to Independence.

 

[jetproppilot]

Nitecap lives again. The MDA is going the way of the dinosaur. Why pay a Physician to do a Nurses job? The AANA is going to hammer this point all the way to Independence.

Geez....my bouncer days at Penrod's on Miami Beach are coming back to me....time to pull out a can...