Sunday, April 06, 2008

What Does A Family Nurse Practitioner Have To Offer In Primary Care?

In my travels on the blogosphere today, I stumbled upon an interesting conversation at DB's Medical Rants. The discussion entailed the difference in opinion regarding the meaning of the term Primary Care.
"Most internists and family doctors see primary care and think - continuity, comprehensiveness, chronicity, and episodic care. These important front line physicians care for patients with multiple diseases. They provide prevention and screening (flu shots, checking and treating BP and cholesterol, colon cancer screening and breast cancer screening) to their patients. They see patients who have a new problem - sore throat, chest pain, dyspnea, fatigue or a rash. They usually make the diagnosis for the acute problem, but if necessary refer the patient to the appropriate subspecialist. They are specialists, not subspecialists. They treat mental health issues and often sports injuries. They are the most valuable players in the health care system. Data show that areas with more primary care availability have lower health care costs.
When suits, politicians, Wal-Mart and mid-level providers see the phrase primary care, they think “simple care.” They think of patients with one problem, like hypertension or even diabetes. They think of urinary tract infections, sore throats and upper respiratory infections. They think of ear aches and knee pain."

A NP's View's response here states "See folks, us lowly "mid-levels" are grouped together with suits, politicians and Wal-Mart executives - quite the grouping! Second, Dr. Bob seems to think that we are incapable of treating anything that's not simple. Apparently, we focus on one thing only. We don't perform screenings, immunizations, mental health evaluations, make appropriate referrals, etc. Please.
Why are you so sour Dr. Bob? Maybe you haven't had the opportunity to work with Nurse Practitioners and/or Physician Assistants and know that as long as they aren't physicians, they must be bad! Maybe you don't know that studies have shown that nurse practitioners render care that is equal to (or better than) physicians. Maybe you could care less. Well, that's why I'm here to help defend the work that nurse practitioners do and maybe, just maybe, open a healthy dialogue to better understand our respective roles.

As a professional, I do not see primary care as "simple care". I never see my patients as one problem. If I did, I would be working in a walk in clinic where "simple" things like colds are treated.(No disrespect to those NPs who work in retail, I just chose to work in Family practice setting). I take care of patients with a variety of diagnoses including hypertension, COPD, diabetes, diverticulosis, GERD, Hyperlipidemia, to name a few. I also make sure that my patients are up to date regarding colonoscopy, EGD, mammograms, prostate exams, and lab work. I am very careful not to dismiss even the most benign symptoms, because as a whole, they may mean something much more important.
I have found brain tumors and multiple sclerosis where MDs told the patients "that it was all in their heads". Well, yeah...but wouldn't have been found had I not taken the time and energy to ask the intensive questions every day. Differential thinking is the key to finding the real problems.

Too often, MDs and patients are not enlightened about the jobs we do as providers on a daily basis. We go through 7 years of schooling with clinical rotations in various settings. We use the science and compassion of medicine and the science and compassion of nursing in tandem to take care of our patients in collaboration with MDs. I am lucky enough to be working with a doctor who actually thinks my expertise is worth listening to. We discuss cases and sometimes he points out things that I may have have thought about. I do the same for him. Imagine that! True collaboration. It's a great combination and it's how it should be. By working together, taking care of patients becomes the end result.

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