Sunday, May 31, 2009

Nurse Practitioners As Primary Medical Homes

Over at DB's Medical Rants there is an entry regarding the primary care medical homes and whether NPs are capable of taking total care of their patients.

"We do not measure long tail events as a quality measure, because it would be very difficult to enumerate such events. So we have a classic important concept which is not easily measured. I will continue to insist that diagnostic errors are extremely important. I heard a colleague state that diagnostic errors are the most common reason for malpractice lawsuits. Yet our current quality measures ignore diagnosis.

Well trained physicians excel at diagnosis. I remember during training that the greatest praise for one of our heros was that he was a great diagnostician.

Our primary care debate often ignores this issue. I doubt that many NPs have the diagnostic acumen of well trained internists and family physicians. I might argue that long tail diagnosistics define a different level of expertise than the concept that primary care currently represents."

The following is my response to the above:

I think that any provider is only as good as their capacity to learn and evolve. I have seen both NPs and MDs who were content not to expand their knowledge base and therefore become stagnant. I pride myself in being an excellent diagnostician because that’s what I am most interested in. Not every doctor or NP or PA picks up on the nuances of patient’s complaints and there will be mistakes made. We are all human with weakness and false senses of pride. It needs to stop being a turf war and become about taking care of the patients in the best way we know how which is through collaboration.

What say you?