Monday, June 07, 2010

Nurse Practitioners As Diagnosticians

Over at Kevin, MD there is a discussion going on regarding whether Nurse Practitioners have adequate diagnostic skills in comparison to medical doctors. This is often an argument in conversations regarding nurse practitioners increasing their presence in primary care.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur says..
"The practice of medicine is the diagnosis of disease and the treatment of patients. “Coordination” of care (diagnosis and treatment; recurring theme here?) is certainly something that could be accomplished by non-physicians, as long as recognition remains that physicians are the ones best suited to diagnosing and treating (AKA practicing medicine). Maggie Mahar may prefer the “comfort and care” approach that nurses claim to offer instead of “the scientific perspective of medical schools that teach about disease processes and bodily interactions,” but without first having an accurate diagnosis, she and many others could find themselves in deep trouble.

Kate from The Accidental Pharmacist said..

"There are several issues here. The first is that allied health professions are constantly asked to prove their worth while physicians can get by on history and anecdote. I’m a health services researcher and a pharmacist. We have repeatedly shown on randomized controlled trials that pharmacists can treat chronic health conditions better than usual care. Yet we face the same arguments from physician lobby groups. Pharmacists have a minimum of 5y university, 4 of which includes pharmacology-based courses. Many other pharms, myself included have an additional 3y of clinical training. The primary care system is strained, family physicians can no longer do their diagnostic jobs and turf wars are complicating everything else. NPs and other allied health profs can help lift the burden. Physicians just need to let it happen. Maybe then their diagnostic skills will return to their former glory.

My reply..
I agree with you Kelly in regards to this issue. Turf wars are really making it difficult to stay focused on the problem of acute and chronic illnesses that are not being taken care of. Patients cannot afford to come to the office or to take their meds. I have an excellent relationship with our local pharmacists and yet a somewhat strained one with the larger chain stores (mostly over the inability to understand plain English) but that's a whole other problem in itself..

jsmith replied on June 2, 2010 at 4:19 pm saying..

"I supervise a NP; I’m looking at her in her office across the hall as I type this. She is just as good as I am at strep throat and ear infections and UTIs, and I am happy to have her see those pts. But every day she consults with me on a couple or a few pts–fine, I’m happy to help her, it’s part of my job. If I were not there, some of those easy (to me) pts would wind up as subspecialty consults. Also, she is not as good at chest pain, abdominal pain, acute shortness of breath or acute on chronic renal failure. I see those pts. They get better and more timely care from me. Unfortunately, these types of pts walk in the door in random order. Every practicing internist or FP knows this fact, even if others don’t.
NPs should be supervised by MDs, period. Much safer for the pts, and, frankly, safer for the NPs."

My reply:

"I think that instead of looking at your fellow medical professional across the hall and noting what she lacks, why don’t you pull her into your office and tell her where she can focus in order to make her a better provider of care. We are not meant to be “just for the coughs and sniffles” and some of us are great diagnosticians. I know my limitations and am not afraid to consult my collaborating MD and sometimes I even teach him a thing or two. It’s about the give and take in a partnership. If you don’t let her know that you find her skills lower than you would like, you are doing her a disservice."

What say you?

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