Hello to all! I have been playing with the template as you can see if you are an old reader. Somehow my comment box has disappeared? Only thing you can do is click on the little box at the bottom of the post. Anyone else have this problem when they changed Blogger? Don't know why I am asking since you can't answer me huh?
Oh well...
Things at the office have slowed down a bit and I just finished my appt with the orthopedic MD and will have to have another MRI with an arthrogram on my wrist/thumb that was damaged by the car accident. I will tell you that it is slowing me down tremendously having to peck at the computer with my left hand rather than being able to type. I don't even want to go on about how slow my charting has become over the last 9 months and that my handwriting is approaching illegible. It wasn't great to begin with but now I sometimes can't read my own handwriting.
I am working on a story for my next post so expect one soon. I am glad that you have found my blog and I hope to keep it updated more often. Once I get the comment box back maybe you will chime in and let me know what you would like to see here. Please no spammers though I know you will try! It is annoying to remove all of the garbage that spammers put on here. Why on earth they would think that I would allow a comment with links to their "Buy Viagra Here!" sites I have no idea.
Till then, keep on nursing!
Friday, June 25, 2010
Monday, June 14, 2010
Nurse Practitioner says, "Pancreatic Cancer Sucks!"
Our neighbors were very nice people. The kind that would offer to let you swim in their pool (though I didn't often because I didn't want to be one of THOSE neighbors). They would come over and talk to the hubby while I was busy at the office and discuss politics and health care issues. They were never loud or obnoxious and always made sure that their dogs never left their "deposits" on our lawn.
Since their move South, I hadn't seen them in a while. On a recent visit I asked him about his drastic weight loss and he said that the doc down south had scoped him and said that he didn't know? Any scans done? Nope.. They were fighting over which imaging facility that his doctor wanted him to go to. I told him that I thought something bad was brewing and that he needed to get a foot up someone's ass and get a CT scan done. I was worried that he had some kind of cancer because of his color and his fatigue.
After months of trying to get someone to listen and scan him, they found the pancreatic cancer too late. He passed yesterday. I hope that his wife finds the strength to carry on after dealing with his cancer and loss. Rest in peace!
Note to providers...
Pay attention to your patient's symptoms.
Especially notice weight loss that occurs by other means, except for active dieting.
Don't play turf wars with imaging centers. If a provider prefers a particular imaging center, ask why? Sometimes patients can't afford to travel distance and therefore won't get the studies done.
Confirm that additional studies are being done and don't assume that specialty is doing them. Ask for the reports! Ask your patient if they have been scanned, if you think they need one, do it yourself first! I think that most specialists would actually rather a patient come in with imaging already done so that they know where to look further if needed.
Any other suggestions or comments? Chime in!
Since their move South, I hadn't seen them in a while. On a recent visit I asked him about his drastic weight loss and he said that the doc down south had scoped him and said that he didn't know? Any scans done? Nope.. They were fighting over which imaging facility that his doctor wanted him to go to. I told him that I thought something bad was brewing and that he needed to get a foot up someone's ass and get a CT scan done. I was worried that he had some kind of cancer because of his color and his fatigue.
After months of trying to get someone to listen and scan him, they found the pancreatic cancer too late. He passed yesterday. I hope that his wife finds the strength to carry on after dealing with his cancer and loss. Rest in peace!
Note to providers...
Pay attention to your patient's symptoms.
Especially notice weight loss that occurs by other means, except for active dieting.
Don't play turf wars with imaging centers. If a provider prefers a particular imaging center, ask why? Sometimes patients can't afford to travel distance and therefore won't get the studies done.
Confirm that additional studies are being done and don't assume that specialty is doing them. Ask for the reports! Ask your patient if they have been scanned, if you think they need one, do it yourself first! I think that most specialists would actually rather a patient come in with imaging already done so that they know where to look further if needed.
Any other suggestions or comments? Chime in!
Thursday, June 10, 2010
Change Of Shift Is Up
Change of Shift is a wonderful compilation of nursing opinions in the blogosphere. Go check it out!
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?
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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