What is the US going to do about our current and future primary care physician shortage? Many believe that the solution is to expand the scope of nursing practice, and license non-physicians (such as naturopaths) to practice medicine. In the face of scarcity, 17 states have licensed naturopaths to provide primary care and nurse-led, in-store pharmacy clinics are gaining popularity.
Studies have shown that nurse practitioners are as capable as physicians at treating common primary care complaints such as strep throat and headache. What studies have NOT shown is that nurse practitioners recognize and diagnose less common diseases with similar symptoms. What if the strep throat were throat cancer? What if the headache were meningitis? Substituting practitioners with half the training and experience of an MD comes at a price. And that price may include missed diagnoses, delay of appropriate treatment, and life threatening consequences.
But the lure of cost savings cannot be ignored. Nurses are paid less to practice primary care, so in theory we could save untold millions each year by having patients see nurses instead of doctors. That sounds good, but now nurse practitioners are lobbying to receive the same salary as MDs for their time. After all, they’re doing the same work, right? Never mind that everyone they treat must be squeezed into a limited set of diagnosis codes – when all you have is a hammer, then everything starts looking like a nail. “Poof” goes the savings, while care quality standards are permanently reduced by forced limitations on differential diagnoses.
A better solution would be to find ways to extend physician reach and expertise with telemedicine platforms, longer patient visit times, and by reducing their non-clinical practice burden. Nurses and ancillary providers are valued members of the clinical team who are dearly loved by patients and doctors alike, but they simply do not have enough training to be ruling out tens of thousands of rare diseases and conditions. This is why we need physicians at the helm of the clinical team – to make sure that patients are on the right treatment pathway.
Some nurses cry “prejudice” when physicians suggest that MDs provide better primary care. But we all know that knowledge and experience are a critical asset when lives are at stake. As the research results begin to roll in regarding better patient outcomes under the care of physicians versus nurse practitioners, common sense tells us that outsourcing primary care to the less qualified will have undesirable consequences for some. And if you choose to get your primary care from a naturopath or nurse, you’ d better hope that headache isn’t anything serious. Because a little savings now could cost you your life.
Our annual “fall back” time change that gives us an extra hour of sleep is welcome news for most of us. But there are some unintended consequences of darker evenings, especially for drivers. According to the National Safety Council, traffic death rates are three times greater at night than during the day.
In a special rebroadcast of the Healthy Vision with Dr. Val Jones show, I interviewed Dr. Christina Schnider, Senior Director, Professional Communications for VISTAKON® Division of Johnson & Johnson Vision Care, about common nighttime driving problems such as dry eyes, headaches, and eye fatigue. I also spoke with John Ulczycki, Group Vice President – Strategic Initiatives, for the National Safety Council, about safe driving tips. You can listen to the show here:
Most people experience a drop in visual acuity in the dark, and this can cause difficulty seeing traffic signs, pedestrians and roadside objects. The primary reason why it’s difficult to see at night is that our pupils dilate to let in as much light as possible. The trade off with large pupils is that visual acuity suffers. It’s normal for the average person’s visual acuity to drop from 20/20 to 20/40 in low light conditions.
Because of vision challenges, driving in low-light conditions can fatigue the eyes and head and neck muscles as the driver strains to see the environment more clearly. Dry eyes can occur from reduced blink rates and motor vehicle heating and cooling systems. Glasses wearers may have a reduced field of vision which further complicates driving in the dark. In fact, in a recent survey one -in-three drivers reported that they didn’t see well at night.
Dr. Schnider and Mr. Ulczycki suggest that night time driving may be safer (and more comfortable) with these tips:
1. Update your eyeglass or contact lens prescription(s). Since darkness reduces visual acuity, wearing lenses that correct your vision to 20/20 in normal light conditions is extra important. Old glasses or contacts with outdated vision correction power can make driving in the dark more hazardous. If you experience significant challenges seeing at night, you may have a condition called “nighttime myopia” and should visit your eye doctor for advice.
2. Avoid driving long distances in low-light conditions. Since we already know that driving in the dark can cause eye fatigue, dry eyes, and reduced visual acuity, it’s best to minimize the time you spend behind the wheel during dark hours. Whenever possible, plan your travel so that the majority of your driving time occurs during daylight hours.
3. Take frequent breaks. Even though it’s tempting to push through your fatigue and finish driving those last miles to your destination, it’s safer to give yourself (and your eyes) a break. Stopping for gas or at a rest area may improve your alertness and visual fatigue. Remember that impaired drivers are more likely to be on the road at night, so vigilance on your part may prevent an accident.
4. Decrease your night-time driving speed. If you do need to drive in the dark, doing so more slowly may prevent accidents. Traveling at a slower speed can improve reaction time under lower-visibility conditions.
5. Check your headlights. It is estimated that 50% of all motor vehicle headlights are not optimally aligned. Potholes and bumps in the road can jolt the lights out of alignment. It’s important not to look directly at oncoming headlights. This can temporarily blind you as your pupils adjust to a quick change in lighting conditions.
The U.S. Food and Drug Administration today announced that it has taken action against eight California surgical centers and the marketing firm 1-800-GET-THIN LLC, for misleading advertising of the Lap-Band, an FDA-approved device used for weight loss in obese adults. The FDA issued Warning Letters to Bakersfield Surgery Institute Inc.; Beverly Hills Surgery Center; Palmdale Ambulatory Center; Valley Surgical Center; Top Surgeons LLC; Valencia Ambulatory Center LLC; Cosmopolitan Plastic & Reconstructive Surgery; San Diego Ambulatory Center LLC; and to 1-800-GET-THIN because Lap-Band is a restricted medical device that is misbranded as a result of misleading advertising by these groups. In the letters, the FDA warns that billboards and advertising inserts used by recipients of the Warning Letters to promote the Lap-Band procedure fail to provide required risk information, including warnings, precautions, possible side effects and contraindications. The FDA also is concerned that the font size of information related to risks on the advertising inserts is too small to be read by consumers.
About ten years ago plastic surgery had a nice little advance- the advent of the disposable pain pump. Breakthroughs in medicine are far fewer than advertising copy would have you believe, but this one is real. Unfortunately some practices use them like a marketing ploy in all cases and really don’t spend the time to make them work well or minimize their risk. Others don’t see the benefit and don’t use them at all.
Pain pumps are quite useful in some cases when used correctly. Plastic surgery is a technical specialty and some surgeons are more adept at making things work than others. There are risks with them and cases in which the benefit is harder to measure.
Remember the 1991 Gulf War between the United States and Iraq (aka: “Operation Desert Storm”)? A new study has been published in the American Journal of Epidemiology that assessed the health status of 5,469 deployed Gulf War veterans compared to 3,353 non deployed veterans. At 10 year follow up, the deployed veterans were more likely to report persistent poor health. The measures were functional impairment, limitation of activities, repeated clinic visits, recurrent hospitalization, perception of health as fair or poor, chronic fatigue syndrome illness and post-traumatic stress disorder.
From 1995 to 2005, the health of these veterans worsened in comparison to the veterans who did not deploy to the Persian Gulf. A study done in the United Kingdom that compared Gulf War veterans to UN peacekeepers who served in Bosnia and other non-deployed Gulf War soldiers found Read more »
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