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Failure For A Doctor

I went to a patient’s funeral this past weekend. I generally don’t do that for people whose relationship I’ve built in the exam room. It’s a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor. It’s awkward getting a eulogy (literally good words) spoken about me at someone else’s funeral. This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north.

But that’s not why I am writing this. As I was sitting in the service, the thought occurred to me that a patient’s funeral would be considered by many to be a failure for a doctor. Certainly there are times when that is the case — when the doctor could have intervened and didn’t, or intervened incorrectly, causing the person to die earlier than they could have. Every doctor has some moments where regrets over missed or incorrect diagnosis take their toll. We are imperfect humans, we have bad days, and we don’t always give our patients our best. We have limits. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Career Counselor? Thoughts On Becoming A Doctor

As a physician, I’ve had several people ask my “honest” opinion of their plans to become a doctor. I know what my response is to this question, but I wonder what others in my profession would answer. Would your response depend, in large part, on who’s doing the asking — could you answer your own child as you would someone you just met? Be careful, your answer to this question, if honestly given, might shine an unsettling light on your own feelings about your current career choice.

Last week I spoke with a college junior working to fulfill her lifelong plans to become a physician. She told me about a recent conversation with her own doctor where she shared her plans to go to medical school and he’d tried to dissuade her. She couldn’t recall a single cogent reason given for avoiding the medical profession, yet it appeared to me that his odium had negatively imprinted her image of the medical profession, which is a shame. At this time more than ever, we –- doctors and patients alike — need to encourage the most talented of our youth to join the medical profession. Read more »

The Insulting Term “Physician Extender”

“Physician Extender.” It sounds like the name of a male enhancement product. It’s a term often used to describe a nurse practitioner or a physician’s assistant. I hate it. It’s insulting.

A nurse practitioner is not an adjunct physician. They do not supplement the care of a physician. They provide essential advance-practice nursing services, services that include diagnosis and provision of medical care.

While some of these services overlap those of medicine, nurse practitioners are not extensions of another profession, they provide care in their own right — as educated, licensed practitioners. Sometimes the only care provider for a community is a nurse practitioner. Read more »

*This blog post was originally published at Emergiblog*

The Dumbing Down Of Nursing Academics

nursing-education-advertisment-NP-DNPI’m embarrassed to say this, but the nursing profession is making a mockery of healthcare education by downgrading the post-graduate degree process. The nursing education requirements in the advertisement seen here are an embarrassment to the nursing profession.

Mrs. Happy pointed out an advertisement from her nursing magazine offering advanced nursing education opportunities. This advertisement for the doctor nurse practitioner (DNP) training track at Creighton University is a mockery of the rigorous educational requirements necessary to care for patients independently. Check out the nursing education requirements on their advertisement: No entrance exam required?  No clinical experience?  No thesis required?  What has this world come to?

These are professionals who are going to be taking care of patients in less than two years. Some states allow NPs to manage patients independently with no physician oversight. That is just plain scary. This is an embarrassment to the foundation of anatomy, physiology, pathophysiology, neuroanatomy, microbiology, pharmacology, genetics — and on and on — required to care for patients independently. Read more »

*This blog post was originally published at The Happy Hospitalist*

“Team Care” In The Patient-Centered “Medical Home?”

“Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree.

There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. Read more »

*This blog post was originally published at Mind The Gap*

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