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« Age Bashing McCain | Main | TGB's "This Week in Elder News" »
March 7, 2008 |Permalink |Comments (2)
Power Up Friday: Be Cool Edition
Dr. Al Power writes...
Here's my take on Bill's March 5th post, "Doctor, Doctor, Give Me the News":
The advancement of the nurse practitioner profession has caused a great deal of controversy in the medical community. From where I sit, it appears that the majority of doctors are happy with NPs in a subservient role, but get nervous when they "strike out on their own", or expand their realm of practice.
There is no doubt that MDs have a great deal of specialized training and skills. However, most of them are using this training to go into specialized fields, and there are few who are willing to provide general care for the population at large, especially for older adults in nursing homes or other communities.
There are many things that doctors do that can be done as well by nurse practitioners. To me, there is something amiss with doctors being so territorial about this. Are they really concerned about quality of care? Or is it more of a "turf war", or a fear of loss of income to someone that a patient might prefer seeing?
A basic premise of the advancement of knowledge should be that it is shared freely with all who wish to attain it. To jealously guard a realm of practice from others who wish to make a contribution will only hurt the community as a whole, and reduce access to care. There is a parallel here with doctors of past decades, who objected to their patients having access to medical information that made them want to be more active partners in their care.
Wake up, folks! There are many excellent NPs out there, providing excellent care. As an internist and geriatrician, if I have a patient that is complex, I often engage the help of a specialist. There's no reason why an NP cannot do the same. If MDs were more pro-active in working with NPs in this manner, we would have a much better, more efficient system of health care.
I work with two geriatric NPs at my nursing home. I think they understand geriatric medicine better than many, if not most docs in town.
Finally, let's stop guarding our titles so fiercely. A "doctor" may be one of various kinds of healers, or one who has obtained advanced knowledge in a variety of fields. No one complains about saying "Dr. Martin Luther King", or addressing their dentist, veterinarian or school superintendent that way. So why get so bent out of shape if an NP was referred to as "doctor"? What are we afraid of?
Al Power, MD
Comments ( 2)
I am so greatful to the nurse practitioners that i have dealt with in my long life full of medical problems. I have noticed their ability to listen, and they open to my comments. Sometimes the doctors are closed minded and sure of their decisions. Thanks for the blog, great comments.
The original post “Doctor, Doctor…” and Dr. Al Power’s response bring to light several interesting points.
It makes me think of the “country doctor” that knew their patients and worked with a broad scope of health issues. These docs also treated generations within a family and often were considered a “friend of the family.” They were generalists in the truest sense of the word. In my opinion, the medical field shifted over time to become saturated with “specialists” with a narrow focus of practice. Also, enter managed care and GP’s are treating patients through an ever-revolving turnstile with time limitation and quotas. The time and attention given are reduced with direct patient interaction as a GP or as a specialist. Often the PA, NP or midwives in OB/GYN practices are the ones that spend more significant periods of time directly with the patients. I truly believe this facilitates a better, broader-scoped understanding of the patient issues and concerns. Regardless of title, I think this is a critical piece of good patient care and practice.
As in any profession, I believe it is the personality of the individual as to how the interaction plays out with an interdisciplinary team or in interaction with various levels/roles. Some doctors (specialist or GP’s), just as some high-level managers in other professions, may have a perceived level of threat in their sense of hierarchy/position or may feel “entitled” as the expert. I do believe that each role carries its own level of expertise-but personally I have encountered specialty doctors and GP’s that spent little time with the patient and presented in such a way that left the patient feeling as if they should feel “privileged” to have experienced this “expert advice.” Conversely, I have experienced both specialists and GP’s who showed genuine concern, reflected collaborative respect for the team and spent more time, in general, with the patients. You can sense the difference between a “collaborative team practice” and when tasks and duties are “dumped” on the other members of the practice.
Personally, I think much of it comes down to an individual’s comfort level within himself/herself and their interpretation of the ultimate goal/purpose. I feel this holds true for the medical profession, corporations and in politics, as well.
To reflect on “what is the mission of the organization?” or “what is the ultimate goal?”-Is it to “best treat the patient” or “provide the best service to the customer?” or is it in preserving one’s role and status? Who ultimately are we serving? ---Patients/clients in our chosen profession, or ourselves?
Just some of my own reflections on the topic….