Dr. Nurse?

Some nursing schools are beginning to offer doctorate level degrees. So eventually we will have people who have a doctorate degree in nursing. So, a nurse could introduce herself as "Dr. Jones."

Now, that sounds pretty weird. I am not sure what a doctorate in nursing allows you to do, but it sure sounds weird.

"Hi, I'm Dr. Jenny, I'll be the nurse that will be taking care of you."

It seems that more and more of health care is being handled by "mid-level practioners" or "mid-levels." These are Nurse Practioners and Physicians Assistants. I don't mind this at all for staffing quick clinics and walk-in type centers for sniffles and Z-packs. They are good at that. And it isn't very hard to do. Any one can treat the sniffles with a Z-pack. You don't have to wait 8 weeks for your family practice doctor to be able to see you.

Mid-levels are also good at extremely complicated and highly specialized stuff. Cardiothoracic surgeons and orthopedic surgeons and rheumatologists routinely use them in their highly specialized fields, and they are well trained and really know what they are doing. I don't mind that at all. Especially for follow-up visits and following routine stuff in their respective specialty.

I will be offended, however, if I send a patient to a cardiologist because there is an issue that I can't understand or I can't handle, and they are seen by the PA or NP on their first visit. That is offensive. I am a freaking physician! If I need help, I don't want a nurse's opinion! That is blatantly offensive, and I won't send my patients to specialists that try to pull that crap.

Last time I sent a patient to a cardiologist asking them for some advice on one simple thing, the NP saw the patient and ordered nearly every single cardiology test under the sun. No thanks! That's not a good way to practice medicine. My patients on't need dumbassedness!

I think that nurses and physicians are trained differently. Nurses go to school for many years learning how to execute orders and perform certain tasks that are asked of them. Physicians go to school for many years and are trained to critically analyze situations and figure out how to treat the patient in the right way. Sure, the nurse may carry out many of those orders, but she didn't come up with them and has no idea why some of those orders are a good idea.

Doctors Think, Nurses Do!

Reversing roles is retarded. How many doctors can start an IV or mix up a drip? How many nurses can figure out which pressor to start?

Yes, there are dumb doctors. I have met plenty of physicians who are mentally lazy, dumb asses that fail to understand simple concepts. I can't tell you how many dumb ass doctors miss simple diagnoses like DKA or Sepsis. We can't have more dumb asses running around with the authority to give orders and treat patients.

Who do you want formulating your treatment plan? A physician? Or a nurse?

I know my answer.

Unfortunately, there are some things in medicine that are complicated and require a lot of mental knowledge. If you haven't been trained in that, you won't know what to do. But a lot of people can put band aids on things.

For example, I can't tell you how many times a patient comes to see me and tells me that their former primary doctor started them on lasix for leg edema. The conversation usually goes as follows:

"So, why are you on lasix?"

"Dr. Jones started me on it when my legs started swelling."

"Why were your legs swelling?"

"I don't know."

"Did he investigate the leg swelling at all? Like what did he think was causing it?"

"No. He said it just happens and that lasix was going to help."

How idiotic is that? Someone comes in with bilateral pitting edema of the lower extremities and all you do is put them on lasix? Are you mentally retarded? No investigation of why they may be swelling? No ultrasound of the heart to look for heart failure? No liver tests or kidney and urine tests? What the hell?

DOCTORS screw this up..... so what happens if we start letting mid-levels start screwing things up? They will screw up more. BIG TIME!

But they cost our health care system less (initially, or so we think), and hence, we are going to be seeing more and more of them. They are much cheaper than physicians, and much worse.

Health care costs will end up going up eventually.