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As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Also,

As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Also, the term nurse is very loaded to your average patient. You could be talking about a CNA with 16 weeks of training, or a DNP with 8 years of schooling.

certifiedloud 9y ago
I've never heard anyone equate a CNA with a nurse.
- JshWright 9y ago
  Hell, I've heard CNA's do that...
  - FireBeyond 9y ago
    "I'm a nurse!" "Okay... I guess Bob the EMT over here, he's a physician!"
toomuchtodo 9y ago
> As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Sort of. What people in this thread refer to when they say nurses should do more "doctor things" is a nurse practitioner: https://en.wikipedia.org/wiki/Nurse_practitioner https://en.wikipedia.org/wiki/Nurse_practitioner If you needed an experience ranking, it would look like this: CNA -> Registered Nurse -> Nurse Practitioner -> MD (think of an MD as a commissioned officer in the military, whereas a nurse practitioner is a non-commissioned office who rose through the ranks but is still slightly below a commissioned office in ranking) Source: Mother was a registered nurse TL;DR Leveling up nurses around the country to "nurse practitioner" and having them take on more traditional doctor responsibilities is a solid path to success versus churning out more doctors overloaded with debt
- AlgorithmicTime 9y ago
  I'd say it's more like CNA = Lower Enlisted Registered Nurse = NCO Nurse Practitioner = Warrant Officer MD = Officer
seanmcdirmid 9y ago
I saw a nurse practitioner at a drug store who prescribed some antibiotics for an ear infection I had. It went well, it was a simple problem, and it didn’t require being examined by an MD. There are definitely things they can do.
- rtx 9y ago
  Maybe it didn't require antibiotics at all.
  - seanmcdirmid 9y ago
    It was a pretty common case of swimmer’s ear. Oral and ear anti biotics were prescribed, along with advice not to swim for awhile and later to wear ear plugs. It was all very standard. Believe it or not, most infections will clear up with anti biotics. I get a painful infection every 3 or 4 years that require them (less often when I was younger), hardly someone you would consider abusing them.
JamesBarney 9y ago
Most interactions with the medical system do not require 11 years of training. The vast majority are things like "Oh you have a sore throat. Let's do a strep test. Oh it's positive here are some antibiotics"
- jquery 9y ago
  That works great... until there’s a subtle reason to think that it’s not streptococcus for reasons ABC or that’s not the proper treatment for reasons XYZ and you have a mild case of death.
  - wyldfire 9y ago
    Physicians that you see in the office won't detect those reasons ABC and save you from death. The expert diagnosticians often work in hospitals and are only used when other PAs/Physicians tell them "I ruled out all of the common explanations for these symptoms, what could it be?"
    - jquery 9y ago
      > Physicians that you see in the office won't detect those reasons ABC and save you from death. Any hard research showing this? Something that addresses confounding factors, overburdened doctors, etc.? Is there a study showing that spending 30 minutes with a physician is equivalent to 30 minutes with an RN or PA for all outcomes (not just death)? I have a feeling we're all acting like medical experts in this thread even though very few of us are. It's like when we see research about programming methodologies and are able to poke so many holes in the study it becomes swiss cheese.
      - paviva 9y ago
        > Any hard research showing this? Probably not. Or, better stated, not that I am aware of. Let's think. Seeing a doctor instead of a PA is associated with better outcomes if, and only if, your condition can benefit from the doctor's specialized knowledge. That means it requires treatment, the treatment is time-sensitive (i.e. worse outcomes if there's a delay), and there are significant adverse effects in case of a lack of appropriate treatment. The problem is, these conditions are either too rare to be studied in any meaningful way, or the patients' very obviously sick and taken directly to the hospital, where he is obviously seeing a doctor and not a PA. A lot of people go to the doctor for pretty benign ailments which don't really require a treatment, or for conditions that any intelligent, motivated patient is theoretically able manage himself without a doctor. Examples : virus infections, sprains, acid reflux, chronic conditions like hypertension, diabetes, and so on. E.g. : someone has type I diabetes, understands how and when to give himself insulin, checks his feet for infection and so on. In a case like this, the doctor can barely bring any plus value apart from ordering the regular blood work. Another frequent scenario is when the patient does have a time-sensitive, treatment-required condition, but does not follow the treatment. Again, him seeing a doctor is unlikely to result in any appreciable benefit.
conanbatt 9y ago
You can have the choice as a patient. Im sure lots of patients would prefer to pay 1/4 for a nurse to do a procedure than full price for a doctor.
gruez 9y ago
>I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be from a recent freakonomics episode http://freakonomics.com/podcast/nurses-to-the-rescue/ http://freakonomics.com/podcast/nurses-to-the-rescue/ >ROSALSKY: The main argument against allowing NPs to practice independently is that they have less training than physicians. But there’s a mountain of empirical evidence from randomized trials, case studies, systematic reviews, and analyses of malpractice claims in states where similar legislation has already passed that all points to the same thing: when it comes to primary care, NPs are just as safe and effective as doctors. there are links in the transcript.

certifiedloud 9y ago

I've never heard anyone equate a CNA with a nurse.

JshWright 9y ago
Hell, I've heard CNA's do that...
- FireBeyond 9y ago
  "I'm a nurse!" "Okay... I guess Bob the EMT over here, he's a physician!"

toomuchtodo 9y ago

> As it stands right now, I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be. Sort of. What people in this thread refer to when they say nurses should do more "doctor things" is a nurse practitioner: https://en.wikipedia.org/wiki/Nurse_practitioner https://en.wikipedia.org/wiki/Nurse_practitioner If you needed an experience ranking, it would look like this: CNA -> Registered Nurse -> Nurse Practitioner -> MD (think of an MD as a commissioned officer in the military, whereas a nurse practitioner is a non-commissioned office who rose through the ranks but is still slightly below a commissioned office in ranking) Source: Mother was a registered nurse TL;DR Leveling up nurses around the country to "nurse practitioner" and having them take on more traditional doctor responsibilities is a solid path to success versus churning out more doctors overloaded with debt

AlgorithmicTime 9y ago
I'd say it's more like CNA = Lower Enlisted Registered Nurse = NCO Nurse Practitioner = Warrant Officer MD = Officer

seanmcdirmid 9y ago

I saw a nurse practitioner at a drug store who prescribed some antibiotics for an ear infection I had. It went well, it was a simple problem, and it didn’t require being examined by an MD. There are definitely things they can do.

rtx 9y ago
Maybe it didn't require antibiotics at all.
- seanmcdirmid 9y ago
  It was a pretty common case of swimmer’s ear. Oral and ear anti biotics were prescribed, along with advice not to swim for awhile and later to wear ear plugs. It was all very standard. Believe it or not, most infections will clear up with anti biotics. I get a painful infection every 3 or 4 years that require them (less often when I was younger), hardly someone you would consider abusing them.

JamesBarney 9y ago

Most interactions with the medical system do not require 11 years of training. The vast majority are things like "Oh you have a sore throat. Let's do a strep test. Oh it's positive here are some antibiotics"

jquery 9y ago
That works great... until there’s a subtle reason to think that it’s not streptococcus for reasons ABC or that’s not the proper treatment for reasons XYZ and you have a mild case of death.
- wyldfire 9y ago
  Physicians that you see in the office won't detect those reasons ABC and save you from death. The expert diagnosticians often work in hospitals and are only used when other PAs/Physicians tell them "I ruled out all of the common explanations for these symptoms, what could it be?"
  - jquery 9y ago
    > Physicians that you see in the office won't detect those reasons ABC and save you from death. Any hard research showing this? Something that addresses confounding factors, overburdened doctors, etc.? Is there a study showing that spending 30 minutes with a physician is equivalent to 30 minutes with an RN or PA for all outcomes (not just death)? I have a feeling we're all acting like medical experts in this thread even though very few of us are. It's like when we see research about programming methodologies and are able to poke so many holes in the study it becomes swiss cheese.
    - paviva 9y ago
      > Any hard research showing this? Probably not. Or, better stated, not that I am aware of. Let's think. Seeing a doctor instead of a PA is associated with better outcomes if, and only if, your condition can benefit from the doctor's specialized knowledge. That means it requires treatment, the treatment is time-sensitive (i.e. worse outcomes if there's a delay), and there are significant adverse effects in case of a lack of appropriate treatment. The problem is, these conditions are either too rare to be studied in any meaningful way, or the patients' very obviously sick and taken directly to the hospital, where he is obviously seeing a doctor and not a PA. A lot of people go to the doctor for pretty benign ailments which don't really require a treatment, or for conditions that any intelligent, motivated patient is theoretically able manage himself without a doctor. Examples : virus infections, sprains, acid reflux, chronic conditions like hypertension, diabetes, and so on. E.g. : someone has type I diabetes, understands how and when to give himself insulin, checks his feet for infection and so on. In a case like this, the doctor can barely bring any plus value apart from ordering the regular blood work. Another frequent scenario is when the patient does have a time-sensitive, treatment-required condition, but does not follow the treatment. Again, him seeing a doctor is unlikely to result in any appreciable benefit.

conanbatt 9y ago

You can have the choice as a patient. Im sure lots of patients would prefer to pay 1/4 for a nurse to do a procedure than full price for a doctor.

gruez 9y ago

>I have to disagree with letting nurses or PAs do more "doctor things". Their training isn't anywhere close to what it needs to be from a recent freakonomics episode http://freakonomics.com/podcast/nurses-to-the-rescue/ http://freakonomics.com/podcast/nurses-to-the-rescue/ >ROSALSKY: The main argument against allowing NPs to practice independently is that they have less training than physicians. But there’s a mountain of empirical evidence from randomized trials, case studies, systematic reviews, and analyses of malpractice claims in states where similar legislation has already passed that all points to the same thing: when it comes to primary care, NPs are just as safe and effective as doctors. there are links in the transcript.