Comments on: MedBlogs Grand Rounds 2:17

By: Jim in Texas

Jim in Texas — Tue, 24 Jan 2006 12:18:34 +0000

Well done from a non-medical guy. You multi-task very well!!!

By: Xhavid

Xhavid — Sun, 22 Jan 2006 20:55:00 +0000

You are wonderfuland great.Since my English is not so good,only i can say that you are filantropic person and you have done the best for humanaity.Continue the same.” Verba volant scripta manent”.Your faitfully Dr.Xhavid Duraku

(ed: Verba volant scripta manent translates as: “Nothing is built on stone; all is built on sand, but we must build as if the sand were stone”, by Jorge Louis Borges. I rather like that.)

By: Dr John Crippen

Dr John Crippen — Sat, 21 Jan 2006 14:33:36 +0000

“I am just wondering if anyone has any opinions on the increasing use of nurse practitioners and physicians’ assistants in primary care practices.”

Yes, yes, yes. This is now causing a real problem in the UK. Not in primary care, though, where you will still see a physicina, but in the hospitals, where what we call “nurse specialists” are now front ending the system. They are doing colonoscopies, cystoscopies, they are seeing patients referred from primary care with possible malignancies….. I could go on….well actaully I do go on and on and on about this on NHS BLOG DOC.

Of course, the “nurse specialists” only see the NHS patients. Private patienets who pay, the prime minister and members of the Royal Family still see doctors.

See particularly http://nhsblogdoc.blogspot.com/2005/12/sue-and-dave-and-hospital-at-night.html
and read the reference under “Sue and Dave”

…and any article under “Dumbing down”

Hospitals in the UK are being stripped of doctors. It is a nightmare.

John

By: Sheila M Blanchet RN

Sheila M Blanchet RN — Sat, 21 Jan 2006 03:17:17 +0000

I am just wondering if anyone has any opinions on the increasing use of nurse practitioners and physicians’ assistants in primary care practices. I took my kids out of a family practice group for many reasons but the biggest reason was that as soon as this group hired a bunch of PA’s suddenly the doctors were always just “too busy” to see my kids when they were sick. The best I could get was an appointment with a PA. I had to get downright nasty and put my foot down to get them in to see an actual physician. It wasn’t long after that that the doctors were also too busy to be bothered to do their routine physicals. I would be told an appointment with a physician would mean waiting between four and six months, but, hey, if I would agree to seeing a PA they could pretty much get me in that very day! It struck me as coercive and very poor medicine since it meant that for all intents and purposes my kids had doctors in name only. Their healthcare was to be entirely provided by PA’s with no physician overseeing anything. I don’t buy the idea that these people operate under the direction of a physician. No physician would even so much as poke his or her head in while we were there to see what was up and what was being done about it. Recently my own internist had his wife, who took one of those fast track MSN Nurse Practitioner programs designed for people with degrees in other areas (in her case an MBA) with absolutely no requirements for any prior clinical, medical or nursing experience at all, join his practice. Now it’s the same thing with him. After ten years of being able to see him when I’m sick, now only his wife is available for sick visits, except for heart attacks I presume. I called yesterday because I had a fever, sore throat, ear pain and a cough productive of green sputum and was told I could see her or nobody; a first in his practice. The receptionist did helpfully offer to let me see him some time next week. What is going on in primary care? I read all kinds of articles bemoaning the lack of respect for internal medicine as a profession and then doctors behave like this. I don’t see the point of doctors calling themselves primary care providers if they can’t be bothered seeing their own patients when they’re sick, or, as in the case of patients who need to be hospitalized, who abandon their patients to the care of hospitalists whose credentials and skill levels the patient’s own physician can’t possibly know. I have already switched the kids’ care to a pediatric group whose doctors see their own patients no matter what and I will be leaving my physician as soon as I can find another who won’t dump me off to a barely trained nurse practitioner when I’m sick. I should have seen the writing on the wall with the family practice group. They couldn’t wait to dump their hospitalized patients on the hospitalist group. One of the doctors cheerfully explained to me that for him it made it possible not to have to spend an hour driving all the way back and forth to the hospital to see just one patient. Now he could use that time in the office to see four or five patients, not just one. How nice, huh! The office patients are not only less complicated, but you can cram more of them into an hour’s time and increase your fees substantially to boot! Any comments?

By: Stacy

Stacy — Thu, 19 Jan 2006 14:12:41 +0000

Thanks to all of you who are in medicine and blog – I’m a medical librarian and Grand Rounds is required reading for me every week and has led me to some wonderful information and insight – and a ton of new blogs to read!

By: mchebert

mchebert — Wed, 18 Jan 2006 21:26:22 +0000

Very nicely done. This is the first time have have seen Grand Rounds. I can promise I will be a regular visitor.

One day I hope my blog will be “up there in lights.”

By: Domenico Savatta, MD

Domenico Savatta, MD — Wed, 18 Jan 2006 00:21:11 +0000

Thanks Doc,

I appreciate the time and effort you put into this.

Dom

By: Rosemarie@MikeMathisProds.com

Rosemarie@MikeMathisProds.com — Tue, 17 Jan 2006 23:26:47 +0000

Hey GruntDoc! Just ran across your blogsite and I must say, you are quite an interesting guy. I’m producing a show called, “E.R. Mysteries” for Discovery and I would love to have you tell one of your E.R. stories. Did you ever have trouble diagnosing a patient right away and the presenting symptoms were baffling? It would be great if you eventually unraveled the mystery and saved that person’s life. Please write back when you get a chance! Thanks!

By: hgstern

hgstern — Tue, 17 Jan 2006 20:19:10 +0000

Terrific job, Doc!

And a Special Thank You for the way you handled our little “gang post.” ;-)

Have a great rest of the week!

By: GruntDoc

GruntDoc — Tue, 17 Jan 2006 18:14:05 +0000

Thanks to all, though obviously Abel hasn’t read this site much.