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Saturday, April 4, 2009

Government health care, the cure that kills?


Please visit sweet wifey's blog, Right Truth and check out the article,

Government health care, the cure that kills?

I left a comment there criticizing some of those non-physicians (there are more and more of them everyday) who try and deliver healthcare to the masses. Below follows my comment at Right Truth on this matter:

Just wanted to relate a little anecdote so yall won't think I'm unfairly picking on nurse practitioners:

A while back a frantic family had grandma brought in to the ER by ambulance from a nearby nurse practitioner's office.

They were told that grandma was in "ventricular tachycardia" and was about to die if she was not stabilized and sent immediately to a cardiologist.

Ventricular tachycardia is a condition where the pacing of the heart is taken over by the ventricles (not normal). V-tach is indeed dangerous and can lead to loss of pulse (you're dead) or ventricular fibrillation (you're dead)! With V-tach the hear rate will usually be very fast, 180 to 200 beats per minute and as the ventricles fire, they will produce a very wide and bizarre pattern on the EKG. (V-tach is also know as wide complex tachycardia).

In the case of grandma, she did not have V-tach. What she did have was a sinus tachycardia with a condition called a bundle branch block. The bundle branch block will cause the ventricular complex on the EKG to appear wide and bizarre. Grandma's heart rate was about 120 and she had no complaint. A sinus tachycardia with a bundle branch block is not in itself life threatening.

So the nurse practitioner saw the wide complex bundle branch block, hit the panic button, failed to take in to account the fact that grandma was feeling fine, failed to notice that the heart rate was only 120 (not nearly fast enough for V-tach), and failed to see that grandma had had the bundle branch block for some time (she would have noticed this if she had taken the time to review grandma's old record).

Instead, the nurse practitioner tells grandma and the family that grandma is going to die if she doesn't get to the ER and a cardiologist right away.

I just love it when other practitioners (nurses or otherwise) pave the road between the patient and me with horse manure and leave it to me to dig out.

At first grandma's family (there will usually be a dozen or so of them) seemed upset with the ER nurse and me that we were not at all excited by grandma's condition. After all, when you hit the panic button, everyone is supposed to panic, right? When I explained that grandma was fine they acted like they didn't believe me and said, "Why did doctor X (referring to the nurse practitioner) tell us all this if it were not true?"

I wanted to say, "Cause doctor X doesn't know her ass from a hole in the ground."

Being the consummate professional I said, "She evidently she was mistaken. Perhaps you should discuss it with her later. Sometimes things are not always as they appear at first"

So on this day, grandma and her family were unnecessarily scared to death, subjected to an expensive and totally unnecessary ambulance ride, and an expensive and unnecessary ER visit. These are your Medicare dollars at work people! Also at the behest of the family, I made grandma an appointment with a cardiologist the next day, so grandma got to spend most of that day sitting in that doctor's office and needlessly spending more Medicare dollars.

I called the nurse practitioner later that day and thanked her for the load of horse manure she had sent me via ambulance.

She said, "Oh when I saw that wide ventricular complex, it just scared me to death!"

I wanted to say, "did not your mother teach you that if you don't know what you're talking about, that you should keep you mouth shut?"

Being the consummate professional I said instead, "Did you consider calling the doctor who preceptors you first for advice?"

"Uh......no, I didn't think of that."

So there you have it boys and girls, just another day in the life of your friendly ER doctor.

5 comments:

  1. Perfect example. It bothers me that patients see nurse practitioners AS physicians. They don't know the difference and that can be dangerous. Many times they make appointments with the doctor only to get there and the doctor isn't even working and their appointment is actually with the nurse practitioner. Conversely, some nurse practitioners actually see themselves as physicians, which can really be scary.

    Thanks.

    Debbie Hamilton
    Right Truth

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  2. Ok. I'm gonna stay anonymous on this one in case any of the administration at the hospital i work at reads this. I do have to pay my bills! I kinda feel the same way about the PA's that have taken over the patient care at the hospital. I do think that there is a place for PAs, nurse practioners, etc. But, they should not have as much freedom with patient care as they do. A couple of months ago I was in a patient's room drawing blood and doing an ekg. The PA(who if I understand right has not been out of school long and does not have that much patient experience) was in there doing an H/P. She said to the patient,"Ok I understand that you have a history of this...." The patient(who is a 30 something year old with some kind of heart history after pregnancy or thyroid meds or something like that) says no that's not right. The PA thens proceeds to tell the patient, "Oh well Dr blank got your history wrong." She does not say it only once but probably 4 times while I was in there. Calling the doctor by name each time. The patient is someone who is very verbal about what she has and what she wants and is taking in every word. You could tell that she believed whatever the PA was saying even though she had just got a diagnosis by a doctor. I have worked with the er doc that admitted this patient for many years and have all the faith in the world that he did not get the history wrong. I felt that as defensive as the PA was being, she got the history wrong and didn't want to take the wrath of this patient. First of all, IF the doc did get the history wrong, should the PA stand there and tell the patient this over and over or should she ask the patient to repeat her history so she could get a better understanding?????? To me, this was taking her position as a PA who is under the docs authority way to far!!!!!!! I could see in the little time that i was in the room that the patient had decided that the doctor didn't know what he was talking about and she should listen to the PA. Scary

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  3. Dear Anonymous:

    It is never a good idea to criticize another practitioner in front of a patient, even if you know the other practitioner made a mistake. This is highly discouraged by my malpractice carrier and is always mentioned during our yearly malpractice seminar.

    In spite of this, some doctors continue to do it. I'm not sure why, other than some of my colleagues can be arrogant asses. The problem with this behavior is that it can generate malpractice suits and sometimes the person doing the criticizing will get sucked into the suit as well. In a lot of cases where it looked like a colleague made an error, I will find out later that I did not have all the facts.

    The best policy is to be the consummate professional and address any problems with a colleague in private.

    ReplyDelete