Sunday, September 25, 2016

Statement on Nurse Practitioners with Independent Prescribing

 

 

If any member of the legislature were having crushing chest pain, and had shortness of breath, with a family history of premature  deaths by heart attacks,  would they want to be seen by a cardiologist or by a nurse practitioner filling out a form on the electronic record? Why are the lives of black people on Medicaid worth any less than that of the legislator?

The movement to allow nurse practitioners to prescribe unsupervised, will result in a two tiered health system, one for whites, one for blacks. It stems from racial animus. The aim is to raise the mortality of black people even higher than it is already.

Their role is falsely justified by lack of access to medical care. There is no doctor shortage. There is a shortage of doctor time. Half of that time is consumed by regulatory quackery. Regulatory quackery is a rule that has not been shown to improve patient outcomes. Its intention is take up doctor time with worthless procedure so that fewer payments are made for real patient care by government and by insurance companies. Because regulatory quackery has consumed $trillions and prevented the real care of millions of patients, it is the greatest financial fraud crime  in the history of mankind. Examples of regulatory quackery include, the electronic medical record, pre-authorizations with all out, implacable resistance to paying for any care, including cheap generic medications, almost all accreditation standards, privacy destroying patient registries, such as those for pain medications, pseudo-scientific and false practice guidelines.

Nurse practitioner programs are so competitive that only people with nearly perfect grades get in. Most qualify to get into medical school. They have chosen to bypass that harder road to clinical competence, to begin making money earlier, and with less student debt. That corner cutting should not be rewarded with independent prescribing privileges.

As a result, they know one quarter that specialists know, and half as much as primary care physicians. They are fit only to prescribe for patients doing well, needing routine refills without any change. They are fit to diagnose routine, common and mild disorders. They are fit to administer first aid and nursing care.

New patients with serious or life threatening conditions should not be evaluated by them. They can read off checklists, but have none of the skills that come from the experience of doctors.

Even after 5 years of experience, because they have not been challenged by difficult experiences of physicians, they will require supervision.

A patient commented on the internet. A nurse practitioner insistently called the growing lesion on his arm  an "age spot" for a year. The patient demanded to see the dermatologist. The doctor arrived at the door, and from that distance, stated, “That is a squamous cell carcinoma. It has to come out.” Squamous cell carcinoma is a common skin lesion in the elderly.

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