[NPInfo] Re: OT- Re: [MapInfo] An editorial From Dave (who, much to his chagrin, physicians may start describing as "An articulate male mid-level" )

Fri Feb 9 05:16:49 PST 2007

Michael: (I think) the law would say that in NY you are allowed to practice
medicine BECAUSE of your collaboration with a physician. The physician is
not there to back up your NURSING diagnosis but I would guess  because it
makes sense to the people who wrote  the law, your medical practice? If NY
went to independent practice, then how would
the law be written? That would be the test.
Dave

 On 2/8/07 2:15 PM, "Michael E. Zychowicz" <mzychowicz at hvc.rr.com> wrote:

> Dena,
> 
> Please don't misinterpret my comments.  I am not saying that NPs practice
> "nursing" and not "medicine".  I totally agree with your comments - 1000%.
> Absolutely!  I agree that I essentially practice medicine and orthopedics
> from a nursing perspective - I assist at surgery also (hip and knee
> replacements and spine surgery) just like an assistant surgeon would.  No
> argument there, totally agree with you.  Insurance companies don't pay me to
> deliver traditional nursing care and make traditional nursing diagnoses.
> 
> The intent of my question was to ask from a strictly LEGAL perspective if we
> NPs are LEGALLY able to practice "Medicine" as nurses or is it technically
> illegal.  
> 
> Mike Zychowicz
> 
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
> Of Diana Galler
> Sent: Thursday, February 08, 2007 1:26 PM
> To: NP Info
> Subject: Re: OT- Re: [NPInfo] An editorial From Dave (who,much to his
> chagrin,physicians may start describing as "An articulate male mid-level" )
> 
> To all who continue to maintain that NPs practice "nursing" and not
> "medicine", keep in mind that many (if not most) State Practice Acts
> prohibit "nurses" from diagnosing medical conditions and prescribing
> medicine. If you see a patient with low back pain and write a diagnosis of
> "alteration in comfort" and prescribe a heating pad, then you are practicing
> "nursing". If you order a MRI, make a diagnoisis of HNP based on the
> abnormal findings, and prescribe pain meds, an anti-inflammatory, and/or
> muscle relaxants, you are practicing "medicine". NPs are allowed to follow
> this "medicine" model in most states (are there any states where NPs still
> can't prescribe?). At least this is my definition of the difference. As a
> NP, I practice "medicine" with a "nursing" slant.
> Dena Galler
> 
> Calif NP <np at c-zone.net> wrote:
> Both NPs and PAs practice "Medicine"! Both come to their respective
> practices with different backgrounds, similar training overall (at least as
> to the end product/results), graduate/postgraduate level credentials,
> respected professional stature, and proven recognition as advanced practice
> clinicians in the health care delivery system as primary care providers-
> providing medical care!
> To say, or allow it to be said, that either NPs or PAs do something
> other than practice "Medicine" dumbs down what their collective practice is,
> what the delivered professional product is, and allows MDs and DOs to
> continue to claim 'that' turf- the practice of medicine. Why allow the MDs
> (who fought the DOs initially on who was practicing "medicine") to keep
> "medicine" as their private domain, and continue to spout their propaganda
> that what NPs and PAs do is somehow fundamentally different and less
> valuable. Why allow their well-funded doctors' public disinformation battle
> against NPs/PAs to continue?
> If you follow unrelated political silliness (George describing his
> assessment of Obama), you may well wonder when physicians will also start
> referring to PAs or NPs who write editorials as "articulate" (ie. as in "She
> is an articulate, blond, female, mid-level")? Oh, they do already???
> Physicians do not want to relinquish the "practice of medicine" to
> anyone, and as long as their lobbyists with the legislatures, public media,
> etc. can continue the very effective propaganda that NPs/PAs do not
> "practice medicine" they have the public believing that NPs/PAs are
> inferior. Their lobbyistst have a vested interest in maintaining the status
> quo. You do not have to go to "medical school" to practice medicine. That
> notion of fearing a physician asking "Where did you go to medical school?"
> may keep the faint of heart awake at night, but seriously, get over it.
> Really, the more appropriate question to ask some physicians is "Did you go
> to medical school?" and "Which States have suspended or revoked your
> license to practice medicine?" "Which states have you ever been licensed to
> practice medicine?"...."How's drug rehab going?"..."Caught up your child
> support yet?"...."What's it like to be paying alimony to four different
> women Doctor?"...
> Contemplate honestly for a moment - What vested interests or motivations
> does any NP have in clinging so tenaciously to the notion that NPs/PAs do
> NOT practice medicine?
> ;>)
> 
> 
> Interesting discussion of terms found in a popular on-line encyclopedia (an
> apparent consensus of what the public thinks medicine is):
> 
> Medicine (or Biomedicine) is a branch of health science and the sector of
> public life concerned with maintaining or restoring human health through the
> study, diagnosis, treatment and possible prevention of disease and injury.
> It is both an area of knowledge - a science of body systems, their diseases
> and treatment, studied by medical researchers (Biomedicians) - and the
> applied practice of that knowledge, which principally constitutes a
> physician's work in clinical medicine.
> Historically, only those with a medical degree have been considered to
> practise medicine. Clinicians (licensed professionals who deal with
> patients) can be physicians, physical therapists, physician assistants,
> nurses or others. The medical profession is the social and occupational
> structure of the group of people formally trained and authorized to apply
> medical knowledge. Many countries and legal jurisdictions have legal
> limitations on who may practise medicine. Medicine comprises various
> specialized sub-branches, such as cardiology, pulmonology, neurology, or
> other fields such as sports medicine, research or public health.
> "Medicine" is also often used amongst medical professionals as shorthand
> for internal medicine. Veterinary medicine is the practice of health care in
> animal species other than human beings. Osteopathic medicine is a new
> approach to medicine as well. A practitioner of osteopathic medicine
> receives a D.O. instead of an M.D., and is licensed to practice medicine as
> all M.D.'s in the United States and various other countries. However, this
> approach has yet to gain official acceptance all over the world.
> Evidence-based medicine is a recent movement to establish the most effective
> algorithms of practice (ways of doing things) through the use of the
> scientific method and modern global information science by collating all the
> evidence and developing standard protocols which are then disseminated to
> healthcare providers. One problem with this 'best practice' approach is that
> it could be seen to stifle novel approaches to treatment.
> 
> 
> 
> ----- Original Message -----
> From: "Margaret A. Fitzgerald, DNP, NP-C, APRN, BC, FAANP,CSP"
> 
> 
> To: 
> Sent: Thursday, February 08, 2007 6:02 AM
> Subject: RE: [NPInfo] An editorial From Dave
>> Hi- One more comment- we say we practice "medicine", the next comment is
>> then, "Where did you go to medical school?" Who wants that?
>> And the nation needs every single NP and PA who graduates.
>> Dr. Margaret A. Fitzgerald, DNP, APRN, BC, NP-C, FAANP, CSP
>> President, Fitzgerald Health Education Associates, Inc.
>> 85 Flagship Drive
>> North Andover, MA 01845-6154
>> 978.794.8366
>> FNP, Adjunct Faculty, Family Practice Residency
>> Greater Lawrence (MA) Family Health Center, Inc.
>> FHEA website www.fhea.com
>> FHEA on line store www.fhea.biz
>> Proud member of "Team Mimi", Leukemia and Lymphoma Team in Training
>> http://www.active.com/donate/tntma/tntmaMFitzge
>> 
>>> From: "David or Diane Dito"
>  
>>> Reply-To: NP Info
>>> To: "'NP Info'"
>>> Subject: RE: [NPInfo] An editorial From Dave
>>> Date: Mon, 5 Feb 2007 19:38:33 -0600
>>> 
>>> I like HCP better than APC. It says it better and is more inclusive. Now
>>> there's some power with Dave and Peg to back this concept! Let's do it!
>>> Diane Dito
>>> -----Original Message-----
>>> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
> Behalf
>>> Of David Mittman
>>> Sent: Monday, February 05, 2007 6:43 PM
>>> To: NPinfo
>>> Subject: Re: [NPInfo] An editorial From Dave
>>> Peg:
>>> I do not disagree. Want to get people thinking a bit. Just saying out
> loud
>>> that people are going to start to look for APCs who can provide medical
>>> care
>>> (I could be wrong also!) and if they think NPs do some sort of
>>> "nursing"-more medical schools will be built. If they think PAs are
> really
>>> "assistants", same for us.
>>> Let's change all our names to HCPs (Healthcare Practitioners) then and
>>> educate people we can provide healthcare and medical/advanced nursing
> care
>>> also.
>>> Dave
>>> On 2/5/07 12:41 PM, "Margaret A. Fitzgerald, DNP, NP-C, APRN, BC, FAANP,
>>> CSP" 
> wrote:
>>> 
>>>> David, You and I have known one another for decades and respect one
>>>> another's work. We are usually on the same page as well. While I agree
>>> with
>>>> most of your editorial, I disagree with you on the medicine practice
>>> part.
>>>> What we all practice is healthcare, not medicine, a word I believe
> puts
>>> one
>>>> discipline in the driver's seat. Healthcare should be patient, not
>>> provider,
>>>> focused.
>>>> 
>>>> Peg Fitzgerald (who sends this note with a big hug to my buddy David
>>> Mittman
>>>> and is a healthcare practitioner, FNP, in family practice)
>>> 
>>>> Dr. Margaret A. Fitzgerald, DNP, APRN, BC, NP-C, FAANP, CSP
>>>> President, Fitzgerald Health Education Associates, Inc.
>>>> 85 Flagship Drive
>>>> North Andover, MA 01845-6154
>>>> 978.794.8366
>>>> FNP, Adjunct Faculty, Family Practice Residency
>>>> Greater Lawrence (MA) Family Health Center, Inc.
>>>> FHEA website www.fhea.com
>>>> FHEA on line store www.fhea.biz
>>>> Proud member of "Team Mimi", Leukemia and Lymphoma Team in Training
>>>> http://www.active.com/donate/tntma/tntmaMFitzge
>>>>> From: David Mittman
>>>>> Reply-To: NP Info
>>>>> To: ACC-Circle , NPinfo ,
>>>>> 
> 
>>>>> Subject: [NPInfo] An editorial From Dave
>>>>> Date: Sun, 04 Feb 2007 19:38:20 -0500
>>>>> 
>>>>> Let¹s Redefine Medical Care, Quickly
>>>>> By Dave Mittman, PA
>>>>> 
>>>>> We will have mandatory national health insurance. Every week one
> state
>>> or
>>>>> another talks about the fact that many of its citizens are not
> covered
>>> by
>>>>> medical insurance. A number of states have come up with plans to
>>> address
>>>>> this and if California can pull it off successfully, they will
>>> certainly
>>>>> be
>>>>> looked at as a model for the other larger states.
>>>>> On top of this, we have a physician shortage. A recent article stated
>>> that
>>>>> the Council on Graduate Medical Education predicted a shortage of
> close
>>> to
>>>>> 100,000 physicians by the year 2020. That¹s a huge number of
> physicians
>>> to
>>>>> be short of. Add to that the fact that there are almost 200,000 NPs
> and
>>> PAs
>>>>> already delivering of healthcare in this country and you know we have
> a
>>>>> problem.
>>>>> Business will demand national healthcare coverage because it has to
> for
>>> its
>>>>> own survival. Not because business people are experts in medical care
>>> but
>>>>> because they cannot compete on a world level anymore because of the
>>> burden
>>>>> of healthcare costs. A small business in the U.S. that has six
>>> employees
>>>>> has
>>>>> to start out budgeting $75,000 for health insurance before they even
>>> open
>>>>> their doors. The same business in Western Europe, Canada, India,
> Mexico
>>> or
>>>>> the UK does not have to worry about this cost. What a deterrent to
>>> opening
>>>>> new businesses and competing on the world level. So, not if but when
>>>>> national insurance comes, how many more providers will we need?
>>>>> And, how can we ever begin to figure out what the medical care needs
>>> will
>>>>> be
>>>>> of the baby boomers as they age into their 60s, 70s, 80s and beyond?
>>>>> What does this all tell us? That the powers that be; medical schools,
>>>>> organized medicine (read AMA, AAFP, ACOG, etc), public health
>>> officials,
>>>>> big
>>>>> business, and others will be called in by Congress and asked to
> develop
>>> a
>>>>> plan to provide more medical care to our citizens. Their logical
> answer
>>> to
>>>>> this challenge will be to create many more medical schools and many
>>> more
>>>>> doctors. What else could they say?
>>>>> What else would anyone expect them to say? This is a no brainer.
>>>>> 
>>>>> That¹s where I get worried. For years there has been a debate as to
>>> what
>>>>> kind of ³care² PAs and NPs provide. Look at most literature from the
> NP
>>>>> movement and you will see that NPs provide ³healthcare² or ³advanced
>>>>> practice nursing care². Rarely does the ³organized² NP world admit to
>>>>> providing medical care, although individual NPs certainly do and
> always
>>>>> have.
>>>>> Now I understand this healthcare/medicine distinction fully and
>>> actually
>>>>> agree with it. But it should change. Now let¹s look at the PA world.
>>> They
>>>>> do
>>>>> provide medical care but always seem to officially say that in a
> humble
>>>>> way,
>>>>> as in ³we do it, but we do not want to say it as loud as we can².
> That
>>> will
>>>>> wind up hurting PAs if they keep it at that level, because when it
>>> comes
>>>>> time for all of the different medical care groups to chime in and
> look
>>> at
>>>>> JUST WHO CAN PROVIDE MEDICAL CARE and whom to give the money for the
>>> future
>>>>> provision of such, where do you think it will go? Thirty more medical
>>>>> schools will be built and many others expanded.
>>>>> 
>>>>> I say let¹s step up to the table now and have both our fine
> professions
>>>>> start educating the powers that be that we provide ³medical care² to
>>> over
>>> a
>>>>> million people every day and want to expand our delivery of it in the
>>>>> future. Yes, I am sure we also provide more than that. Maybe it¹s
>>> holistic
>>>>> care. Maybe it¹s more patient oriented care? But in this context will
>>>>> Congress or your state legislature even understand the nuances? We
> have
>>> to
>>>>> tell the world that yes, we do medicine, and we do it well! We also
>>> must
>>>>> not
>>>>> be afraid to ask for a seat at the table when this new healthcare
>>> delivery
>>>>> system is being carved out and to lobby to make sure both professions
>>> are
>>>>> involved. If the country needs medical care, let us answer the call
> and
>>>>> give
>>>>> it to them.
> 
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
> 
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
> 
> 
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
> 