[NPInfo] Dr. Feldman replies. Nice, very nice............

[David Mittman]

My second reply is first, so scroll down and read his first.
Interesting light on how he feels the retail clinics will destroy continuity
of care and the healthcare ³home².
Good insight.
Dave

Richard: 
Thank you for your thoughtful reply back. I am impressed.
If what you say is true and I have absolutely NO reason to doubt your
sincerity, we disagree on the retail clinics. I still think there is a place
for them because so many of our citizens need the services they will
provide. I was involved in the beginnings of family medicine 32 years ago,
worked with a bunch of militant FPs and know how important it is to have a
medical/healthcare home. The point is, if it is to really be a home, it must
accept all patients as family and as we all have painfully learned family is
accepted unconditionally. Offices open till midnight.  Extensive use and
input from NPs and PAs by the healthcare system and your colleagues.  Lower
fees or co-pays to those without insurance, and all of us pushing together
for equitable reimbursement until a national healthcare system arrives. Also
respect for each other and what each of us (NP, PA, MD) brings to the table.
We have to start understanding each other. What we do all understand is that
clogging up ERs with bronchitis, allergies, flu, immunizations and other
primary care illnesses is not working. Truly in many cases our patients have
no where else to go. A real family takes care of it¹s weak, depressed,
elderly and other members. It also has mutual respect for everyone who lives
there. It is now our job to fix the parts of it that are dysfunctional. Part
of that dysfunctional behavior is one group thinking they are better than
everyone else who lives in the house. That does not help the situation.
Thanks again for the kind comments. I and many other NP and PA leaders look
forward to a continuing dialogue to help resolve the problems that exist in
our healthcare world. Lastly, I would like to stress that we truly do want
to work together to make this happen.
Sincerely,
Dave Mittman, PA


On 9/5/07 9:28 AM, "Feldman Dr. Richard" <Richard.Feldman at ssfhs.org> wrote:

> Dave,
>  
> Thank you for your very thoughtful and respectful letter.   I got a lot of
> nasty replies, believe me. I do not disagree with most of what you say, in
> fact I have every respect for PA's and NP's and have worked with them for 30
> years.  I teach PA and NP students in my office and in the hospital and
> believe in the team approach to health care.  I was involved in the Indiana
> legislation and spoke in favor of script authority.  I am sorry that my
> editorial appeared to be an attack on midlevel providers.  It was really meant
> to be more of a criticism of our broken health care system as you point out
> and our current state statutes that promote the fragmentation of medicine. The
> result is retail clinics and the lack of respect for primary care and the
> medical home.  I would hope that PA's and NP's would look beyond the business
> opportunities of retail clinics and promote true medical homes where we can
> all work together in an integrated system.  To me, this is not about money,
> but the preservation of continutiy in health care.
>  
> I will keep your e-mail to refer to as we look at this situation in Indiana.
>  
> thanks again,
>  
> Richard Feldman
> 
> 
> From: David Mittman [mailto:dmittman at advancedprac.com]
> Sent: Wednesday, August 29, 2007 3:24 PM
> To: Feldman Dr. Richard
> Subject: I had to Write
> 
> Doctor Feldman:
> Truly it is with great respect that I write you this letter. I did not post a
> reply in the newspaper as that would have not achieved what I would have
> wanted to. I would love for my letter to actually inspire you to look beyond
> where we are today to a medical care future that utilizes all professionals
> best, at the level where they can they can best practice at, be they an NP,
> physician or PA.
> No one ³owns² medicine, nursing or even our laws. All of these are disciplines
> that are fluid, they change and evolve over time. When I graduated PA school,
> nurses were just picking up stethoscopes to listen to peoples chests, now they
> are quite adept at doing that.  I remember docs saying they would never let
> someone take a blood pressure of THEIR patient or give them an injection. As a
> new PA, I could not imagine having a profession in which we would practice in
> every specialty, first assist at open heart surgery, get hospital privileges
> in thousands of hospitals, become professors at medical schools, or be judged
> by our competence-not just our title. Much has changed in the 32 years since I
> became a PA. To insinuate that either PAs or NPs are not trained well enough
> to staff these retail clinics is actually so transparent that people see right
> through it. That¹s why this series of attacks will backfire. It¹s funny, let
> me relate 2 short stories. When I started to practice I worked in a large
> medical group. Some of the docs flat out did not like me, others did and most
> were of the ³prove to me how good you are² types. I was pulled aside early in
> my practice by a pathologist who was very, very famous in our area. He asked
> me to tell him what I could do, what the training was, what my beliefs were
> about many things and said ³You can take care of me anytime². He told me that
> all of healthcare is based around money and if people think you will take some
> of theirs, no matter how much they have, they will be angry at you. Advice
> which has made me a better leader and clinician over the years. This fellow
> was also pretty famous for being one of the first people to liberate
> Buchenwald, as he spoke Yiddish was a young Brooklyn MD, could communicate in
> ³German² and so he was put at the front of the line. I think that experience
> made him someone who looked way beyond day to day problems and one who saw the
> worst that there was to be seen. I know what he would say today about
> organized medicine being critical of new ideas. Makes me smile even now. The
> same month I met our radiologist. He told me he would not read any X-Ray I
> ordered and not to come near him. Slowly he came around and 4 years later when
> his wife had an emergency and was coming into the group for care, he called
> and asked if I would see her. He said he wanted her in good hands. Like I
> said, evolution of thoughts, practices and people.
> So now it is almost 2008 and the evolution continues. Just so you know, PAs
> and NPs now prescribe in ALL 50 states, your state being the last state that
> decided to allow us (PAs) to do that. We are officers in all services of our
> military and are providing both primary care and advanced care in Iraq and
> Afghanistan. A PA has even been named ³FLIGHT SURGEON of the YEAR² (see
> below). In fact, we have lost 2 PAs in these conflicts. They were killed
> providing advanced trauma care to our boys. Rather than worrying about NPs and
> PAs treating pink eye- if you really believe we are that poorly trained,
> please be worried about the inferior care being given to our soldiers. This
> might be a much better rallying point than whether we can provide care in
> retail clinics.
>  
> Dr. Feldman, what I am trying to say is that things change. The retail clinics
> are springing up because the system is broken. While the AMA has attacked
> almost any group (even when scientific studies could show they could HELP in
> this crisis), Americans have suffered. I fully understand that you believe
> that if you are not a physician you can¹t really practice good medicine. I
> think if I was a physician I might also, but I would remain a man of science.
> I would also be open to the belief that it was possible to get the training
> and experience to be a good clinician. I would realize that most NPs and PAs
> chose their professions after being another type of healthcare professional
> for a number of years. All of us came with experience. All of us care about
> this crisis also. All of want to work with physicians as our close colleagues,
> not people who take pot shots at us. It is with this in mind that I ask you to
> take some time out and meet a few seasoned NPs and PAs. Most of us care about
> the same things you do, and worry about what the future will bring. I think we
> have to figure out how to work together and understand each other or others
> will ³fix² the system for us, which is not in our best interests, or most
> importantly the best interests of our patients.
> Have a Happy Healthy New Year.
> Dave Mittman, PA