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

Thu Sep 6 05:56:43 PDT 2007

David, Thanks for your leadership in this area. 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> Date: Wed, 5 Sep 2007 17:16:15 -0400> From: dmittman at comcast.net> To: acc-circle at listserve.com; NPinfo at nurse.net; PAForum at mc.duke.edu> Subject: [NPInfo] Dr. Feldman replies. Nice, very nice............> > 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> > _______________________________________________> NPInfo mailing list> NPInfo at nurse.net> http://lists.nurse.net/mailman/listinfo/npinfo> *****************************> > 