Radiology - A High Yield Review For Nursing Students (1)

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Yale researchers have introduced countless medical and health advances over the last century, including the first success with antibiotics in the United States and the first use of chemotherapy to treat cancer. University scientists have been responsible for the identification of Lyme disease and the discovery of genes responsible for high blood pressure, osteoporosis, dyslexia, and Tourette's syndrome, among other disorders.

There are many benefits to receiving your care at an academic medical center. As faculty at Yale School of Medicine , we are innovators and researchers, constantly seeking out better treatments for our patients. Many of us are national and international leaders in our fields, providing the most advanced diagnostic and therapeutic approaches and using the most advanced technology. Read more about the Yale School of Medicine or read more about the patient care provided at Yale Medicine.

The Yale New Haven Gamma Knife is the only radiosurgery unit in Connecticut dedicated to the treatment of head and neck conditions and is the radiosurgery center with by far the most treating experience in Connecticut. Staffed by a team of specialists with cumulatively greater than 30 years of radiosurgery experience, treatment at our center results in predictable and nationally recognized outcomes.

Here, Veronica Chiang, MD, prepares to surgically remove a brain tumor. More than 1, Yale physicians provide primary and specialty care for patients through Yale Medicine. Yale Medicine delivers advanced care in more than specialties and subspecialties, and has centers of excellence in such fields as cancer, cardiac care, minimally invasive surgery, and organ transplantation.

Here, Karen Santucci, MD right , talks to a young patient about the importance of bicycle helmets. In its MD and other degree programs, the School of Medicine educates future leaders in medicine, public health, and biomedical science. The MD program follows a unique educational philosophy, the Yale system of medical education, which was established in the s by Dean Milton C. No course grades or class rankings are given in the first two years, examinations are limited, and students are expected to engage in independent investigation.

Here, students are celebrating graduation day. Read more about the admissions process. Founded in , the Yale School of Medicine is a world-renowned center for biomedical research, education and advanced health care. Office visits are 15 min. Trust me I can see that doctors have no control over their position in all this.

This is just you speculating. Did you have access to the work up done by APRN? Yes, I should clarify that. We use a common medical chart and I had access to the workup. You ran across this encounter but you really should not generalize the entire NP profession. It is still a renal stone, but the size is very tiny. I for one, have renal stones that range from 0. My kidneys are a factory. Which by the way was diagnosed by a NP. No they are not doctors, but sometimes they catch things a doctor refuses to see, because they have become so arrogant in their ways.

What I see here, is old school thinking. Dr Davis, so explain something to me then. I see asthmatics daily — oftentimes they are a complete mess in terms of medications, adherence or disease understanding. Patient 1 had been put on Anoro by itself and continued to have ongoing issues including recurrent sinus infections. Interesting that her asthma is so much better controlled being on the right medications though. This article is ignorant. Agree that details matter. Misinformation hurts all of us. That was one thing we learned often in medical school.

Davis Liu, not Dr. Would you not expect a practicing PCP who is an MD to understand basic treatment for asthma especially after 8 years of practice , including the proper use of ICS and improper use of other medications e. Instead of the ego and opinions, provide me with solid, objective evidence to support your claim. All from varying levels of expertise. I would never sit there and generalize them all as incompetent based on my experience like you have, however.

BTW, I practice very independently within my practice. Sure, my partners are Pulmonologists, but I see patients independently and only involve them when they need to be involved. I know my scope, limits and what I am comfortable with. This is the standard of care. Mild, moderate, and severe persistent should have ICS. There is plenty of evidence that patients not on ICS for those types of asthma and who are only in LABA are at risk for increased morbidity and mortality. If a PCP who is a MD does not know that, that is unfortunately what the evidence shows, and as you note.

There is extreme variation in health care. In general, it takes 17 years typically of something that is published in the New England Journal of Medicine, to be commonplace. If a MD with all of that training can have this problem with providing the latest evidence consistently, in such a broad specialty like primary care, how can we expect others with even less training to do a better job?

Note, I am talking about primary care NPs and need for physician oversight. If someone like yourself prides on understanding details and facts, then when I talk about 10, hours of deliberate practice to be expert, when I ask that NPs be held to the same certification standards as doctors, where is the harm? That is simply an example to start a discussion. Why should there be double standards, particularly in primary care where having deep expertise broadly is extremely difficult? Re-read the article instead not as a NP but a policy maker and ask yourself the same question — why the double standard?

This is what Dr. Sandeep Jauhar, author and cardiologist, posed in his NY Times op-ed piece. My call out about Dr. My staff routinely refer to me as Davis as plenty of research shows having hierarchy decreases psychological safety. So I insist on a first name basis. However when people provide feedback on my perspectives and when people say they are particular about details and facts, saying Dr. Davis rather than Davis or Dr. Davis Liu or Dr. Liu, that seemed like very easy thing to have overlooked or missed. As a consequence, it appears you and many others have also missed the entire point of the post as well.

I understand your frustrations, however NPs never declared that they are doctors. They have advanced training that allows them to provide primary care to patients and refer to MDs when necessary. You sound extremely bitter. NPs are not MDs and MDs are not NPs, we should all understand that a cooperative interdisciplinary approach to patient care is what is needed in this healthcare climate. Your approach is divisive and condescending. You are the type of doctor anyone should ever boast about…your attitude needs a lot of work.

Where to start, well lets hit the obvious, how did an article based on 3rd party description from one single client get published? You state the level of education by MD is superior, this is a prime example of the difference a NP having a masters based education and a physician with a medical degree. Last time I checked MD no one graduates knowing it all.

As a NP who works in Primary Care, I find this article a sad misrepresentation of the care being provided. What a sad uneducated article for what we as nurse practitioners have as education required, stringent testingcertification and knowledge.

You write this article as if you have a grievance against anyone not a physician. You demean nurse practitioners. You fail to understand research, evidenced based that demonstrates that NPs care is as safe or safer than a physicians. I would certainly wonder with you on a team of working professionals in an office whose goal is to focus on patient care and not walk around with grievances about a profession that can do what you do, can understand complex medical problems and has years of experience many times over yours.

Of course laws are changing based on this evidence based practice and in lieu of our present economic crisis you will more NPs than you do MDs. The care is the same or better actually. There are many MDS that have a God complex and you sir need to experience teamwork ad respect for a leading group of medical professionals that can and do many times what you are doing in a practice.

We are trained thoroughly to look at a patient holistically.

Primary Care Is Not Simple Or Easy – Doctor Training Is Different

There are times when we have to speak on a patients level to help them understand the process of their problem or educate them on options for resolution. This is something that I do not see frequently with physicians. In this day, people want medical providers who are knowledgable, and provide education and options for their own health. I am a nurse practitioner and have 30 years of experience. I also specialized in one area and have continued to expand depth of knowledge. Primary care MDS seem to be comfortable with referring out to other MDS any problem and the depth of their knowledge is gone.

I would not if I were you show my lack of knowledge of how prepared we are as NPS especially in specialty areas. Your opinion, however strong and bias, does not mean that nurse practitioners are less competent.

You are comparing one anecdotal account of nurse practitioner practice to the entire profession. Is this the way you practice medicine? Without evidence and based on anecdotal accounts? I am happy that the thousands of hours you spent training in medical school, which are based on the Flexner report of an untested opinion on what medical education should look like, makes you feel like the superior provider in primary care.

Unfortunately, the evidence does not support your claim. Many nurses have thousands of hours devoted to patient care prior to becoming nurse practitioners. Nurse practitioners seek to function at the full scope of their practice- which is to provide primary care. Medicine should seek to function similarly- your license is in medicine and surgery. You could be performing neurosurgery- but instead you are managing hypertension and other chronic conditions.

My point is that healthcare is not a hierarchy, patient outcomes matter the most. Nurse practitioners do not have inferior patient outcomes in comparison to physicians. You are entitled to your opinion in this matter. Some of the things I have seen doctors do are far worse than anything you mention. This one example does not prove anything at all regarding nurse practitioners. I think they must have given you classes in how to be arrogant as well. I think worked for five years full-time in medical-surgical, oncology, and home health nursing for approximately an additional 7, hours of direct patietn care.

In graduate school I will receive another hours of direct patient care, not counting the coursework. The primary difference is in my holistic model versus a medical model. As a patient I have to agree with Susan. When I was 13 years old I had severe back pain and at the time was quite literally crooked. He then proceeded to give me all the vicodin in the world.

Because of HER my NP I am doing much better, I am no longer in the shape of a S because she actually helped me instead of shoving pain pills in my face. When I am sick I get seen in a matter of a week. I also see a NP for my vagina. So I, along with most of North America, disagree with you. My kind regards to your Doctor EGO. I do not and never will feel that any one who is a nurse practitioner is as qualified to make a medical decision as an MD. I am not denying the education it took them to get to that point, obviously a lot of hard work. That said it is just not the same and never will be.

If you go to a group of Doctors, without requesting anyone specific, you get an nurse practitioner or if you are lucky a PA. Where are all the doctors and is it just a matter of who is cheaper to keep on the payroll? I was web-surfing for message board material on the topic of public perception of nurse practitioners when I ran across your blog. We will also agree that anecdote has limited value. These anecdotes are illustrations of individual frailty and failure. I think humility is an essential requirement for a scientific mind.

For intelligent folks, simply studying physiology or anything medically relevant, come to think of it should provide an ample dose of humility. The amount of information is unwieldy, and despite the quantity of information, humanity is not living in an age of enlightenment. I often hear persons of average education express distaste for the arrogance of physicians.

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The NP reactions are here are knee-jerks, driven by ego. Jane Fitch was apparently in possession of oversized ego prior to medical school. Personally, I do not require the gauntlet of medical school to know where I stand intellectually. I am not an egomaniac.

I am good at using references. I see some connections, I miss others. Why might NPs have egos out of proportion to their abilities? If you want them, just email me. Personally, I like the collaborative practice model. Attempting to practice independently as a new NP graduate sounds utterly ludicrous. The ego battles help no one. I found that my medical expertise were more suited to a tertiary center where people with advanced medical or severe illnesses generally came after a referral from their primary physician.

I see the future of Physicians in primary care will change towards most working in major centers with no real need to work in outpatient clinics. There may not even be a need for family physicians and most will probably become internists or branch out to other specialties.

In the hierarchy of the medical field a Physician is at the top. The scope of practice for a nurse practitioner in the United States is defined by regulatory boards of nursing, as opposed to boards of medicine that regulate medical doctors. If an NP wants to get the same pay-scale, same respect as a physician then there are no shortcuts but to get an MD degree. What is factual; however, is that many doctorally prepared nurse practitioners are proving their egalitarianism by passing the same final USMLE step in the board exam.

So yes, please call me your primary care provider; call me your primary care doctor; call me Jack; I am all of these. If this is something you aspire for, then medical school is the only track to take. I liken this to any kid can learn to ride a bike in a day; this for the most part is primary care. Furthermore, I would not expect a new family medicine doctor to have the wherewithal to do much more than your average nurse practitioner fresh into practice. Furthermore, family medicine docs and internists need to set their egos aside and stop falsifying the aptitude of other interdisciplinary providers.

Advanced practice nurses have a hard road ahead; primarily because of the precedence set for our profession at inception. It blows my mind that Nightingales fundamental theoretical constructs are still being glorified within nursing institutions, as the discipline has undeniably grown markedly away from its premise.

Moreover, as a nurse working in the 21st century, I remind myself that what makes my discipline unique is not theory alone, but caring for my patients through a multi-disciplinary approach meanwhile paying careful attention to evidenced based medicine in my practice. This is what sets us apart from physicians. Lastly, my name is Kathryn and not Jack. If you want to treat patients and prescribe medications, do the work and go to medical school. They are taking advantage of a healthcare system that wants the McDonalds approach: I will fight until the day I day against this ridiculous and fraudulent practice.

As for you NPs who are offended by this, I only recognize credible sources. I refuse to seek medical care from a person who has to look at pictures of what I may or may not have on a computer screen, and then have to look up the medication to prescribe, because the picture resembles what I might have. I should add, I think nurses in a hospital setting are wonderful.

I was hospitalized with a serious injury a few years ago, and I could never thank them enough for their compassion. An NP who specializes in neurology? Wanna fly with me? This does not make them frauds. It also does not mean that physicians are perfect and do not make mistakes, because I can tell you they do; and more often than you may think.

I cannot tell you how many times I have had to beg a physician to order more tests on a patient because they were actively having a hemorrhagic stroke, MI, going septic, etc , instead of transferring them to another unit or discharging them home. I agree with Dr.

I started my career as a Navy Corpsman medic in the military, serving 4 tours in Iraq and 2 tours in Afghanistan. Not only was I responsible for keeping my Marines alive, I was also responsible for providing care to entire civilian populations because their doctors fled the country as soon as the war broke out. I provided various levels of care to men, women, and children who were caught in the crossfire of war. As an RN, I worked in the intensive care unit of a Level 1 trauma hospital, where I continued to learn from physicians and nurse practitioners who are some of the best in the business.

Now, as an NP, I work in a busy primary care office where I see up to 30 patients a day. I also know my limitations and I know when to make the appropriate referrals to the specialists. In , there were around , nurse practitioners in the United States. Now there are over , This is a biased opinion. One NP cannot represent the entire NP population. I have a Microbiology Degree and another degree in Nursing.

Nurses Are Not Doctors

When I used to work in the lab where MDs call me to ask me the most stupid questions. I assume they are new to the profession. Do they represent the entire MD population? Your article is unfair. Do you really think nurses can do their job without knowledge of pathophysiology and symptom recognition? Most docs miss those and nurses with good symptom recognition is the first one to alert the doctors. The success of hospitalists are mostly due to nurses. Especially if they have received mentoring and on-the-job training. Becoming an NP requires NO clinical experience between the two degrees.

Are you kidding me??? Even then, I had 2 more years of residency and had to pass my FP boards before I was fully ready to be out on my own. In fact, during my residency, I have seen many experienced PAs and NPs who do quite good work and, they taught me a lot. But they had years of on the job training. But not all NPs have this opportunity. I thought they wanted to be completely independent.

NPs are not being trained adequately across the board. To me, that signals a flaw in the program design. There is NO substitute for hands on experience and hands on, collaborative clinical problem solving. One that guarantees minimum competencies of all graduates upon completion of the residency. Sure, let NPs have the independent practice privilege and PAs for that matter but make them do a residency first. Derm biopsy; Fluorescein stain eye exam; Sutures; Joint injections; Navigating a patient through a Hospice experience; Signing the death certificate; Doing a day newborn exam; Knowing pediatric developmental milestones; Guiding parents though bed wetting, feeding and behavioral challenges; Knowing peds derm; Knowing how to deal with in office emergencies etc, etc, etc.

We learn a lot in med school but residency is where the real, day to day learning takes place. Primary care can fool you. Easy stuff is easy. Straightforward stuff is straightforward. But not every patient has the classical or typical presentation of diseases. Thinking that we can take the shortcut by not requiring adequate training for NPs might look like a quick and cheaper solution to the primary care shortage.

Mid-Level providers basically function at the level of a 4th year medical student with half the intelligence. Sorry truth is truth. The tests came back and confirmed that it was lyme and she was started on treatment right away. As a nurse practitioner for over 17 years, I liked to add to the discussion that anything outside the scope of practitioner is ALWAYS referred to a specialist. We, as nurse practitioners, are not in the practice to just shrug patient issues off. This is where most doctors get this wrong. We want our patients to be well. If we are unsure of a diagnosis, we will reach out and refer.

I am truly insulted that doctors believe that we minimize and are undereducated regarding patient care. I truly care about my patients and will do whatever it takes to make my patient well and get an accurate diagnosis. I know my resources and use them if need be. Why would you want NPs independently staffing ERs? I also recently found hepatitis missed by MD. I am not smarter or wiser and thankfully the MD I work with does not feel I am incompetent as with two eyes, we seem to help each other.

Instead of patients being the focus of our efforts through collaboration, there is this animosity between medical doctors and the mid-levels that is getting in the way. If you trained as an NP then that is what you are and do not compare yourself to a physician. This is where I am finding a whole lot of hypocracy in our healthcare system. Mid-level providers now have the opportunity to practice independently — it scares me and frustrates me to no end because of what I had to go through to become an MD.

Doctor is a privileged title and I cringe every time I hear an NP or PA call themselves a doctor — most of it has to do with wanting to be perceived as more than they are to their patients. Many will deny this happens but I see it everyday where I work. This is so incredibly wrong and this is where we are headed as long as mid-levels continue to try to elevate themselves to the MD status without the credentials to back it up. I have seen it over and over.

Do you call that a success story? The same goes for antibiotic use — when I review charts I am baffled at how many times they are prescribed without a legitimate reason — at least there was nothing charted that would justify their use. Again not an isolated event — I have seen it hundreds of times.

Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight

The basics of primary care! Even after six months of working in a clinic making k they have a hard time making decisions without significant clinical support. Turns out the patient had a broken arm. I understand not all NPs are trained the same but so far I have not seen anything that indicates sufficient competence for independent practice. Many of my doctor colleagues have expressed the same sentiment. Important to note — all of our NPs have been trained at different schools. Yes, I am bitter about what is happening in our healthcare system.

There needs to be a better definition of roles to improve collaboration of care. Those of you that do this will lose the respect of those that can become your mentor and advocate. Learn your place and stick to it. Not only is it misleading and false advertising, it violates the fundamental trust patients have in all of us who care for them. I am a PA with 16 years experience. I currently work in Cardiology. Will I sometimes catch things that my MD might miss or overlook? Will I occasionally make mistakes?

While I occasionally save the day? They did not go to medical school. I might have a somewhat controversial opinion on the matter, as I teach nursing. I do feel that physician extenders are important, but I believe in the collaborative model as it relates to nurse practitioners, and not the independent model. I also believe part of the problem lies in the wide disparity in education and the format of delivery in many graduate schools as it relates to the quality and intensity of the theory and clinical piece.

If graduate schools of nursing would make the admissions requirements tougher and the required clinical hour piece longer, the quality practitioner might be better. Which tests, if any, were needed that the NP did not order in her work up? If I had a nickel for every upset family member that called because their mom or dad mistakenly told them they had an some awful, serious condition when in fact it was a UTI or the likes.

A missed symptom or misdiagnosed symptom can send me into a whirlwind of symptoms that were silent days before. I think there should be a limit on the number of NPs in the nation. Hard to regulate and insulting to enforce? Your friend will not have a problem finding a job in internal medicine. If anything that is a specialty that needs more doctors. Here is a place that is actively hiring… http: We are well educated and perfectly suited to the job.

Physicians make mistakes too. Sounds like you are feeling threatened. This article is nothing short of hate speech, and you are not exactly a credit to your profession. I went to medical school because I wanted to be sure I had a solid understanding of basic science followed by a solid understanding of pathophysiology. I willingly sacrificed years of my life because I realized that the privilege of becoming a medical doctor also came with it the responsibility of lives.

A first-year medical student should be able to tell you that. My mom is an elementary school teacher with no medical background. She said she loved that her NP was thorough. I informed my mom that the correct term is called wasteful, and now she sees a medical doctor who DID make sure she had her yearly mammogram which was missed the past two years despite a family history of breast cancer. To someone with no medical knowledge, that may seem unpersonable and not thorough but far from it. First, do no harm. When my mom learned she no longer had to have a transvaginal US every six months which also means she no longer has to pay the copayment for the procedure her loyalty quickly changed from the NP to the MD.

And this is just one example….. I have so many more including my own personal experience. Maybe appalled or dismayed more appropriately describes the feelings? They are all important. Important for our patients and that is what should matter. At least to me that is what is important……I naively thought everyone felt the same way.

To me this makes sense because student loans are killing new MDs, and they can make a lot more in a specialty. This is what the medical community need to figure out and change. The 21 states that have passed a form of independent practice for NPs is because of the primary care shortage, not so they can do hip replacements. I am a nurse practitioner and worked as an RN for a decade in level one trauma centers.

I do not doubt that most doctors understand pathophysiology and diseases more than most nurse practitioners. The school I attended also had a large medical school, and many of our classes were combined with medical students. Part of this was to get us to understand the others profession. Great for NP students, but it was pointed out in some lectures they wanted to break doctors tunnel vision. For decades medical students were trained to look for and treating the disease, but they failed to see and treat the whole patient. Nurses are trained at seeing and treating the whole person, which is probably one reason that for 40 years nurses have ranked first in honesty and ethics except for after when it was firefighters.

The MD I work with and myself consult often to specialists and people we know. They are also open-minded to what is the best for the patient. I have seen mistakes made by both NPs and MDs. I think it is import for large metropolitan Drs ti understand Davis that more rural areas in midwestern states have a real shortage of all physicians right now. This is not anecdotal; there are literal thousands of studies you can find on line.

Then my health started to decline and I could not find a Dr or a NP who would listen empathetically or just order some tests other basic labs. There are no neurologists here. After 2 yrs and a formal complaint against a NP in a local hospital, my own diagnosis was finally taken seriously: I think the idea of primary care was changed away to its true definition. Upon looking it up, primary care is health care at a basic with an initial approach from a doctor or nurse for treatment so it means the one who should be giving consultations are the ones who has a wide range of knowledge on such field.

It is safe and assuring to say, I think it is better to have the care from nurses with physician oversight to fully cover what is to be taken care and the right treatment to be applied. Person responsible for health will be the one with the license of your ailment. I can see the frustration on both sides: In these areas patients are traveling 2 hours for medical treatment. Nursing school, NP school, and experience versus medical school , residency cannot be compared. A medical doctor is a medical doctor and I respect their dedication. A nurse practitioner is an intelligent nurse with an advanced degree and experience, which is to be respected as well.

Both professions bring different experiences, but possess the compassion and commitment to safely treat patients. Doctors consult nurses on the hospital units daily and nurses consult doctors routinely. We work as a team. As a new FNP, I can safely exam, prescribe, and treat less complicated primary care patients.

I do not wish to replace a doctor in complicated, tertiary cases. I refer patients routinely to their PCP or a specialist if it is out of my scope of practice. I understand my limits. No amount of education or experience can guarantee perfection in healthcare. As a nurse and as an FNP, I have noted many errors on physical exams, diagnosing, treatments, documentation made by both disciplines. We are not perfect, that is why healthcare has always been a team. There is plenty of work! The first was when I stupidly allowed on to do a uteran biopsy on me. That resulted in excess bleeding, pain and even after the suggested rest period I collapsed in my garage due to what felt like a knife in my lower abdomen.

The second mistake was allowing a NP with only hours manage my psychiatric medicines. My gut told me no, but I took a leap of faith and I should have known better. She was rude, acted like a know-it-all and dangerously dropped mgs on a controlled substance I am taking. Only hours of experience past the 4 years of RN? It take floor hours to get a state beauty technician license. Sometimes no one corrected the patients and that was very strange to me. Patients see anybody wearing a lab coat as doctors. We as clinicians should enlighten them about the different types of providers in healthcare and definitely correct them.

I completely agree with everyone whatever that even means , but I can see both sides of the argument. Who would I trust the most with the amount of knowledge to treat me? As a doctor from a different discipline, my classmates and professors often had this discussion. You are a primary care provider, but not a physician so introduce yourself as such. Healthcare is complicated and to your average person, white coats are doctors no matter how long or short the coat is and everyone else in scrubs are nurses not CNAs, MAs, RTs, etc.

Why Nurse Practitioners Should Not Do Primary Care Without Physician Oversight

This particular situation reminds me of the hierarchy within mental health providers: Before seeing a mental health provider, the consent form and terms of agreement involves the education and background of the provider, what they are trained to do, and their approach to treatment. If it matches with the individual being served, then great. Medical care needs to be clear cut! Or be able to practice independently? Liu I am currently a Family NP student right now. I have a big respect for the primary care specialty and I understand how difficult it is to become an expert in this setting. That being said I also understand the knowledge that MDs have and the rigorous education that you guys obtain.

So I agree that oversight is definitely needed. I am saying this from my own perspective and no experience in the field. There can be a million things that a primary care provider must be able to discern for the patient and without the proper education it is an extremely daunting task. My question is even with MD oversight, after many years of experience do you think an NP will be able to practice independently eventually? Many of the questions include images, ECGs and x-rays. Please use the buttons below to find out more.

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