Friday, October 29, 2010

Doctor Nurse

It occurred to me many years ago that to the extent medicine is a science, we don’t need doctors.

Science is the means by which we identify what we are willing to accept as facts. Lab results are one example. When the lab reports that my fasting blood sugar is 200 mg/dL, we don’t need a doctor to decide that it is higher than normal. Neither, in a smaller but still large number of cases, do we need a doctor to decide that it means that I am diabetic. Evidence-based protocols lay out what is to be done about it and so we don’t necessarily need a doctor to figure that out either.

In other words, medicine begins where science leaves off. It is when the lab and the evidence are unable to make a definite determination of diagnosis or treatment that we need the judgment of trained and experienced professionals.

With the passing of years and the advancement of science, the ability to establish facts has greatly increased, thereby reducing the incidence of the need for professional judgment in health care. It would seem logically to follow that a larger portion of the work of patient care could be done by people other than physicians.

By a different route of logic, the Institute of Medicine seems to have come to the same opinion. As reported in the October 11 issue of Modern Healthcare, the Institute’s recent report (The Future of Nursing: Leading Change, Advancing Health) “….argues [that] giving nurses more leadership roles and caregiving authority could save time and money on the path to healthcare reform.”

This point of view also matches my own experience. As mentioned in a previous posting, I have recently had a couple of Emergency Room experiences in which I was diagnosed and treated satisfactorily by Nurse Practitioners and Physicians’ Assistants and discharged without seeing a doctor.

The Modern Healthcare article reported opposition to the Institute’s recommendations by spokespersons for the medical profession. Such opposition is understandable, but I think the die is cast.

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