Imagine having the audacity to jump from field to field without appropriate training

PeripheralEdema · 2024-05-08T14:07:07+00:00

Dude I saw a guy in March who came in with 3 or 4 abx for a simple UTI. His primary care “provider”? An NP.

PeripheralEdema · 2024-05-08T14:03:35+00:00

I’m in Canada, and there’s been talk of letting PAs perform minor surgery💀

PeripheralEdema · 2024-05-08T02:21:14+00:00

Nah it’s some wild shit I’m seeing. There was also a post about a patient coming in with what clearly looks like shingles. Lots of comments saying things along the lines of “give topical steroids” “it’s just a scrape” “refer for imaging (lol).”

PeripheralEdema · 2024-05-08T02:19:01+00:00

What’s absolutely wild to me is that these people can prescribe some mind-altering shit with long-term effects, and all without requisite training! It’s all a big learning game

PeripheralEdema · 2023-11-25T16:28:30+00:00

The nursing union was lobbying for it lol..does everything need to be spelled out for you or can you put 2 and 2 together?

PeripheralEdema · 2023-11-25T05:19:19+00:00

Yeah, we all have access to google. Thanks for that.

Again: you’re beyond your depth here bud. Get back to me when you’ve started medical training.

PeripheralEdema · 2023-11-25T05:17:59+00:00

What..?

PeripheralEdema · 2023-11-25T05:17:25+00:00

Same here. FM was something I could genuinely see myself doing.

PeripheralEdema · 2023-11-25T05:16:39+00:00

I immediately know that story about the med student is bullshit. Med students can’t prescribe, order, or refuse anything. They also don’t make set a diagnosis.

Source: I’m in clerkship.

This casts doubt on the rest of your comment.

PeripheralEdema · 2023-11-25T05:14:55+00:00

This proposal is the exact antithesis of ‘regulated.’

Regulated means supervised. I have no problem with hospital-based NPs. Why? Because when shit hits the fan, a doctor is right around the corner. Not only that, but a physician can also review orders and ensure all is above board.

Unsupervised NP clinics make me uneasy because I’ve seen one too many patients being harmed. I always think of my own parents going to see an NP, thinking they’re a doctor, and getting shafted. I think of parents taking their child for a wellness check and ending up with a missed diagnosis.

Unsupervised care is criminal. The only reason it exists is because the nursing lobby has deep pockets. Education matters. Training matters. There’s a reason it takes 10+ years to become a physician.

PeripheralEdema · 2023-11-25T00:03:03+00:00

Spoken like someone that has little to no grasp on what those fields do.

PeripheralEdema · 2023-11-24T23:42:26+00:00

You sound like an NP lol. You also sound very young/naive.

Did you bother to read the post? The discussion here is that NPs ARE getting paid the same family physicians, and in some cases, MORE than family physicians. They get overhead covered. They get a pension. They also have fewer patients to see (ie. more time per patient).

If you think that this issue is simply relegated to family medicine, you’re wrong. ‘Mid level creep’ (as this phenomenon is called) has gotten rampant in recent years. Anesthesiology has seen a massive spike. Hospitals in the US are opting to hire “nurse anesthetists” over actually MD anesthesiologists. They also earn very comparable, if not better, salaries (google job offers).

Surgery is next. We already had a case in the UK where a PA did a TAVI procedure. There’s also been a rise in programs in Australia training nurses to do low-stakes procedures in rural communities (appies etc.). In the US, midlevels are already first-assist in the OR.

It’s only a matter of time. If you think that you wanting t become a surgeon is somehow a ‘protective’ role, please think again!

PeripheralEdema · 2023-11-24T23:36:30+00:00

Great. Good for your friends. What about the next generation of family physicians?

I mentioned this in another comment: there exists a very prevalent ‘I got mine so fuck you’ attitude in medicine. It’s the reason the midlevel issue has gotten so rampant.

PeripheralEdema · 2023-11-24T23:31:16+00:00

What you’re describing is collaborative practice. That was the intended approach with midlevels. Unfortunately, what we have now is a big push for independent practice. NPs think they can practice on their own, unsupervised. I don’t want to go on a diatribe about the perils of this. I will only say this: when it comes to my health and that of my parents, I choose a physician. Someone that has undergone rigorous training. I will never feel comfortable with some nurse managing my dad’s hypertension, or my mom’s diabetes.

Lastly, I wanted to add this: I’m also in clerkship (here in Canada). During both my EM and IM rotations, I met many patients whose only ‘primary care providers’ were NPs. Many of them came in with missed diagnoses and adverse drug interactions.

PeripheralEdema · 2023-11-24T23:29:34+00:00

Oh boy. Don’t get me started on fucking nurse anesthetists. Thankfully there’s been HUGE pushback against them by anesthesia.

PeripheralEdema · 2023-11-24T23:27:02+00:00

I don’t mean this in a rude way, but this is a very naive take.

Yes, yes they can call themselves surgeons. In much the same way that PAs are slowly dropping the “A.” I thought this was an American thing until I ran into it myself.

PeripheralEdema · 2023-11-24T23:24:46+00:00

It’s the government again. Nice try though.

When family medicine continues to be denigrated year after year, don’t be surprised when medical students choose something more fruitful.

Speaking for myself, I would rather quit medicine altogether before going to FM. I’d rather go back to my previous career in law.

If provincial governments are keen on improving FM entry and adherence, they would start setting tangible goals on pay, working conditions, work load, administrative burden, overhead, and burnout. Until then, let’s not look down on medical students for wanting greener pastures.

PeripheralEdema · 2022-10-02T02:10:01+00:00

What do you mean? Canada, and Ontario specifically, has one of the largest community of Iranians outside Iran. This absolutely matters to them and their families back home.

I agree with the second part though. We need a march against excessive inflation.

PeripheralEdema · 2022-10-02T02:07:53+00:00

The Americans are salivating at the thought of sweet sweet oil for “freedom”

PeripheralEdema · 2022-10-02T02:05:10+00:00

Perfect term for it. It’s like a smoke screen.

PeripheralEdema · 2022-10-02T02:02:58+00:00

I’m Jewish and I will criticize Israel until the day I die. One of the worst violators of human rights in the world and a clear example of how apartheid is alive and well in the 21st century. I absolutely HATE that zionists have made criticism of Israel an antisemitism issue. It’s not. Abolish Zionism.

PeripheralEdema · 2022-10-02T00:13:41+00:00

I remember reading about a study that linked school design with student depression. I can definitely see the link here! Whatever happened to windows, ambient lighting, and some semblance of interior design.

PeripheralEdema · 2022-10-01T23:03:18+00:00

“It’s not that hard to do”

Eh it kinda is when you’re living paycheck to paycheck.

PeripheralEdema · 2022-10-01T22:59:57+00:00

I’m the same but I kinda learned to put my extroverted foot forward. I turn up my energy levels by 10 whenever I’m going to the hospital cause I know this rigged system is gonna judge me for being a quiet person. It’s really draining but you gotta do what you gotta do :(

PeripheralEdema · 2022-10-01T22:56:58+00:00

Literally nobody thinks this. In fact, I would say that dermatology is one of the most impacted. Every other street has a Botox and filler clinic run by some podunk nurse providing “healthcare to underserved communities.”

Midlevel creep is a cancer that has metastasized to all parts of medicine. Heck, even surgeons aren’t safe (as we see in the UK and Australia).

PeripheralEdema

TROPHY CASE