What are /r/Noctor's favorite Products & Services?

From 3.5 billion Reddit comments

Notes for the show:

> Gerald "Jay" Baltz, a psychiatric mental health nurse practitioner, was investigated by the California Board of Nursing after allegations that he had entered into a sexual relationship with a patient who subsequently took her own life. The Board received this information in April of 2018, began its investigation, and filed a claim against Baltz on June 15, 2020. Today, six months later, Baltz continues to practice psychiatry as a nurse practitioner in California and in Washington state, where he has autonomous practice and does not require physician supervision. We are joined by psychiatrist Dr. Natasha Cervantes to discuss details of this tragic case. > > If you are someone you know is having thoughts of self-harm, help is available. Contact your physician immediately, or call the Suicide Prevention Lifeline for help at 800-273-8255. > > Learn more about this issue - get the book Patients at Risk, available at Amazon and Barnes and Noble. https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/

I live a few blocks away from one of the offices and decided to read some Yelp reviews. There’s mentions of groupons for B12 shots and massage therapy. Sure enough. https://www.groupon.com/deals/suburban-medical-wellness-center-6

Listen to this podcast... Dissects the studies. Bottom line is no evidence... they just didn’t say it straight out.

“Drs. Rebekah Bernard, Niran Al-Agba, and Phil Shaffer break down the 2018 Cochrane Review "Nurses as Substitutes for Physicians in Primary Care," pointing out that of 9,000 studies reviewed over the last 50 years, just 18 were of adequate quality to include in a review of the subject. Of these 18 studies, just THREE were published in the United States, most contained high degrees of bias, had small sample sizes, were of short duration, and ALWAYS included physician supervision or nurses following physician-created protocols. Bottom line: there is no evidence that unsupervised nurse practitioners can provide the same quality of care for patients.”link

I am not fluent on the history of either role, but I can lightly touch on their purpose today. I'm also guessing you don't have patient contact, so I'll phrase this with that in mind.

Let's use the emergency department (ED) as an example. In theory, PAs or NPs should be seeing low acuity patients such as 4s or 5s. '5' is something like a prescription refill or rash. An example of a '1' could be cardiac arrest.

That being said, what has happened is the American Association of Nur$e Practitioner$ (AANP, you'll see them frequently mentioned in this sub) and other groups have money on their minds. They actively lobby congress to expand scope of NPs. Using the ED example, this would allow them to function in the ED without direct physician supervision (or really any, depending on the state). They would be able to prescribe controlled substances, perform procedures, and other complete other complex tasks without any formal training in their NP program.

The problem with this is there are no strict standards or guidelines for accreditation of nurse practitioner programs. There are programs that are 99% online who send their students off on their own to find a preceptor (someone who the student can shadow such as an NP). There are rumors that even NP preceptors no longer accept students because of their incompetency and the poor quality of their programs.

There's a lot more that I don't have the time to touch on here, so see below!

​

If you are interested in learning more, I highly recommend the book Patients at Risk. I have not read it, but I listen to the Spotify podcast by the same name and authors.

Thank you for telling your story.

Thoughts:

1 - Read patients at risk (the book)

https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164

2 - Understand that a non-physicians may not be held to physician standards of care in a court of law.

https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/

3 - Get a copy of the Medical directive disallowing non-physician care for dx/tx. (Back of patients at risk book) in your medical charts.

4 - When scheduling, let the receptionist know that you and your husband are not ok with 2nd tier care (with more legal risk) and that you want to see the physician (MD/DO)

5 - review practices that do not allow you to schedule with a doc and let them know you are doing so.

Good luck! 🍀

Sounds like an awful experience.

I would never allow any of my family to see a NP in any field - including primary care - for anything diagnosis or treatment related.

They are rarely well supervised (often inappropriately used by corporate medicine) and they never have the extensive formal standardized background and training needed to practice independently.

In addition, if a NP screws up they may not be held to the same legal standards of care as physicians. Patients may not expect compensation. Demand a real doctor. You get no discounts for seeing a lesser trained clinician.

See the book: $9 on kindle (many real life horror examples of NP care)

https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164

And website: https://www.physiciansforpatientprotection.org/

for more information and to report your story.

Highly recommend this book for further information: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164

Apparently the paperback is sold out on Amazon but it is still available in the kindle edition and paperback from Barnes and Noble