OB-GYN-L Messages for May, 1999: Re: IUD and PID

Re: IUD and PID

From: Geffrey H. Klein, MD

gklein@icsi.net

Sat May 29 11:19:45 1999

> The obvious conclusion is that you were not able to think of anything
>that an NP
> could not master about IUDs, and therefore didn't want to answer this
>question
> directly. Of course, if that inference is incorrect, you can easily
>correct it
> by telling us precisely what an NP is incapable of learning about IUDs.
>But I'll
> bet you won't.
>
> The honorable thing to do would be to admit that you're wrong, rather than
> concocting excuses not to respond to people who challenge your
>ill-thought-out
> opinions.

I would be glad to jump in here.. This is a great place for the slippery slope argument..

I would agree that IUD placement could be within the realm of a NP. Obviously, there would need to be some physician back-up to deal with the potential complications needing surgical intervention. I think that some MDs charged with the responsibility of dealing with the complication would then justifiably hesitate to delegate that responsibility. This, to me, would be more likely to explain their reluctance that economic salvation.

Now specifically address the issue of licensure.. I think that there is an argument to be made that physicians in general have a financial motive to prevent alternative providers from stealing market share. Perhaps, organized medicine has unfairly lobbied our legislative branches to prevent competent providers without traditional medical training from practicing. But perhaps, the motive of this group is not purely driven by greed. Is it at all possible that the public good is better served by insuring that those who care for the health of our population have been adequately trained?

I think everyone would agree that a NP can easily perform a pap smear and counsel on contraception. I think we are all equally convinced that the NP should not be performing a vaginal hysterectomy. The problem is that in between are the grey areas. This is the battlefield. Interested parties have financial stake, no doubt. However, my personal view is that some societal protection needs to be provided.

We can see the consequences of cost cutting efforts in place already. Rather than using RNs in the office and hospital, some of their functions have been delegated to MA's. Doesn't everyone remember the uproar from the nurses on this issue? I recall their argument was based solely on patient care issues. Sure there was a job security issue, but I for one did not doubt the sincerity of their argument. Do we really want to go down that path? Would it not be possible one day, due to cost cutting measures, that the person doing the vaginal hysterectomy was a technologist with 1 year of training? Do we not owe it to the greater good to fight these battles rather than succumb to the harsh Woollian rhetoric? Do we benefit from the fight, hell yes we do! We went to college, med school, and trained in residency for the right to practice medicine. No one is better trained to do what we do than we are. To passively sit back and let our realm be invaded by less qualified alternatives is derelict.

-- Geffrey H. Klein, MD geffrey.klein@obgyn.net 17448 State Hwy 3 Suite 200 Webster, Texas 77598 (713) 741 2273 ext 2628

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