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Re: IUD and PIDFrom: Karen J. Bacon, RNC, WHNP (karennp@iei.net)Mon May 31 22:13:02 1999
Steven Crawford wrote: > > Another excellent example of how the breadth of a physician's training would have > prohibited the insertion of the IUD in this case. A physician would have been > more likely to NOT have placed the IUD in this particular patient (I would not > have done so), based on her medical history, IMO.. Wow, I go away for the weekend and look what happens. I should've known. I might regret this, but I am going to make a vain attempt at an over-simplification of the problem...but first I will address the snip above. Is is NOT fair to say that only the "breadth of a physician's training" would have been sufficient to question the placement of an IUD in a 48 y/o, nonetheless with problems. I would have done the same. The issue is that different providers make different decisions about their plans of care, regardless of whether they are an MD or not. I see it everyday with my 9 physician collegues (and believe me, they do things VERY different from each other). You all know that in medicine there is quite often more than one reasonable way to skin a cat. But physicians see themselves as responsible for the non-MD's decisions, and when they differ from what they would personally have done, they challenge. But, and hear me now, this is OK in my book. Because if the non-MD provider knows what they are doing, they will be able to give a rationale answer based on sound medicine as to why they did what they did. IMHO, if they can't do that, they shouldn't be practicing, whether they are an NP, CNM or physician! And I think what is so imflammatory to many of the docs on this list is the notion that most advanced practice nurses (APN"S) think they are praticing on an island. I speak for many of the APN's I know when I say that I know (and would shout from the rooftops if it would make you all happy) that I am NOT a physician, and that I appreciate and highly value the additional expertise and knowledge that my physician counterparts bring to my ability to care for patients. I have NO desire to practice outside of my scope of practice (which has been specified by our licensing and credentialling entity), and consult ALL THE TIME with my collegue MD's about ANYTHING that falls outside of that scope (which may mean consulting with them several times a day). And I welcome and expect their advice and input. This is the way it works in the real work with most MD/APN collaborative practices that I know of. So what is the big problem? So if you want or have an APN working for you, and she/he doens't know what she/he is doing...or tries to practice outside their scope...or anything else stupid or imprudent, FIRE HER/HIM (and I'll be right there supporting the decision). But remember, I've seen plenty of examples in my many years in the business of physicians practicing imprudently too, so don't try to say that when an APN does something stupid it is because they are an APN and lack all the training and breadth and blah, blah, blah. It's just because they're stupid. Simple enough?
-- Karen J. Bacon, RNC, WHNP Indianapolis, IN karennp@iei.net
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