| | Expected | Unexpected |
| Prepared | Prepared/Expected | Prepared/Unexpected |
| Unprepared | Unprepared/Expected | Unprepared/Unexpected |
In the original post I describe the left column, the expected course of disease. The rows indicated how prepared or unprepared your provider is in caring for you. In general you as the general public don't have to worry about getting unprepared providers of care for expected course of disease. Unless the provider is practicing outside their scope of training. This process can happen if you are a NP a comprehensive care doc or a surgeon. Your scope of practice will guide you. I went on to discuss my thoughts with having two different providers practicing in the same scope with a large variation in experience and education. That's how you become unprepared for the expected.
But what about the unexpected column? How does one become prepared or unprepared for the unexpected? There is only one way. Education and Experience. At some point or another, most, if not all patients, will follow the unexpected course of illness. They may limber on for years with controlled type one diabetes. Then they may show up in your office with a blood sugar of 800 in florid DKA because of a diverticular abscess.
The only way to be prepared for the unexpected is to prepare for it. And the only way to do that is to experience it. To study it. To recognize it. When we start talking about truncating residency hours to accommodate work restrictions we risk creating a whole population of physicians who are unprepared for the unexpected. When we plan on NPs with their residencies and educational training that is thousands upon thousands of hours less than a board certified physician practicing in the same scope, we risk over and over again being that patient for the unprepared for the unexpected. When we send surgeons home earlier and they miss the rare anatomical variation or that life threatening complication, we risk creating thousands of surgeons who freeze in the operating room. Who have no one to turn to when they don't know what to do.
What's the risk of harm? That's hard to measure. It could be nothing. It could be delay in diagnosis. It could be unnecessary morbidity. It could be death. Given enough time, most patients will have an unexpected course of illness.
How can we expect to minimize the unprepared for the unexpected when all of our current policies are pushing us here?
As a patient, you want to live in the prepared for the expected quadrant. But as a country, we are moving more and more into the unprepared for the unexpected. One more reason to take care of yourself, exercise, eat right, and don't smoke. Because those taking care will be unprepared for your unexpected.
As a patient, I only care that my condition be caught and treated. Every healthcare practitioner, regardless of title, has seen different things, and I rely on your *collective* experience to help me.
ReplyDeleteMarco
I guess what has always struck me as odd with Happy is that even as a totally untrained person working in..ah...pre-triage, I was able to spot sickness in others and, at least in the ER setting, was able to "diagnose" on a regular basis. (Zebras? No, of course not. But most ERs tend to see very regular patients and diagnostic/treatment tends to follow a very predictable course...)
ReplyDeleteI think what bothers people like happy is that their training is really based on experience. Most intelligent people can probably teach themselves a lot of medicine, pathology, etc. Words are words. Experience is experience. But what is YOUR experience worth if others can also gain from so-called "lesser" experiences?
People are not boxes. They do not learn simply within the scope of what they have been taught. Nurses don't simply learn "nursing things" just like doctors don't simply learn "doctor things." Although the boundaries of practice are rigid, the boundaries of knowledge are not.
"Although the boundaries of practice are rigid, the boundaries of knowledge are not"
ReplyDeletevery well. i guess that would describe my thoughts in just one statement.
Okay, maybe I am totally off the mark here, but what I am getting from this post is that the more experience a provider has, coupled with training, the wider their scope of knowledge and simple odds of picking up unusual problems, presentations, and interplays of multiple co-morbidities. PA's and NP's have less training and experience, limiting their knowledge base.So, excuse me if I prefer an honest-to-gosh board certified MD when I am ill. (Lack of DO-delibrate, not an oversight.)
ReplyDeleteI have seen RN colleagues who were marginal as nurses hang out their shingles after 14 months, and the lack of insight about their LACK OF INSIGHT scares me. (Yes, perhaps I am also still miffed about an NP missing a 12 cm ovarian mass--luckily picked up seconday to a kidney stone workup--BY A PHYSICIAN--and removed before I needed chemo....) If I need cookie-cutter treatment, NP's have some value...but only if nothing else is hiding in the bushes behind the positive rapid-strep test. I'd like to see a DOCTOR, please. Pattie, RN