Monday, April 7, 2008

Scare Tactics

An article about retail clinics in Michigan appeared on today's Crain's Detroit Business website. For those of you not having the pleasure of reading the typical retail clinic article in mainstream media, I'll summarize 95% of them for you now:

1. They usually start out talking about the fast growth of retail clinics. Some even throw in a "joke" of getting a tetanus shot where you shop for toilet paper.
2. Sometimes they interview an actual patient seen in the retail health setting. The patient usually has sinusitis or streptococcal pharyngitis and remarks about the convenience of the clinic's hours, location, price, accessibility, etc. The patient's experience is positive and state they would return again in the future.
3. Here it comes: "Doctors feel threat, have concerns, are skeptical," etc. This is the part for good ole fashioned nurse practitioner-bashing. Here is my case in point:

"Nurse practitioners play an important role in health care, but, in general, they don't have the skill or experience to (properly) diagnosis a patient." That quote is compliments of Dr. Chris Bush, board member of the Michigan State Medical society.

Let's dissect that: "Nurse practitioners play an important role in health care." I'm not sure what role NPs could play in health care if we aren't diagnosing & treating illnesses, writing prescriptions, ordering and interpreting lab results, coordinating health care services, since that IS what NPs do. Also, everybody knows that whenever you preclude a sentence with "but," you essentially negate what you just said.
Back to dissecting: "...don't have the skill or experience to (properly) diagnosis a patient." Here is the recurring intimation that nurse practitioners are not smart enough or can't critically think to autonomously care for patients. Is that a hit on the education that NPs must endure to become licensed and board-certified? Or is that merely the opportunity to scare patients reading the article that NPs shouldn't be providing care to anyone?

The other notable part of the article is: "In addition, many medical concerns handled by a walk-in clinic can either be treated at home by the patient, such as the common cold, or should be something that is handled by a physician, such as vaccinations, Bush said." Wait, vaccinations?!?! Maybe that should've been the part where he said "CABG surgery" or "craneotomy." But vaccinations? Oh sorry, I'm forgetting, we aren't capable of thinking with that level of complexity. He also just threw all of his urgent care physician colleagues under the bus with that statement. I'm sure they appreciate the support.

What is sadly missing from the vast majority of these articles is the NP response to the questions of NP-directed care. If the very care is being questioned, why isn't there an opportunity to defend it? Would it have been that hard to contact a representative from the Michigan Council of Nurse Practitioners or the Michigan Nurses Association?

I'm sure similarly written articles on retail health will continue appearing in mainstream media. My exception is with the relentless attacks that the clinicians (usually NPs and/or PAs) take as the main "problem" with the clinics. Perhaps local & national NPs need to maintain vigilance in setting the record straight when these derogatory articles are written about our profession. Believe it or not, there are a few physican-only staffed retail clinic operators out there too. I never hear the same negative arguments holding true for them as to the NP model.

Unfortunately, the vast majority of folks won't likely read this positive NP article appearing on medpage.com, National Kidney Foundation: NPs Help Hypertensive Patients with Kidney Disease Improve BP Control. Kudos to NP Naima Ogletree of the Henry Ford Health System in Detroit for her involvement with this preliminary, retrospective data review.

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