Working Together

Here is a great post from a medical student about retail clinics. Here is someone who clearly understands the need the clinics are filling and more importantly (in my opinion), how nurse practitioners are part of that solution. It's good to see such an un-jaded perspective and how we can all work together in today's complex health system.

The 'Diff' iculty With Antibiotics

Today's WSJ Health Blog writes about the infection, Clostridium difficile (C. diff), and how it's becoming known as the 'new' MRSA. The blog writes:



The dark irony is that, because C. diff typically kept in check by the healthy bacteria that live in the digestive tract, people often get C. diff infections after treatment with antibiotics (which kill both harmful and healthy bacteria).



It amazes me to this day, how many people come into the office demanding antibiotics for what are mostly viral infections (which of course, antibiotics do not help). I hear the same stories from my colleagues. Usually, once the side effects are rationalized, most people understand the consequences and we decide that antibiotics aren't indicated for this illness. Of course, this approach takes time and unfortunately, it's much easier to write the script for the antibiotic and not have to take more time out of one's busy schedule to explain this.



Just as unfortunate, is that some providers will criticize those non-antibiotic prescribers and scare patients into thinking they had a much more "serious" case of sinusitis than what was originally diagnosed. (I don't know of an ICD 9 code for "serious sinusitis." Is there such one?) Apparently some equate quality care with how many prescriptions are written or keeping everyone happy.



All of these prescriptions and complications from them just add to the wasteful spending in health care today. Don't get me wrong, if a patient needs an antibiotic, they should have the appropriate antibiotic for that current illness. I've also seen many instances where patients are treated with the "latest and greatest" antibiotic for a condition that could've been treated with amoxicillin. Amoxicillin?!?! Yes, amoxicillin. Some hear amoxicillin and think, "oh that won't work for me." "My body is 'immune' to that." We don't get immunity from antibiotics. The onus should be on the provider to explain and educate our patients with facts, not fiction. Shouldn't we already be doing that as providers? With all of the drug ads that we see everywhere on television, print ads, and the like, I guess I can't fully place blame on patients. But alas, this all takes time and time is money and healthcare is ultimately a business. What a vicious cycle.


See another post here on antibiotics that I posted a few months back.

Stand Up To Cancer

On Friday night, September 5th, the three major networks aired the telethon, Stand Up To Cancer. It is estimated that they raised over $100 million dollars which according to their website:

...will support research projects conducted by interdisciplinary, multi-institutional translational and clinical research "Dream Teams" and high-risk Innovative Research Grants from which ideas for new Dream Teams may arise. The funds will be administered through the American Association for Cancer Research (AACR), the largest scientific organization in the world focusing on every aspect of high-quality, innovative cancer research.

This is an amazing cause and could've even had a larger impact had it been on more networks and if it aired on a night other than Friday. The show featured patients battling cancer as well as celebrities and their cancer stories.

The show followed actress Dana Delany for her annual breast exam. I was stunned and pleasantly surprised to see the exam performed by a nurse practitioner! The nurse practitioner identified an area of concern and sent Dana for a mammography and ultrasound (see video below). The NPs approach was very calm and reassuring.

Bravo to the producers for documenting this very real scenario and for using a nurse practitioner in this role as the examining provider. It helps to further validate our roles on the healthcare team as NPs are performing examinations like these every day and caring for all types of patients.

In just this past week, NPs have appeared on TV in prime time and in an political ad. That is change that I'm starting to believe in.

Obama Ad Narrated by NP

Politico.com reports on a new Obama ad that uses a Planned Parenthood nurse practitioner narrator. The ad happens to be about the pro-choice vs. pro-life debate. The nurse practitioner says:

"“Let me tell you: If Roe vs. Wade is overturned, the lives and health of women will be put at risk. That's why this election is so important,” says the nurse-practitioner who narrates Obama’s ad. “John McCain's out of touch with women today. McCain wants to take away our right to choose. That's what women need to understand. That's how high the stakes are.”"

While my intention is not to turn my blog into a political forum, this certainly is a poignant event for nurse practitioners - to be featured in the national spotlight by the Democratic Presidential Candidate of the United States. It is, however, on a polarizing topic that may further shape individuals views of nurse practitioners either positive or negative.

I have been unable to hear the ad for myself so if anyone can point me to a link, please do so.

Update: Here is a link to the powerful ad: http://audio.cbsnews.com/2008/09/03/audio4411721.mp3