A Nurse Practitioner's View

Just when you think you might've seen it all, some companies are rolling out medical gift cards . There is perhaps nothing more complicated as a health care consumer attempting to navigate the health care system and trying to figure out costs. I can see it now: bewildered looks from health office personnel trying to decode what the card even is in the first place; "should we apply this towards your deductible, or maybe the lab fees" etc. Of course, the problem is most of the time folks have no idea what they are paying for health care services and providers don't know what they are getting reimbursed. Here is just another poor attempt at trying to solve the mess of the health care system we have today. At least with a Health Savings Account ( HSA ) you get a break with it being tax-exempt. I'm not sure what benefit these medical gift cards offer. Maybe since costs are so out of control, people would rather not carry around the wads of cash to pay for services? So...

Hi All, It has been awhile since I've last had a thoughtful blog post (a hectic personal life has a way of re-prioritizing things!) Though there's been no shortage of topics to write about. The heath care reform bill has gained momentum, mammogram screening guidelines were revised , and H1N1 vaccine and cases continue to make headlines. This is certainly an interesting time to be in health care. I look forward to seeing what the future brings and plan to be part of these discussions (or at least have something to say about them here on my blog). Till then......

Happy NP Week to all of my NP colleagues out there! If you are a patient of an NP or work with one, be sure to recognize the fine work they do every day. Here is the press release from the American Academy of Nurse Practitioners and the theme this year is 125,000 Solutions to the Primary Care Shortage. (I'm a bit late, but also Happy PA Week to all of my physician assistant colleagues).

I came across this well thought out commercial that has appeared on TV from the U.S. Department of Human Health & Services' Agency for Healthcare Research & Quality ( AHRQ ). Their website has a few other public service announcement-type of ads. With their, "Questions are the Answer" campaign, they are encouraging patients to ask questions about their care and to take an active role in the provision of their care. Hopefully, patients and providers alike will embrace this idea so that there are more answers than questions. Any questions?

With all the talk about H1N1 influenza, I think it;s important for folks to understand where the H1 and N1 come from. The "H" comes from the substance hemagglutinin and the "N" comes from neuraminidase . There have been identified influenza strains of the H and N types and this is how some influenza viruses are classified. The particular "swine" flu that has garnered so much attention is of the H1N1 type. A few years ago, the fear was of the avian type, H5N1. This past Spring, the Wall Street Journal Health Blog did a good job explaining some of the background regarding the naming of this particular strain of influenza. This may help us all understand the nomenclature and rationale behind what has become household names.

I recently decided to obtain auto insurance quotes from most of the major insurance companies websites. The quote process is generally very simple: enter your information and you get an instant on-line quote. As I feel it necessary to perform some due diligence and not just go with the least expensive quote, I Googled "auto insurance ratings." Well, what a frustrating experience. I wouldn't say that I am now more confused - only that it wasn't at all helpful. The Web is filled with a smattering of reviews and many of the negative ones seem that there is more to the story than what is written. In addition, we mostly know that an unsatisfied customer is much more likely to take their story to the Internet and post it as opposed to a satisfied customer with no issues. What's my point to this post? I have come across various articles and websites that give patients the opportunity to rate their health care provider. In fact, here is an example of such a site. One can...

The New York State Department of Health recently passed emergency regulations requiring all healthcare personnel working in hospital and nursing homes to receive mandatory influenza vaccinations or face termination of employment. I am a vaccine advocate and believe that vaccinations have decreased and in some cases eradicated some infectious illnesses. I do, however, worry about the mandate aspect of this law and how it will be truly be enforced. What do you think? Good idea? Cutting-edge? Violation of privacy? I'd love to hear your thoughts.

Pennsylvania Governor Ed Rendell , a longtime champion of NP practice writes a column in today's USA Today, " Health reform can count on nurses ." I am encouraged by this support and recognition for the thousands upon thousands of NPs , Nurse Midwives, Nurse Anesthetists, and Physician Assistants practicing and caring for patients in community, hospital and out-patient settings every day. We are not a new concept nor fad. Our practice is centered on our patients. I invite everyone to read the blogs on my NP Blogroll . You will find examples of the extreme care and commitment we give to our patients. It certainly seems as if Governor Rendell is reading. Its exciting to ponder who else may be reading as well.......

It's back to school time and that means droves of physical forms flowing into offices as a requirement for school. Each form is different in its length, complexity and readability. Some practices have refused to complete forms and will attach a copy of their own. Some practices charge an additional fee to have the forms completed. Why can't we ascribe to a standardized school form that everyone can use? I have seen some forms ask only for height, weight blood pressure and immunization history while others require a complete review of systems, physical exam, diagnosis, and dietary restrictions. What do you think? Should we have a standardized physical form? Do you charge extra for completing patient's forms? If you are a parent or a patient, what do you think of this superfluous and redundant paperwork? I'd love to hear your thoughts.

Here is an article from the U.S. Preventative Services Task Force and is a resource for NPs to implement evidenced-based preventative practice. When the buzz today is about health care reform, here is a good place for us all to start - talking about a preventative proactive evidenced-base approach rather than the opposite of that (which is what we largely have now!)

Here is a very informative interview about current NP practice and health reform from nurse practitioner, Dr. Thad Wilson, president of the American College of Nurse Practitioners ( ACNP ) . Dr. Wilson eloquently provides clarification of the NP role and how our health system will be a better place when full inclusion and barrier-free practice is consistent along state lines. Thanks, Dr. Wilson. There is a post on the same site from a third year medical student about health reform and refers to chatter about nurse practitioners supplanting primary care physicians on a particular board . The posts on that board are certainly entertaining and show how turf wars are alive and kicking. I hope that folks will read Dr. Wilson's interview to get an alternative perspective and realize that we need to work together to ensure that our families and our communities will be taken care of in the health care system of tomorrow.

Here is a rather short and short-sided article written by CNN Money about an "endangered breed" of "family doctors." Interestingly, it ends with asking the question: Should specialists, nurse practitioners and physician assistants be encouraged to fill in the gap left by shortage of primary care doctors? We want to hear about your experiences. Now, the article mentions nothing about NPs or PAs yet asks for reader experiences. Fair enough. However, the barrage of degrading and insulting comments from self-identified physicians and others in healthcare are downright angry. I wonder what impact this has on their patient care.

The media has picked up a story of a tragic alcohol-related death of a 16 year old male. His autopsy reportedly revealed a relatively low blood alcohol level but high levels of papaverine , a drug sometimes used to treat erectile dysfunction in men. What do the headlines read? Erectile drug mystery in teen's death at party Traces of erectile drug found in dead teen The problem here is that papaverine needs to be INJECTED into the penis to work for erectile dysfunction. Oral forms of papavarine are not routinely used and will do nothing for erectile issues. The headlines can cause people to panic because the complete medical information is not presented in the articles. This boy suffocated on his own vomit when he was unconscious due to a combination of alcohol and this medication found in his bloodstream. Questions surround why this medication was found in his bloodstream and perhaps these articles were crafted to bring increased attention to the case as his family were growing ...

Here is some validation for the work that we do as recognized by our Commander in Chief. Thank you, Mr. President. Now its time to "Buck up!"

Here is a great initiative that the Institute of Medicine and the Robert Wood Johnson Foundation has launched on the Future of Nursing in America . This gives a wonderful depiction on how nurses and nurse practitioners will be part of providing the solution to health care reform. As we have sensational portrayals of nurses in such recent series as Nurse Jackie and HawthoRNe , it is refreshing to have a vivid description of the impact nurses have in health care in America. This goes beyond the petty back and forth between other health care providers that is good for TV and some blogs and puts us on the high road - that is, taking better care of our patients, their families and our communities. And quite frankly, that to me is what it's all about.

A friend of mine was recently browsing McNeill's Monistat website and noted that their " Ask the Expert " section is authored by a team of Nurse Practitioners . Kudos to McNeill for utilizing NPs as experts in women's health.

ABC News recently sat down with President Obama for their "Prescription for America" forum. You can read the transcript here . It is a wonderfully transparent and thorough conversation on the major issues of health reform today. They address the primary care and nursing shortages, comparative effectiveness, putting an emphasis on prevention/wellness and even discuss nurse practitioners and physician assistants as being part of the solution. I truly believe we will see steady, incremental progress regarding health reform because all of the stakeholders are/will be part of the process. This has started with a dialogue where respect for each other is paramount. We all know that it is rare for everyone to agree and that's ok . But if we can respect one another's views and roles we are well on our way to addressing this ailing system. This is a prescription that must be 'dispensed as written.'

Once again, a debate is reignited about physicians versus nurse practitioners over at A Happy Hospitalist's blog. I'm not getting into a contest of who is smarter than who. I have always acknowledged that a physician's education is longer than that of a nurse practitioner's. My education and training has prepared me for a career in primary health care - a field that I am passionate about, am constantly trying to increase access to and one that I'm good at. Primary care is part of that vision of primary health care. There are many definitions of what "primary health care" is and the one that I use is not made up by me in my fairy tale world - it is the one that the World Health Organization defines as: reducing exclusion and social disparities in health (universal coverage reforms) organizing health services around people's needs and expectations (service delivery reforms) integrating health into all sectors (public policy reforms) pursuing collaborati...

Today, legislation has passed Congress and is on its way to President Obama that will allow the F.D.A. for the first time to regulate tobacco products. This truly is a huge step. As a health care provider, I see the harmful effects of cigarette smoke, not only on my patients, but on their families and on unsuspecting members of the community. Just recently I spoke with a patient that at one point in his life was smoking 4 packs a day. He now enjoys regular trips to his pulmonologist and annual arterial blood gas draws from his wrist - not fun nor painless. (If you ever thought having blood drawn from a vein is uncomfortable, as is the case with most labwork , drawing blood from an artery is a completely different ballgame). Unfortunately in this legislation, nicotine (the highly addictive "feel good" substance found in cigarettes) isn't banned altogether but some chemicals in tobacco products are and there are restrictions put on advertising. It still amazes me whenever ...

I love this. Fellow blogger (and I mean fellow only that he blogs, not that I can ever approach the level of "care" that he provides) just loves to rant about NPs . We aren't smart enough, we don't know what we don't know, provide good "nursing education" to our patients, we believe what we do is "good", are good at kissing boo-boos and holding hands, is at it yet again. (I think when his traffic is down, he decides to post about NPs and how "inadequate" he "thinks" we are to drive his blog traffic up.) It's really interesting - he harps on about how bad NPs are (i.e. we are mindless monkeys that can code a good level 5 visit) - he even has an "anonymous" NP post comments that claims their education didn't prepare her for the real world. I am so over it. I've left respectful comments on his blog only to get shot down. He continues to denigrate NP practice and gets his fellow "colleagues" t...

Representative Allyson Schwartz along with nearly 100 cosponsors recently introduced House of Representatives Bill 2350, Preserving Patient Access to Primary Care Act of 2009. The legislation will improve access to primary care and increase the number of primary care providers in part by allowing the Nation's nurse practitioners to lead the Patient Centered Medical Home. Here is the full text of the Bill. This has the potential to be monumental legislation for our nation. In addition, an unprecedented number of physician (American Academy of Physicians & American Academy of Family Physicians) and nurse practitioner organizations (American College of Nurse Practitioners & National Association of Pediatric Nurse Practitioners) are supporting this bill. Though it seems that the AAFP is begrudgingly "putting up" with the inclusion of NPs as evidenced by AAFP Chairperson Jim King, M.D.: The legislation also would allow nurse-practitioner-managed practices to serve ...

Here is a post of a lighter nature. The new Schick Bikini razor is new on the market and with it comes "viral" advertising of sorts - Mow the Lawn. The ad is posted below: Now to make this a health-related post, I will add a few tips about grooming since I've seen patients with significant folliculitis (infected hair follicles "down there" that are red and painful) after their grooming regimen: Use a new razor with clean, sharp blades. Consider using a pre -shave to soften the hair and protect the skin Use plenty of cream/gel (I suggest a good hypoallergenic gel - at least for my face) Use plenty of clean warm/hot water and rinse razor frequently Use a good aftershave lotion/balm If you are into genital grooming/shaving, you probably want to avoid using a traditional men's shaving cream and aftershave lotion. There are many products out there made specifically for this sensitive area. This goes for men too. I've seen plenty of infections after guys have...

Here is a link to an article where Health and Human Services Secretary Kathleen Sebelius spoke to a nurses union today and stated, "If health care reform is to be a reality, we need you at the front line." Since health care is multi- disciplinary entity which no one profession "owns," it is encouraging to see an inclusive approach. I look foreword to health care reform and working with my other health care colleagues in making this a reality.

Here is a news-worthy article and clip about NP practice in New York. The piece is from East Syracuse, New York and highlights how NPs can be part of the solution to primary care shortages. Also, April is Nurse Practitioner month in New York State. This would be a fine time to recognize NP's contributions to the health care system and patient care.

Undoubtedly, most are aware of the swine flu by now and the potential impact it has on pandemic fears. While cause for concern, it isn't cause for panic...yet. Know the symptoms of the flu. That is, remember that influenza is a respiratory illness. Typically, if one doesn't have a cough (usually non-productive), fever and body aches, then it is unlikely that it is classic influenza. Common sense precautions are in order, stay home if you are sick with mild symptoms, seek care if they worsen wash your hands frequently, especially after touching your nose & mouth. (Most people don't wash their hands properly if you can believe it. You should wet your hands with water, use soap and scrub for at least 30 seconds {sing "Happy Birthday" twice to yourself}; be sure to get your wrists and under jewelry. Phone your health care provider if you have specific questions. Also visit credible sites such as the CDC. Anti-viral medications exist for pre or post exposure to ...

This is a wonderful post over at The New Life of e-Patient Dave's website about electronic health records. I strongly encourage patients and clinicians to read it. While there has been much debate about whether EHRs actually improve patient care and save money (I believe they will do both) the move to electronic records will enable transparency when it comes to viewing and reviewing your own chart. Have you ever tried to get a copy of your own record? It is not exactly the easiest process. Most providers offices require you to complete a records release form which is filled with legal jargon and makes you seriously question if you really want to get these records in the first place. Some providers charge you per page to photocopy your record and good luck in thinking that this will be processed promptly by the staff. Once you get your hands on a traditional paper chart copy, it is nearly impossible to decipher. Is this acceptable? Maybe accessing your health record should be like...

Hi All, It has been a full year since I started this blog. I wanted to thank everyone who stops by and reads it. I hope to continue posting with some semblance of regularity and share my view on topics not only specific to nurse practitioner practice, but to all relevant healthcare topics today. Thank you! Stephen

Feel free to check out some questions I answered over at The Nurse Practitioner's Place ! I thoroughly enjoyed it. Also check out the interviews with two other NP bloggers , NewFNP and Barbara Phillips, FNP . Thank you to The Nurse Practitioner's Place for my 15 minutes!

Nurse Practitioners in Florida currently cannot write prescriptions for controlled substances (47 states currently allow NPs to prescribe these). One can understand the fear that having more prescribers can potentially lead to more abuse. However, that is a very narrow view and really doesn't help the thousands of patients NPs are seeing every day in Florida. What I find most disturbing about this article is (R) Senator Thad Altman's comments. He is quoted as saying: "We need to protect the practice of medicine," Altman said. By sharing tasks that used to be solely the domain of doctors, who have the highest level of training among health care professionals, "it's discouraging people from going through the vigor of becoming a physician." Why must this be a MD vs. NP issue!?! After all, we now consider "pain" as the fifth vital sign. For us to not adequately address pain, severely inhibits practice and our patients are the one's suffering...

The NY Times reports on a significant health initiative that is part of the $787 billion dollar stimulus bill. It is specifically referred to as Comparative Effectiveness Research. A council will be formed that will study the effectiveness of current treatments including medications, procedures, medical devices and surgeries by examining the research. I imagine these will consist of systematic reviews of the research and will examine the validity of the studies conducted (including Confidence Intervals, p-values, etc.) This is a major step towards integrating evidenced based practice ( EBP ) and cultural competence into our practice. There is often a significant lag time before research actually impacts daily practice. I recall a wise professor of mine stating that it would take a clinician reading 3 primary research articles every day of the year to stay current. I am hopeful that we will ultimately see treatments and outcomes tailored to gender and ethnicity (it is a fact that certa...

The NY Times has a regular section that aims to debunk common health-related myths. This week, they take on the claim: Can Hot Liquids Can Ease Symptoms of a Cold or Flu ? Unfortunately, there isn't a lot of research examining these effects. However, the research that is out there supports hot liquids over room temperature or cold ones. (See the study referenced here and I searched for any meta-analysis studies and could only find this one study.) Of course, there are still lots of questions out there regarding how much liquid you should drink, does caffeine affect these results, is there an ideal beverage to drink over others, etc? So the next time you have a cold or the flu, consider consuming hot liquids over cold ones. Your nasal passages and respiratory tract will thank you for it. Also should you need to visit your health care provider, be sure to tell them all of the self-care steps you are taking to ease the symptoms. They will thank you for it too!

There are a few pharmacy chains currently running free antibiotic promotions . I really question if that is the right message to health consumers. I have blogged about the dangers of over prescribing antibiotics and resistance here and here . Most of the free antibiotics include penicillins and the like. It is worthy to note that these prescriptions normally cost no more than $10 for a standard course. I can imagine that this will make it harder for the prescribing clinician. While it is wonderful to practice in a cost-efficient way while being cognizant of the costs placed on patients, I wonder if this sends a message that it's OK to take antibiotics (because they are free) for conditions that clearly don't warrant them. What do you think? Do you have patients asking for antibiotics now because of these promotions?