A Nurse Practitioner's View

Thank you to New York Senator Montgomery of Kings County for introducing legislation that will allow nurse practitioners to sign death certificates ( S.2969 ). The bill passed the NY State Senate with strong bi-partisan support, 58-3. It must next pass the Assembly and then on to the Governor's desk for approval to become law. Here is some additional information on the bill and its rationale.

I am a techno geek. I love my iPhone and BlackBerry . I have a laptop, a netbook and a couple of desktop computers. I am currently piloting a Kindle DX , which is pretty cool. Today, Apple introduced the iPad , their hotly anticipated tablet computer. It is a beautiful device, about the same size as the Kindle DX , though basically a blown up iTouch . While I can't wait to get my hands on one (it's not available for another 60 days or so), I wonder what apps will be developed to enhance the flow of information in health care. There are already a number of EHRs that run on mobile platforms and since this basically uses the iPhone operating system, it would appear that this is tailor made for health applications - both on the patient side and on the clinician side. This device may aid in the modernization of health records. The flow and integration of data can and should be so much better. I believe this is a game changer and we will see a further explosion of health related a

I came across this wonderful post on Dr. Edwin Leap's blog, " Attention Doctors: People may not like you. " It is relevant for all clinicians and talks about the interactions between patients and providers, patient expectations, and the handling of these expectations. The important thing to remember is that we are providing a service to our patients. Patients come to us for our advice, opinion and to make them feel better. Some may not agree with our plan and will seek further opinion - and sometimes they certainly should. Patient's should be empowered to be actively involved in the decision making process. But oftentimes silos are created, further fragmenting care and communication. That's why I believe firmly that comprehensive care is best delivered in teams - where team members share the same focus and are aware of each other's strengths and weaknesses. There are so many patient variables to consider: culture, socio -economic status, gender, past medical

An article appears in Health Magazine advising its readers " when its OK to skip the Doc ." But of course in doing so, nurse practitioners get slapped. You see, the article refers to convenient care clinics - a continually hot topic - and how their nurse practitioner staffed model makes it OK for them to treat minor boo-boos but aren't capable of treating more serious maladies. Now in all fairness, most clinics aren't currently designed to treat conditions beyond episodic-type care and health screenings though there are reports that say this trend may be slowly changing to include other conditions. I just don't understand why the inference is always that the NPs staffing them are limited to treating just those conditions as well. I know plenty of instances where NPs referred patients to other providers based on subtle signs picked up during a convenient care visit which might've otherwise gone unnoticed. Further, patients in these settings were easily abl