Fugging Lies! “Evidence-Based Care and Excellent Outcomes”
Fucking is an Austrian village in the municipality of Tars Dorf, located in the Innviertel region of western Upper Austria. The village is 33 kilometres (21 mi) north of Salzburg, and is 4 km (2.5 mi) east of the Inn river, which forms part of the German border. In their 17 November 2020 session, the council of Tars Dorf voted to have the village’s name officially changed to Fugging (pronounced the same as Fucking in the dialect spoken in the region), effective 1 January 2021. So what? Well, I use this to draw reference to an item that has been floating around social media recently. It concerns an unscrupulous person proving psychiatric care to a vulnerable psychiatric population and the violations of ethics, standards of care, and just plain human decency. This person took sexual advantage of a vulnerable female suicidal psychiatric patient who ended up committing suicide and this licensed person still practices. There is lots of Facebook and Twitter chatter on the person, case, and story, so I won’t rehash it here suffice to say the FUGGING LIES I found on this person’s practice website consistent with rhetoric and talking point of many mid-level providers. See, I didn’t want to use the other “F” word in the blog title, so hence the reference to Fugging Austria Here’s the Fugging Lie:
“Analyzing decades of research, two international reports by the Institute of Medicine and the Robert Wood Johnson foundation found that care given by a Nurse Practitioner (NP) versus a physician resulted in comparable patient health outcomes. They also found NPs produced superior outcomes when analyzing measures of consultation time, patient follow-up, and patient satisfaction. The original research can be found here.”(https://melrosepsych.com/affordable-psychiatrist-near/)
The “evidence”:
- https://campaignforaction.org/resource/quality-care-provided-advanced-practice-registered-nurses-aprns/
- https://www.sciencedirect.com/science/article/abs/pii/S1555415513004108
The notorious case:
I’ve written many blogs on the topic of research being used as evidence to tout equivalence and superiority of nurse practitioners (NPs) over physicians. Having been a former NP, I’ve written about the lies, data manipulation, talking points, rhetoric, practicing at the top of one’s license, education, and training and full practice authority (FPA) etc of my former profession. I just find it rather frustrating that my former profession is getting lost and going down a bad road (https://authenticmedicine.com/2019/06/getting-lost-my-former-profession-is-being-led-astray-practicing-to-the-full-extent-clinical-supervision-a-barrier-nonsense/). The irony of it is the education is becoming worse and worse and yet there is desire for more and more scope of practice and authority. Even worse, is the so called “evidence” being used to make the talking points. Take the 2nd research article listed above. It reports “Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed.” But what it doesn’t say is that it compared MD teams both with and without NPs and made generalizations about NP versus MD. It was really MD with NP and MD without NP teams. This exemplifies flawed methodology so often seen in this “evidence.” The study also reports “Primary ambulatory care involving NPs resulted in similar though not better blood pressure and blood glucose control.” But what it doesn’t say again is that about NPs being on physician led teams, that the follow up period was short, and that MDs in general had sicker and more co-morbid patients. However, I will give the study credit where credit is due. They reported on some of this in the limitations section which I found telling:
Limitations in the body of research reviewed should be considered when interpreting the results of this systematic review. Heterogeneity of study designs and measures, multiple time points for measuring outcomes, limited number of randomized designs, and inadequate statistical data for meta-analysis were among the methodological limitations encountered. Diffusion of treatment because of inclusion of MDs in both experimental and usual care groups was also a potential problem in some studies. In addition, the failure to fully describe the nature of the NP roles and responsibilities and the relationships of team members, including frequency and qualities of
collaboration with MDs, limits the ability to replicate the models of care employed.
Fugging (_____fill in the blank_______)
Have a great day.
Excellent points.. As a PA-C WITH 44 YEARS AS A PA-C I agree with you.I became a PA-C to be #2 in the supervising physicians practice. I would handle the routine problems, follow ups and my Physician would take care of the complicated cases hospital rounds,consults if any.I would always assist. NOT REPLACE.
I had several physicians who did not suture,I did that for them. I have been suturing since age 18.I am 70. 52 years now. If I want to be The Doctor I will go to med school.Not PhD. MD or DO.
Many PA’s now need 3 to 5 years of clinical experience before they can be turned loose on a patient. No prior clinic skills or exposure. They Need training still.. So do many RNs who became NPs. No clinical skills or practice experience..