You Sir, Pee: An Uncomfortable Experience at the VA
You sir pee’d on me when you, as my primary care provider, introduced yourself as “Dr. ‘Usurper’ at my VA primary care appointment, and didn’t clarify you are a nurse practitioner (NP). I only knew because I’m a former NP turned MD and I pay attention to this stuff. But in return, I find it ironic that even though I’ve earned my MD and due to start residency this July, I cannot even use the term ‘doctor’ in a clinical setting just yet. What is Joe Public supposed to think? Exactly, it’s a mirage being perpetrated onto the unsuspecting public to deceive them into thinking you are an actual doctor, a physician. The term ‘usurp’ (you-sir-p) is a verb that means “take (a position of power or importance) illegally or by force;” “take the place of (someone in a position of power) illegally; supplant;” or “encroach or infringe upon (someone’s rights).” ‘Usurper’ is the term used for someone who usurps, or “is an illegitimate or controversial claimant to power, often but not always in a monarchy. In other words, a person who takes the power ……for themselves, without any formal or legal right to claim it as their own.” Just like you “Dr. ‘Usurper’ did to me. The American College of Emergency Physicians has a position statement addressing this very disturbing issue (https://www.acep.org/patient-care/policy-statements/use-of-the-title-doctor-in-the-clinical-setting/#:~:text=ACEP%20strongly%20opposes%20the%20use,being%20treated%20by%20a%20physician):
“ACEP strongly opposes the use of the term “doctor” by other professionals in the clinical setting, including by those with independent practice, where there is strong potential to mislead patients into perceiving they are being treated by a physician.”
Now, at the time of my appointment, it put me in a very uncomfortable position. What to do? I ended up not saying anything at the time of the appointment, but have since filed a complaint with the patient advocate. I did so anonymously because the beauacracy, politics, and retribution at the VA is horrible. This needs to stop! I wrote:
Just an ethical and fraud complaint: I myself am a former nurse practitioner and now I’m a physician (MD). When my PCP introduced himself as Dr. ‘Usurper’ – this unethical as it is meant to deceive that the individual is a physician and not a nurse practitioner. There was no clarification I was seeing an NP. This is fraud and unethical and NPs are not supposed to call themselves “Doctor” in a clinical setting. Even if he has a DNP degree, this is an academic degree and not a clinical degree to the same extent PhD’s for example in mathematics, can call themselves doctor on a college campus but not in a clinical setting. Make it stop.
I will say that when I was an M-3 medical student and following around a G.P. The staff would call me “doctor” and I knew danged well they “knew” I was just a med student. It felt very odd to me but I just went with the flow. Maybe they were trying to get me to get “used to it”. Perhaps it made it easier for me to watch a master treat patients and made it un-concerning for the patients as they thought there was another “doctor” in the room. It helped with my education and heck, I was sworn to the secrecy and confidentiality oaths as a regular practitioner anyways.
When I traveled to the satellite area with three other students to our prospective docs (I had the nicest car a ’79 Buick regal) on the way home, we never talked patients but shared all the “dirty jokes” the patients, doctors and nurses told us! (Paternal grandma gave me the car since I made it to med school. She told me, “Don’t tell the other grand kids!”)
The NP situation. I had one assigned by the “corporation”. She took care of run of the mill stuff and did the pap smears when women “liked me” as their doctor but felt more comfortable with a female doing the pap. Fine by me as if I wanted to spend my time between women’s legs, I would’a been a groinocologist.
Debbie would dump the “tough stuff” on me and it all turned out o.k. When she grabbed me and said, “I got this patient.” I knew I was in for a rough time. That’s o.k. because it was a good legitimate medical problem that made me think. Always turned out good in the end as I could call on a specialty if I needed to.
In my situation it worked well. As long as NP’s work with docs to extend their care in under served areas they can be a real assistance.
Let’s face it. It doesn’t take an M.D. to do a throat culture or do a pap smear. When sh!t is flying at you from every direction, an N.P. can take some of the load off. I was in a traditional office, hospital and taking call practice. (Which I think is rapidly disappearing from the landscape.)
I think independent practice of N.P.’s is going to eventually die or become less popular as once they get the taste of malpractice attorneys that will be the bitter pill. One has to remember that they will have to get their own malpractice insurance and once the cases start rising, the rates will get ridiculous for them to be independent.
Those N.P.’s who are really good at what they do will likely survive. I will suspect they will have to have the best M.D. and hospital backup to do so.
Oh, I still have social contact with my N.P. Debbie and her husband. We collaborated medically for over 20 years. Did a great job with me.
Kurt Savegnago
Yes,like robbrs and political scialists/communists everywhere ,first you take over the schools then you graduate all the stealth idiots get into positions of influence at universities,govrnment at all levels, and gradually take over. My wife graduated from John Hopkins school of Nursing in 1973. She told me then tkat
was Nursing’s plan and to take over all of medicine from MDs and DOs. Looks like it is working.
The DOC’S LET THEM DO.. Now have fun dealing with it…
And no one cared at the VA. The PCP MDs are slowly being replaced by all NPs in N. Florida.