“Spinning Makes The Bulls**t Go ‘Round and ‘Round
I am a wordsmith. A lover of the English lexicon. I find words and their uses magical and incredibly fascinating. Authors weave stories, musicians create lyrics and poets utter magnificent locutions of verbal artistry…with words. Unfortunately, like anything else, words can also be used to manipulate and deceive so surreptitiously that one will be none the wiser. And it can be done with such prowess that the actual definition of the words, which should expose misused terms, are virtually ignored by the masses. The ability to spin or twist the meaning of a word(or phrase) requires a special kind of malicious expertise. To do so with the intention of misleading others also demands one lack a moral compass–to be as effective as possible.
Nowhere is this behavior more egregious than in the movement for Full Practice Authority(FPA) in which nurse practitioners are permitted to practice medicine without oversight of a physician. FPA is a misnomer for “independent practice”. Let’s delve a bit….What exactly is “full practice authority”? Practice of what? Nursing? Medicine? It’s not clearly defined although some proponents claim “advanced nursing” is an actual practice. As defined by the American Association of Nurse Practitioners(AANP), FPA “is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing(https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief)”. Neither FPA nor “advanced nursing”, whatever the f**k that is, should indicate that one can then engage in medical interventions or perform medical procedures on patients without oversight of a physician. Why? Because that is the practice of medicine. Ironically, the AANP’s definition of FPA is eerily similar to that describing the practice of medicine:
“The practice of medicine includes the diagnosis, treatment, correction, advisement, or prescription for any human disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real or imaginary(https://medlineplus.gov/ency/article/001936.htm)”.
OR
“Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health(https://en.wikipedia.org/wiki/Medicine)”.
In my opinion, FPA as defined by the AANP is professional appropriation–it’s no accident and it’s no spin. “Professional appropriation, in medicine, is the usurpation and perpetration of perceived ideas, symbols, behaviors, roles, practices, etc. by a separate and distinct OTHER discipline to gain acceptance, prestige, respect and/or acknowledgment for actions promoted as medical accomplishments, when those “accomplishments” have not actually been appropriately earned (https://authenticmedicine.com/2019/12/professional-appropriation-a-new-term). In other words, professional appropriation is straight up theft of another discipline’s identity. But I digress…
“Spin” originates from the Old English term “spinnan”, meaning to “draw out and twist”. How apropos. Why do some individuals and/or entities find it necessary to spin? Well, let’s look at the informal definition of “spin” as defined by Oxford’s English dictionary: “A particular bias, interpretation or point of view intended to create a favorable(or unfavorable) impression when presented to the public”. The purpose of spinning is best described by Wikipedia: “In public relations and politics, spin is a form of propaganda, achieved through knowingly providing a biased interpretation of an event or campaigning to influence public opinion about some organization or public figure. While traditional public relations and advertising may manage their presentation of facts, “spin” often implies the use of disingenuous, deceptive, and manipulative tactics”. Bingo. It is my contention that this descriptor also applies to FPA.
The FPA movement has been incredibly successful in duping incognizant, mentally lethargic legislators into supporting and passing laws which permit NPs to practice medicine without formal medical training or a medical license, while simultaneously refusing to hold them to the medical standard. From anyone on the outside looking in, this concept would be preposterous. And that ladies and gentlemen, is the genius of spinning. It authenticates the absurd without requiring proof–validity is presumed. Spinning exemplifies the power of words. Even the most intelligent of beings can be deluded by masters of the spin, much like unsuspecting followers of charismatic cult leaders. Spinning is the worst form of lying because it embellishes deception. Simply put, spinning is bulls**t to the highest degree. Imagine the Herculean efforts it must take to avoid being truthful because it interferes with a self-serving agenda that is not in the best interest of the public. A scheme which also enables the corporate practice of medicine to flourish and continue its insidious destruction of the House of Medicine, with patients paying the ultimate price. It’s diabolical how much this behavior has been normalized in health care. It stinks to high Heaven….and to the depths of Hell. Bulls**t is unaffected by boundaries.
“Just for the record, the weather today is calm and sunny, but the air is full of bulls**t.” ~ Chuck Palahniuk
What to do as a practical matter?
I wonder if NP’s should just enjoy full practice rights, held to a physician standard of care.
Eliminate all “supervision”, and let the chips fall where they may.
I would have to agree on this. I retired in July 2020 but I collaborated with an N.P. in a group practice because we docs were told, if we used N.P.’s the gubbernmint would reimburse us better! I was like “O.K.”
Turns out I was paired with a dynamite N.P. She was a bit older than me but her life story was something I could admire and she didn’t mind a dirty joke every now and then. In fact had a store of her own colorful jokes to tell.
Told me she got pregnant at 19 and unfortunately married the *ickhead until she had sense enough to divorce him. Worked her way through college and got a nursing degree. Married a very nice guy who was a school teacher along the way who might have helped support her.
Decided to be an oncology nurse and did that for 8 years. Then heard about this “Nurse Practitioner” thing and asked the onc group if they would be o.k. and support her. Heard nothing and quit them. Husband was working so she went back to school, got the M.S.N. and N.P. credentials. Once done, she applied to the clinic I worked for and by just blind chance, she was paired to me as the corroborating physician.
Ahhhhhh, we had over a 20 year professional corroboration and there was nothing interpersonal about it. We had a work life that I can reflectively say was a blast. She could take care of run-of-the-mill stuff without my interaction but when she came up to me and said, Kurt, ” I have this case I need to discuss with you.” I knew I had to put my freaking thinking cap on! Annnnd, sometimes it led to a direct admission to the hospital. I still have social interaction by phone or snail mail to this day with her and her husband. What a friendship.
Direct admissions? Back in the very old days, I could stuff/admit someone to the hospital where the s#it was hitting the fan in the office with no question. I did “another” residency tract before I did F.P. so I had 5 and 1/2 years before I got out.
Later on, there was so much criteria to get a patient into the hospital it was a PITA.
I developed a reputation as a “legitimate” admissions guy and they didn’t bother me as much as I did as much as I could in the dictations to document the legitimacy of the direct admit.
Kurt (glad I retired) Savegnago, M.D. (in another time and place!)
Natalie, This an excellent and careful discussion of the way in which many in nursing leadership is advocating practicing medicine by calling it “practicing primary care” and at “the top of the nursing license”. Congratulations on this needed expose.
Fred (Alfred M. Sadler Jr MD FACP)
Well put. Once, becoming well-educated meant mastery of grammar, rhetoric, and logic. Each of these vital skills of true adulthood originate in the competent use of language. However, writing and speaking has undergone degeneration into the memorization of verbal phrases and terms – memes – which can be asserted even if they are contradictory. We have long ago renounced the idea that individuals have consistent principles, and take on such things that further their beliefs, and renounce those which oppose them. We now dutifully memorize our memes, and hurl them at those whom ones despises for no coherent reason.
The AANP insists that the practice of medicine can be placed in two separate boxes, differing only in name. One, called “Doctors” is said to practice medicine; the other, is called FPA, and is said not to practice medicine. This logical absurdity is, as you pointed out, embraced by incognizant, mentally lethargic legislators who are motivated by a lust for magical thinking.
The habit of superstition – pretending sincerely that whatever one wishes will become true, if one only wishes hard enough – is hardly the fault of stupid legislators, but a symptom of a decaying civilization. Such civilizations are often led by cynical or deluded prophets who cast forth the brilliance of their own wishes as a substitute for their connection to reality.
I have seen the trend growing in America for decades. By virtue of this change, we should celebrate January 6 as a day when fantasy trumped reality in America. The capacity to construct a grammatically correct assertion does nothing to ground it in reality. But the eagerness of people to be deluded by magic is perhaps eternal in the human spirit.
One should watch Triumph of Will by Leni Riefenstahl, showing the Nazi Party conference in Nuremberg. It is important to consider the vast sea of confident Nazi warriors, the audience, a legion of fighters of indescribable magnitude. But remember that most of these young and misinformed men died not as a legion, but one at a time, in bitter cold, hunger, and suffering each alone, over the next decade. There you have the fruits of the triumph of will.
The fate of sloppiness of logic is not constrained to the embrace of incompetence in medical practice. It is part of a civilization-wide decline which could only be stopped by those who currently embrace it the most fervently. Corruption of thinking in one place, such as the AANP, is no difference than corruption of thinking elsewhere; there are no boundaries to contain it. But in a free society, nobody can say this is what was forced on us; rather, to a greater or lesser degree, what we chose.
Once again Natalie, 4 gold stars. Thank you!