Did The Devil Make You Do It?
Many who know me are aware that I am an avid supporter and believer in the value of education–I’ve lectured on it for over 35 years. I find the intentional diminution and manipulation of education, in all realms where it is required, to be despicable because it is almost always done as a means to an unethical end. That end being the almighty dollar. Particularly in the healthcare industry, it represents a false narrative to mislead the public into believing that they are being provided quality services by properly educated health care professionals when they are not. For the deception to be successful, it is essential that the public remain ignorant. Therefore, private equity-backed corporate medical groups and predatory health care professionals(HCPs) perpetuate these lies out of necessity, because they benefit financially, professionally and personally.
As much as I despise corporate medicine, they are acting as business people do. They focus on profits, not patients. Their aim is to please the shareholders, not the public. The consequences of their actions on the health of human beings is of no concern to them; the repercussions are acceptable as they are deemed to be in the best interest of the business. On the other hand, HCPs have a professional and ethical duty to prioritize patient care. The onus is on them to know when they are in danger of practicing beyond their scope and stop there. When they knowingly take advantage of a loophole created by the business of medicine and legislators, a loophole which falsely extends their scope of practice(SOP), then they are no longer acting as just widgets of the “machine”. They become active accomplices in this treacherous system. The examples below demonstrate the OPs significant lack of medical knowledge. I have chosen to redact identities because this is not just about the behavior of individual NPs, it is about a systemic issue within NP education itself that assists in perpetuating this profound problem which also enables the corporate practice of medicine to flourish.
This is not guidance, folks. This is not learning. This is not education. This is someone lacking the requisite medical knowledge, asking a question and expecting to be spoon-fed an answer. The answers are more a game of guessing than they are a reflection of actual comprehension. If you throw enough darts, one will eventually hit the bullseye. Keep in mind that the OP is a fully educated, trained and licensed NP. The question is demonstrative of the travesty that is called NP education. Nevertheless, NPs are permitted to “manage” patients in this manner without medical supervision, with social media being a heavy source for gathering medical information and advice on the treatment and management of patients. This is not the exception, this is now the rule. The payoff being a misperceived parity with physicians. This particular dermatologic issue is not complicated based on the picture. A medical student would know that the affliction from which this patient suffers is not shingles simply because it appears on one side of the body. The history provided by the OP is sparse and poorly presented. If a 2nd year medical student gave a similar presentation it would be unacceptable. A referral to a dermatologist should not be required simply because this appears to be a skin-related issue, it can easily be referred to a primary care physician who, without a doubt, could manage this condition. Cases like this illustrate exactly why no one should be stating that primary care(FM/IM/Peds)physicians and Family Nurse Practitioners(FNPs) are equivalent, it’s absurd. In addition, it is sub-standard referrals of this ilk that jam-pack specialists, causing legitimate referrals to be delayed by months. It is an inconvenience to the patients, a poor use of the specialists’ time and saves no one money in the long run. The irony is that the NPs who point out that forums of this sort are an inappropriate place for such a question to be asked are often vilified for being harsh and unsupportive, when they are in fact correct. In my opinion, NPs who post cases like this purposely avoid asking physicians because they don’t want to be viewed as being incompetent or unknowledgeable. Their need to protect their ego and incessant desire to attain fictitious parity with physicians places patients at risk. They become part of the problem and not the solution. And the problem is that too many HCPs are selling their souls to the Devil, motivated by selfish aspirations.
I’ve long intimated that I believe we, our society, exist in a medical bubble that is destined to burst(https://authenticmedicine.com/2020/02/the-medical-bubble/) and when it does, it will be catastrophic. Why do I believe as I do? Because it is not possible to “fake it until you make it” in the practice of medicine. The foreseeable failures of HCPs practicing medicine without the relevant knowledge are manifested in human beings who will inevitably present to a medical setting or an attorney, which subsequently leads back to the culprit(s) who errored. It is unavoidable, unless the patients die first. Then the hope will be that nobody asks any questions. Every time I see a post or article in which a group of physicians are replaced by non-physician practitioners(NPPs), I have a visceral reaction. It’s as if the powers that be are intentionally seeking to “thin the herd” of what they perceive as “undesirables”, those patients who drain the system financially, by permitting HCPs untrained or possessing limited training in medicine to practice unsupervised. They institute NP/PA-only staffed emergency departments and intensive care units….all areas in which patients are very sick or critically ill. Any mishap, in particular, those leading to severe morbidity or death, will most likely not garner suspicion because those outcomes are to be expected in those medical environments. Hospitalist medicine is not exempt from this fraudulent activity. The majority of NP/PA-only staffed medical floor misadventures occur primarily at night, not as often during the day when there are many more medical staff and family members(aka witnesses) present. Patients and families have no idea that no ACCREDITED hospitalist programs currently exist for NPs or PAs. Begs the question, why are NPPs then allowed to practice as hospitalists? Because the hospital bylaws don’t prevent it, the state boards of nursing and medicine don’t give a s**t and the Department of Health and Human Services(DHHS), whose responsibility it is to oversee hospitals and the care they provide, won’t get involved until the damage is done. Legislators sanction it when they pass FPA and OTP laws. Don’t think that these corporate entities are not aware that NPs and PAs are not held to the medical standard–they are aware and don’t care. I daresay it is part of their diabolical strategy to transform the humane practice of medicine. And why aren’t NPs/PAs held to the medical standard? Simple. Because they are not physicians. You read correctly. NPPs are authorized to practice medicine WITHOUT appropriate medical training, WITHOUT a medical license and WITHOUT being held to the medical standard. This leaves the patients and their families WITHOUT much protection or recourse. Yes, they can sue the hospitals/corporations and NPPs, if they are aware of the mishap. However, NPP financial culpability is limited–they do not have deep pockets. Also, who is going to report mismanagement, malpractice and/or negligence when there is no oversight? No one. Again, NPPs are not physicians. If they are not familiar with or held to the medical standard, how the hell can they be relied upon to report a case that does not meet the medical standard? They can’t. See the loophole? For corporate medicine, the ignorance of patients and their families is indeed bliss. Because of the willingness of physicians and other HCPs with questionable morality to turn their heads and entities designed to protect their interests relinquishing their responsibilities, it is easy to see how one can enable substandard practices which border on criminality. Any nurses and physicians with integrity who witness and report such troublesome practices can almost always expect to be terminated. Again, maintenance of the status of the unenlightened is imperative for the business to remain successful.
There is no doubt in my mind that plenty of health care professionals today are witnessing exactly what I describe. We know when there are no physicians covering a hospital at any one time. We know the families are never informed of this. And we observe the predictable mismanagement of such practices….every single day. We normalize what should never be the norm, because it is the only way to cope–by convincing ourselves that this is the future of medicine and therefore unavoidable. Even when we know it is wrong. Do we not understand that in doing this, we become passive accessories to what should be considered a crime? Where is your line in the sand? Yes, speaking out may cause you to lose your job–wrap your head around that possibility. And those of you who think you are off the hook in FPA/OTP states, think again. FPA/OTP does not control the actions of attorneys and they can sue whoever the f**k they like. If a physician is present when a NPP mismanages a patient to the point of malpractice/negligence, then that physician has an obligation to intervene, because they possess the highest level of medical expertise. Docs can use the excuse they didn’t know–sometimes it works in court, sometimes not. Good luck with that. The only way to ensure no accountability is to not work with NPPs. Otherwise, appropriate supervision and oversight is necessary to ensure that the quality of care being provided to the patient is optimized while simultaneously improving the physician’s medico-legal risk.
I truly despise what medicine has become. I hate even more what has happened to my beloved specialty of emergency medicine. I am disheartened that I have colleagues within my specialty who have sold out. Who instead have made a conscious decision to renounce their oath and pledge allegiance to the almighty dollar and ally themselves with the Devil(s), the malignant corporate entities who are destroying our profession. They embrace the mediocrity that is becoming more prevalent in our field. All for the love of money. It’s enough to make a person sick.
“Never dare to sell your soul for money, because no amount of wealth would buy you an air conditioner in hell.” – Edmond Mbiaka
Wow! Glad I retired from FP in July 2020. It was a rural group practice that still did office, call and hospital care. It was getting intolerable. After I left, they went to an office practice only and the hospital hired hospitalists which is what they (the hospital) wanted to do all along. EHR has killed off primary care medicine and anyone who recommends to students to go into it should be condemned to Hades.
Had a front row seat for this during my dad’s last illness. The only physician who ever saw him after his admission to the hospital was a pulmonologist who visited three times during his 5 day stay. Guess elderly patients are indeed part of the herd which is getting thinned.
Reminding the readers here of a clinic in Vancouver WA. That’s just north, over the Columbia River, from Portland, Oregon.
Payette Clinic in Vancouver, then changed its name to Walnut Grove Medical, then as best I can tell, sued out of existence. Say what you want about the trial bar, but the State regulatory agencies would not do anything about these arrogant idiots. They were, after all, NURSE PRACTITIONERS. “They cared about their patients”. Shit like that actually came out in the state investigation. They were the poor nurses oppressed by evil corporate medicine. But under the weight of multiple well-deserved lawsuits, they were finally shut down.
They must have listened to some lecture about “no upper limit to opiates” back in the 1990’s and never read another thing on the subject.
The clinic was all nurse practitioners. No physician involvement. They were notorious all over the Portland metro area. Physician complaints went nowhere. You’re just a bunch of evil corporate (male) doctors trying to bully a girl with a lemonade stand.
They were prescribing methadone 100 mg, q-6 hours. Most don’t believe me when I tell this story, here’s the reference and a picture of the prescription bottle.
https://www.pulitzer.org/files/2012/investigative_reporting/seattle/methadone-exhibit3.pdf
Scroll down to page two, for a picture of the prescription bottle.
Methadone 10 mg
Disp: #1200 (that’s one thousand, two hundred)
Sig: 10 (TEN) PO q-6 hours
Similar dosages with oxycodone back then.
Well Said..
Did you see the recent article from UK THAT 62%OF DEATHS FROM COVID is in the Vaccinated!!!
Liars lie science is dead.. Our Business of MEDICINE KILLED IT and maybe A LOT OF PEOPLE.
This Vaccine is bad,makes COVID Worse..
The CRAP is going to Cover a Lot of people.Government,Pharma, Physicians..
Torches ,Pitchforks, MOBS all heading our way.. Please prepare….
Thank you for this post. Heartening to see the that other Physicians feel the same. I was just replaced by Corporation with NP because they can and money is much more important. Criticized for putting kids in gowns for well visit, made the visit too slow. Told “no complaints about my clinical expertise, just need to cut cost”. Our trade is being silently sold out and we all need to stand up and fight. AMA has good advocacy for this. We should all become more vocal – for why did we do all this work to become Physicians only to be told by administrators who know nothing of medicine we are easily replaceable with people not nearly as trained but passed off as Doctors?
I was the only inpatient doctor/hospitalist in house nights other than one ER doctor (they only leave the ER for codes). They cut my job and replaced me with an NP.
So now, in the level 2 trauma center/stroke center/cath center hospital there is only a single NP in house overnights. The ICU “intensivist” is also an NP.
Good luck.