Agonist Antagonist: Vitriol & Civility Two Novel Drugs Seeking FDA Approval in Healthcare (A Satire on the article: M.D. vs. N.P. – Let’s Put Egos Aside And Patients First)

“When all members can come together and agree – or agree to disagree – on the best way forward in a patient’s care, the population thrives. When voices and opinions are given respectfully – and respected – an effective healthcare team is made (1).”

            Within the Limbic System, a new receptor called the Emotional Reactionary Receptor (ERR), has been discovered. When activated or triggered, it causes extreme emotional responses seemingly out of proportion to the context or content of an environmental stimuli. Typically leading to overly emotional cruel and bitter criticism, disregard for truth, feelings of superiority, and an exaggerated sense of importance. Vitriol (not to be confused with Vivitrol) is a new drug designed as an ERR agonist with the indication of overcoming inferiority or numbing extreme emotional distress. Due to abuse potential it will be placed in Category IV of controlled schedules. When the ERR is inhibited, it potentiates formal politeness and courtesy in behavior and speech and disagreeing without disrespect.  Civility(not to be confused with Trulicity) is a new antagonist drug to the ERRwith the indication of civilized behavior or polite acts with respect. It will not be scheduled, as it seems apparent that in healthcare today it is not as sought after as Vitriol. However, it seems that Civility is needed by more individuals. The irony of the agonist-antagonist concept. Just like with opiate agonist/antagonist, the agonist is more sought after but the antagonist is more needed.  

            That’s the point of the article referenced here that tensions between Medical Doctors and Nurse Practitioners have seemed to grow more intense this year. Just look at the response when a blog is written, or when someone posts an idea or comment that differs from your own. Vitriol. “The animosity between NPs and MDs is very much alive and sometimes tangible (1).”

However, I do hold out hope: 

“Despite tension between the two practicing bodies, there are plenty of examples of healthcare teams that cultivate a positive, healthy, symbiotic relationship between all members of all licensure.”

            Dare I say with Civility. Randomized control trials show that Civility has a 75% risk reduction in terms of getting along and solving problems. Through all the points of contention in the referenced article if a dose of Civility is taken 30 minutes prior to reading, or to the debate, the outcomes are better.  The article says (see chart):

But it goes both ways. Civility is not a one-way drug; it works equally on both MD/DOs and APRNs. Civility however has a side effect. It reinforces the focus on your own side of the proverbial street. In other words, getting your own house in order before looking and trying to solve someone else’s problems. Owning one’s own problems and not focusing on the problems of someone else. One discipline cannot solve another discipline’s problems. Let the physicians solve the physician and primary care problem and let the nurses solve the nursing shortage and the problems going on in NP education quality. The article references this whereby:

“But in order to grow and move forward in a progressive way, we must put down our egos and work on the kinks in our own system, and for nurses, the first step could be examining the NP education system (1).”

            Don’t jump on me, I didn’t write the article. Where I disagree with the article is where is says: “No matter who you are or where you stand on each argument, it can be said that ego lies at the center of the feud.” I think it’s an over abundance of Vitriol and a lack of Civility.  Maybe these are rooted in ego, I don’t know. Perhaps we could say the ERR is a receptor on the ego part of our brains. 

Ok………… whatever…………… Vitrio or Civility……… pick your drug wisely……..



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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

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