Attacked by the illiterati
I reproduce in full (and uncorrected) a splendid piece from someone who styles himself as an “Advanced Practitioner” – whatever that is. Cheaper than a doctor, I warrant.
I'm sure you've all heard of him, Dr Crippen the man who hates Midwives, Nurse Practitioners, Nurse Specialists, but loves District Nurses. He dislikes the fact that some nurses have extended skills and knowledge that tresspass (sic) into the medical domain. Is this because he feels threatened by advanced practitioners and not by by DN's. (sic) Is he aware that DN's (sic) are extending their roles to include physical examination and diagnosis?
Dr Crippen, i (sic) assume (sic) is a man probably approaching retirement age who was trained in the days when doctors were thought to be gods with omnipitant (sic) powers and still believes that nurses are doctors (sic) handmaidens.
So let me open your eyes Dr Crippen, (sic) we are professionals with extensive knowledge who have not been to medical school as we do not proclaim to be doctors. (sic) We are independent practitioners working not just in secondary care or primary care walk-in-centres, but in many GP practices throughout the UK. Are all those other doctors wrong or misguided? Maybe they are secure human beings and professionals who understand that times are a changing.
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Independent practitioners of what?
Yes, I am a great fan of district nurses and no, I do not feel threatened by them. Nor am I threatened by the monstrous regiment of quacktitioners that has been let loose on the general public. The only thing that is threatened is the patients' health.
Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing. All doctors have passed “O” level or GCSE English. Could I suggest you get one of them to glance at your copy before you publish?
How the hell do you expect doctors to treat you seriously when you are verging on illiterate? I hope to God you do not write up drug charts.
I still have more years than I would like before retirement and during those years I shall continue, undaunted, to wage the war against dumbing down in the NHS, against allowing the development of a system in which the poor folk are seen by non-medically qualified “health care practitioners” whilst the rich, and the great and the good, continue to see doctors.
I shall be publishing a piece tomorrow upon which I would particularly like your comments.
++++++++
PS I trained at a time when doctors were treated as God. Capital "G" and singular.
93 Comments:
This is the interesting bit:
"we are professionals with extensive knowledge who have not been to medical school"
Are you really?
What proof or tests have you had of your 'extensive' knowledge?
Certainly not the equivalent of medical finals.
I rest my case.
Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing.
ok John I agree my grammer and use of commas and apostrophes are embarrasing and have detracted from the point I'm trying to make.
Must try harder!!!
'Pot calling the kettle black' regarding spelling lol
Depending on age and education, it is entirely possible that some people were taught that forming the plural as DN's is the preferred usage (see section 2) although it has been deprecated for some time.
Is tomorrow's post going to be a test piece that we should parse into subject and predicate? I draw the line if you are going to ask us to embark on a scale and category or branch grammatical analysis of a passage...
Truman Capote, Ernest Hemingway, F. Scott Fitzgerald: three poor spellers.
factoidman,
and billions of others who are far less famous!
(I think your quoted examples are the exception to the rule)
John
No matter that the content of my blog is important, interesting or entertaining - all my efforts could be disregarded to one extent or another due to the content being filled with poor examples of spelling, grammar and punctuation. Unfortunately, this came about as a result of carelessness, i.e. not checking my writing or reading through it once or twice after I'd completed it in order to look for grammatical errors and/or spelling mistakes.
But illiterate I am not. Oh to be so perfect!!
Dr Crippen - you are exceptionally talented with words, so perhaps some of your regular commentators will forgive your latest fit of pique over the literary style of a fledgling blogger.
Still, this latest distraction does little to address your worsening phobia of NPs.
Attacking style rather than content is a new low, even by your own impressively dismissive standards - I wait with baited breath for the main course after this unsatisfying h'ordeurve.
Garth - I look forward to meeting you on the battlefield, have your predictable anecdotes on standby.
By the way docs I will concede in advance that most of you passed the '11plus' at the age of 3 - so try to keep your comments about examinitis to a minimum.
Thanks.
Shinga
DN's?
Gratuitous apostrophe me thinks
It may be pedantic to look at spelling and grammar but I think it is incumbent upon someone embarking upon an ad hominen attack to get it right. If they don't, they make fools of themselves.
John
"PS I trained at a time when doctors were treated as God."
Full marks for self-diagnosis of your problem.
Dr Crippin - I laughed this morning! 'People in glass houses should throw stones'!!! Come on, your spelling isn't perfect all of the time!!!
Gareth - your surperiority complex is getting really, really boring *YAWN* and it's only 0810!!! :-)
A question to open up - at what stage does calling readers 'FUCKWITS', 'TWATS' and telling people to 'FUCK OFF' become 'Professional Misconduct' or 'Bringing the Profession into Disrepute'?
Dr Crippin, I fully appreciate your anger and this is YOUR Blog, but there really is no need to be offensive, it detracts from what you are trying to say...
I am sorry but this attitude that it is arrogant for doctors to think that they are superior to non medically trained staff at doing their jobs is bizarre and nonsensical
It is this kind of namby pamby politically correct idiocy that is stifling excellence and encouraging shoddy standards of practice
It is simple (and it is not arrogant, or demonstrative of a misplaced 'superiority' complex to point it out) that non medically trained staff having a stab at diagnosis without the thorough training that doctors have is frankly less safe and an overt dumbing down
As I have said before and I'll say it again to all the ignorami who think anyone with a fisher price stethosocpe should be allowed to have a go:
If HCPs want to practice autonomously then they can bloody well be subjected to the same proper rigorous tests and examinations that doctors are subjected to, ie medical finals.
As it is, many HCPs are let loose with much less rigorous testing of their knowledge and skills, and it is not bloody fair on patients to have this shoddy two tier system in place.
It is not arrogant to point this out.
if you think it is arrogant to think that more training and knowledge makes one generally better at one's job, then you sir are an utter imbecile of the highest order!
I wonder whether this trend can be reversed. I doubt it, because it's much cheaper to have nurse pracs than doctors.
Perhaps some high-profile fuckup cases might do something to stem the tide but I think this is something we're going to have to deal with (both as patients and as as professionals) for the forseeable future.
Attacking people's SPAG is always a low blow (especially when your own leaves much to be desired).
This particular quacktitioner's mistakes weren't "typos" though, were they?
They seemed much more consistent with a *systematic* lack of spelling and grammar.
No commonly used words were misspelled for example.
I would be frightened to have someone with little general education and only his or her "protocols" to go on having anything to do with my healthcare.
But then I have private health insurance and, living in London, get to see Professors in teaching hospitals.
As do all the politicians of course...
This post has been removed by the author.
No, in some circles that is not a gratuitous use of the apostrophe although it is now unusual. Again, it depends upon your age and where you were taught. I don't like it, but for some time, D.N.'s, C.D.'s and C.V.'s was the preferred plural form (as per the link). As for the rest, I did, of course, take your point and agree that the Apostrolypse is upon us.
From the profile, your adversary is female which affords an opportunity to explore whether or not it is appropriate to re-analyse ad hominem to form ad feminam.
Regards - Shinga
PS: Voice confused with tense at the Economist.
anon,
in fact they are not good value for money either,
it's more about expanding who can deliver the service and breaking the medical profession's monopoly on the work that should be done by yes......medics!
it's simple, privatisation is being catalysed by this dumbing down, unfortunately it's ain't even cheap!
Garth - 'It ain't what you do it's the way that you do it'. Think about it....
Dr Crippin - 'Advanced Practitioner' - is a female, so your opening sentence should read 'I reproduce in full (and uncorrected) a splendid piece from someone who styles herself as an “Advanced Practitioner” – whatever that is. Cheaper than a doctor, I warrant.'.
anonymous,
It is not arrogant to state simple facts that point out that many HCPs are not sufficiently trained for their jobs.
I rest my case.
I do take your point that being offensive doesn't help, however some apologists for the dumbing down really leave some with no option.
Cheap Shot by your standards, John.
Can I just point out to John, Garth, and the other medi-bloggers given to this vein of rant that the spelling and grammar in the original post were rather reminiscent of what I have been reading for most of the last decade in 1st and 2nd yr medical students' exam answers?
My reality would be that about 10% of medical students can't spell and rather more - 20%? - can't "do" grammar.
I'm not blaming them - as I have posted elsewhere when we were discussing dyslexia, the overwhelming conclusion, shared by most Univ academics I know, is that schools no longer teach kids how to spell, punctuate or write.
The original poster at least has the excuse of rapid typing in a fit of anti-DrC rage. It is much easier to mistype than to actually spell a word wrong when writing.
I know John may find it hard to accept that medical schools nowadays admit 19 yr olds who cannot tell the difference between "their" and "there", but believe me, it happens.
Hi Garth - I understand what you say - however, if you feel that some HCPs aren't sufficiently trained for the roles they perform, then this needs to be taken up with their Supervisors and Managers.
Attacking the individuals personally doesn't actually achieve anything positive - it simply perpetuates the status quo and the view that 'Doctors are God(s)' - (depending on your religion) and that anyone else is bottom of the food chain. Which isn't true, is it?
My Brother in Law has a Phd and HE uses 'there' when he means 'their'... I've also seen text written by a girl who had a VERY expensive private education and her grammar and spelling were pretty crap too! (She's now at Uni!)
anonymous,
indeed, this is what many doctors I know have done and the managers do nothing about the clinical risk.
I think you need to work in the NHS to understand that the DoH functions like a totalitarian state, they do not listen to problems on the ground.
The DoH knows that this dumbing down is dangerous, it's part of teh government's privatisation reform agenda.
Many doctors I know have complained about incompetence to these HCP's line managers and even above, nothing is done. Many doctors I know have also tried to address problems with government reform putting patients at risk to no avail.
http://ferretfancier.blogspot.com/2007/06/hospital-at-night-working-well.html
the consultant quoted in the above piece took her concerns to the line manager of the particular HCPs and their line manager ignored the issue!
This is what needs addressing if the NHS is to improve as it could.
This top down dictatorship is not a safe way to run a healthcare system. Complaints and problems are routinely brushed under the carpet, while a lot of people are too scared to speak out.
Gareth - thanks for your note. I am aware that it's very easy to make suggestions from the outside without experiencing the frustration from the inside. I have worked in organisations where it's easy to see how processes can be improved, but management have a different agenda. It's hard to work somewhere where morale is low - I've done it and it ain't nice!
At the end of the day, I guess the more people that make noise the better. If everyone sat back and said 'nothing will ever change' - it won't.
I'm neutral about the whole advance practitioner issue, but just wanted to say that despite their high level education in medicine, some doctors cannot spell to "save their lives". I happen to know one. Very smart man. Cannot spell and very bad grammar.
Reading correct grammar and spelling means we see what we expect to see, so can read without effort.
Errors cause us to pause and evaluate what we're reading, to ensure we are in fact correctly interpreting what's been incorrectly written.
And for me that's the rub.
It's at best irksome and at worst misleading to read text that's badly presented throughout.
We all make minor typing mistakes and spelling mistakes, the odd error's just glossed over. This interweb thingy and scribing in the blogsphere (a written medium) necessitates both good form and good content.
A low blow, and not up to your usual standard of genuinely thought provoking articles, which I imagine drive most of the traffic to your site, and are the reason for your winning of awards.
We looked at this post weeks ago, so why pick on it again now - other than to provoke a rather venomous attack? A quiet week for medical news stories?
I know - your blog, your content. But disappointing all the same.
As another trained doctor it belies belief that people get where they are with the use of such gems as
" they was doing this because they was in the right"
Many people I encounter have such poor use of grammar and I do wonder how they get promoted when they can not talk proper..
For example in our local unit a notice was appended thus
Occupational therapy as been suspended due to staff shortage thank you for you're understanding
Nice ...Not...
To be honest, I'm far more worried about the appalling lack of pathology knowledge of junior doctors than the work of advanced practitioners.
Additionally: A friend of mine had a car accident. The radiographer looked at the x-ray and said he'd broken a number of bones in his hand. The doctor then looked at the x-ray and proclaimed there to be nothing wrong.
2 weeks later - phone call from hospital: you need to come back straight away; bones broken in hand.
I'd trust a senior radiographer or advanced practitioner in radiography over a doctor any day. They know their stuff - that's what they've been trained for. Obviously I wouldn't want them prescribing stuff for me, but there is room for specialists (and not just medically trained specialists) in health care. Their opinions should be respected and valued.
anonymous,
indeed radiographers should be listened to and this junior doctor clearly buggered things up
I don't think there is such thing as an advanced practitioner in radiography so I don't know what you're driving at there!
I could point out many anecdotal mistakes by non medical HCPs but it doesn't really affect the crux of the argument:
some HCPs are being undertrained for roles which they have a lot of responsibility and it is dangerous!
anonymous,
also if you read the original thread regarding the ambulace staff, then your quote
"Their opinions should be respected and valued."
applies pretty well to the ambulance worker trying to tell the GP her job!
In fact doctors are on the whole pretty good at taking things on board when given criticism from other workers. You may find that the NP is a species that becomes incredibly aggressive if their decisions are questioned.
Don't be silly, a radiographer cannot diagnose fractures on an x-ray to the same accuracy as a trained specialist doctor.
Even if they could, they would not know the appropriate treatment, surgical or non-surgical, prognosis, appropriate advice and general medical implications in relation to the patients previous history, pharmacy social issues etc etc etc etc.
The radiographer would probably have extremely poor spelling and grammar, pah!
agree with aac and others.
John, at least one of your sics (I bet that should have an apostrophe...) is unwarranted, viz
'So let me open your eyes Dr Crippen,' (sic) 'we are'
and as Shinga says, NP's for pl is, to some, correct. (I hate it too, Shinga; btw I refuse to renounce 'ad feminam'!)
As another trained doctor
Dr Ray, who commented at the AP site, can't spell. Incidentally, 'as a trained doctor it belies belief' is grammatically poor.
Garth, I do understand the irritation doctors (and others) irritation feel when people who aren't as well trained/qualified as they, purport to be able to do their jobs. I really do. But John's attack here is unpleasant and counter-productive.
You may find that the NP is a species that becomes incredibly aggressive if their decisions are questioned.
the psychology of this is surely clear? (Shouldn't that be 'its decisions'?...)
Quack, quack .... Quack, quaeeek ... quwwwwk quiowck ....
Beats me, why nurses don't like nursing!!!!!
Maybe they should move to the city! Hehehe :-)
Just remember who wrote the post assassinating Dr Crippen, it is hardly a one way street me feels
Garth, I agree it isn't a one way street. John has every right to hit back.** It's the manner and content of the attack that I dislike. And nurses have been subject to fairly sustained attack on this blog; 'nursey''s been used far too often (I'd like to see it dropped altogether), 'Oh dear, nursey/X, you just don't get it, do you?' has been used (used when the commenter clearly had 'got it'), and so on. So though it isn't a one way street, there are an awful lot more tanks going in one direction.
**But perhaps doctors shouldn't hit back as hard at nurses. It's a difficult issue, admittedly, but how about some noblesse oblige?
noblesse oblige leaves the doctors with bloody noses
And I know this isnt grammatically correct but the nurses who belligerently attack doctors are nasty souls.
grainger is going! press release is out!
ding dong the witch is dead
Henry - are Doctors who attack nurses 'nice souls'?
jayann,
I won't speak for Dr C and I'm sure he wouldn't want me to,
I do agree that all out attach is often not the best way to approach things, but when the adrenalinse of battle is in the veins and all.....
Anon 1.24 wrote:
"Don't be silly, a radiographer cannot diagnose fractures on an x-ray to the same accuracy as a trained specialist doctor."
Absolutely, no-one would expect the radiographer to "outdo" the Radiology SpR.
On the other hand, consider a radiographer who has spent hours a day every day over many years looking at x-rays vs. an FY2 doc... different answer?
As Anon also says, doctors know all sorts of other stuff that the radiographer doesn't. No argument there.
But I come back to my comment on a previous thread of "different people in the system should recognise both the limits of their own knowledge and the things other people might be good at, e.g. through having done it a lot".
Surely this isn't controversial?
I would say that an FY1/2 doctor who was looking at a X-ray of a suspected fracture and couldn't see an obvious one would be entirely sensible to ask an experienced radiographer doing the x-ray what s/he could see. No doubt many FY1/2s would. Equally, no doubt, some wouldn't due to "status issues" but would go off to annoy the registrar instead.
Who in this scenario is displaying "lack of insight"?
Is it too much to ask everyone to put the Status Defence Verbal Missile Launch Systems on one side and show some common sense?
Please, this is so tedious...
What I want to know is why "advanced practice", for nurses, seems to look a bit like basic medical practice, rather than something that might be an extension of actual nursing practice as done by the majority of nurses.
Or, to put the question another way, why have "advanced practitioners" (of nursing) chosen a medical model of advanced practice rather than a nursing model?
Can anyone help me with this?
I thought, and think, that it was very funny.
Still not clear to me what an "advanced practitioner" is. When my liver finally packs in, I want to see a doctor, and I bet they would, too.
Anon 1.24 to Sitting on the fence-
There are crap doctors. There are crap radiographers. There were and will be crap kings, queens, popes and prime ministers.
One poorly trained F2 that doesn't understand that an x-ray is a 'confirmation tool' rather than a substitute for clinical acumen doth not an entire profession useless make, if you follow.
F2s are learning, and should be backed up by a fully trained team. At the A&E I worked at in London, the percentage of missed fractures, as found by the detailed annual audit, was tiny, less than 0.01%. It was incredibly rare to miss a clinically important fracture.
You wouldn't have radiographers waltzing around pretending to be doctors in that department, still rooted in the fusty, dusty 'old-school' world of doctors being doctors and radiographers taking the photos. Shocking.
It simply isn't on for non-medically trained staff to be let loose on the public like this. It's an effing scandal.
Henry, I do see the problem. Garth, well yes, still, it was unfortunate.
Oh damn it, 5.15 was me (I refuse to say 'not I'!)
Agreed doctors are the people we train to do the job, Anon 1.24.
I was hinting that it is not the case that only a more senior doctor can ever teach a junior doctor something useful (as too many medical students and juniors I encounter still seem to believe).
Also agreed that crap "practitioners" are present in all walks of life.
I was only suggesting one must be careful of translating the statement:
"HCPs are now routinely given responsibility they are often not trained for" (with which I would not disagree, although I would say the same is true of some doctors under things like HaN - heard the one about the nightshift where neither the on-call med reg, or the at-home-but-on-call medical consultant, had ever put in a central line?)
- into:
"No-one in the NHS apart from doctors knows anything"
- even if only for public consumption.
Perhaps we should turn this around - under what sort of circumstances IS it appropriate for non-medical types to be doing jobs once done by doctors? Are we happy with "Specialist nurse-led clinics" for some routine monitoring of chronic conditions? If not, what is the alternative? It is quite clear that it is not feasible in the present UK economic and political climate to have doctors do everything they once did. The boat seems to have sailed on that one.
Unless, of course, we are going to have a large pool of junior doctors with fairly minimal training washing about in low-level service positions to do all these tasks...
Aha! is that a light-bulb going on?
Speak to the South Africans. They are happy with a similar system where some doctors are trained up to consultant level, and other doctors are happy with a more service orientated career. Not everyone can be a consultant. Fine.
However, that doesn't excuse the massive shafting administered by the DoH and assorted quislings.
Comments from an (anonymous) orthopaedic surgeon:
"60% of ENP diagnoses to fracture clinic were wrong!!
Need I say more - missed in three months 2 malignancies, 3 achilles tendon ruptures, 2 brachial plexus injuries, one supracondylar fracture, 1 radial head fracture, 2 ankle fractures, 1 ACL injury and those are the ones I remember off the top of my head"
This is a joke. When will this outrage be exposed for what it is - the destruction of quality medical care for the people of Britain.
sitting on the fence says
"It is quite clear that it is not feasible in the present UK economic and political climate to have doctors do everything they once did."
This says it all! Why the fuck should politics have anything to do with it? Also, it is not cheaper in the long run to have HCP's doing Doctor's work. It just balances your books in the current financial year and keeps Patsy Fuckwit in her job.
"Aha! is that a light-bulb going on?"
No, its the bulb going off as in "will the last person to leave, etc.............)
Why don't you change your name to Nero?
Something which should, I believe, be remembered in all this is that the criticism of NPs by doctors is being carried out on private forums and Dr Crippen is one of the few who are making such criticism public. If my profession was being widely criticised by doctors, I'd far rather know about it than have the criticism take place behind closed doors.
anonymous said...
Something which should, I believe, be remembered in all this is that the criticism of NPs by doctors is being carried out on private forums and Dr Crippen is one of the few who are making such criticism public. If my profession was being widely criticised by doctors, I'd far rather know about it than have the criticism take place behind closed doors.
Monday, June 18, 2007 7:37:00 PM
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I am grateful for that.
Remember that what I say, though it is absolutely what I feel, is said without bile or rancour and, I hope, with some humour. And I say it openly, not behind anyone's back.
If you could all read the tirades of vitriol on doctors.net on this topic, you would appointment me President of the Royal College of Nurses
John
John - trust me, your posts do not come across as being 'with some humour'! You actually come across as being rude, offensive at times and very bitter!
If you could all read the tirades of vitriol on doctors.net on this topic, you would appointment me President of the Royal College of Nurses
***********************************
Then open the Doctor.net site up to the public.
Is their grammar and spelling correct? lol
Matt asks what economics has to do with it.
How about this? (I am now ducking behind my armour-plated table.) Perhaps we could afford to have doctors do the work that is now being passed on (unsatisfactorily) to HCPs if doctors were paid less.
If doctors in the UK earned what they do in many parts of Europe.
Or if we could say out loud (without the howls of protest) that a significant group of the people training in UK medical schools today will NOT end up either as consultants or as GP partners on 80-120 K /yr, but will instead be salaried doctors somewhere in the system, working regular hours, treating patients autonomously and earning, say, a comfortable graduate professional salary of £ 36-50 K / yr.
The BMA's own figures show that "the earnings of doctors in the UK are in line with middle to senior grade professionals in other sectors".
http://www.bma.org.uk/ap.nsf/Content/ddrbev2005~annex3
Staff grades and other service post doctors may well be underpaid. I see no evidence that the rest of UK medicine is, other than "doctors in the US earn more" (yes, and the US system is perfect - not) or "lawyers earn more" (so be a lawyer).
So how about this? Doctors can have the roles back that the HCPs are taking off them, and the autonomy that they think the managers are taking away. The quid pro quo will be that they henceforth earn "upper half graduate salaries" rather than "very top end graduate salaries".
Ok, we'll take a pay cut if the NHS also slashes management and admin roles by 90% to private sector levels, and we have our professional status restored, and we have training budgets restored to pre-MMC levels and also increased. Otherwise you can fuck right off.
non 9.30
Can honestly say I would sign up for the solution you're proposing in a heartbeat, but I think the managers and politicians might be a harder sell.
I'd vote for a party that had that as a manifesto commitment, though. Any takers?
Now that the DoH have abolished banding, of course, newly-qualified doctors will be earning about 18,500 for the first couple of years they're training - that after five or six years of study.
What do first-year nurses earn?
Actually, don't answer that. Why? Because if we start arguing with one another over who gets what out of the available money, we're all - doctors, nurses, physios, OTS - fucked. All of us. If the shafting of a succession of subgroups of the health service in isolation has taught us anything, it should be that we need to take unified action against the government when this idiocy first arrives, and refuse as a group of professionals to implement it.
See you with whoever marches next...
Agreed 100% about sticking together, Nick. It's a classic formula... "Divide and rule" (or to a man with your literary sensibilities and possibly classical education, "Dive et impera" - apologies if the Latin is wrong).
I can't help but wonder what real affect this has on the quality of doctors that are graduating out of medical schools now. Would this lead to a "quality" problem, or really just too few that will be graduating? (It really gets worse when you think of all the baby-boomers that will be needing doctors as they get older.
Becky
www.spiffylinks.com
I think it would be a "quantity" problem myself.
I meant "quantity" problem. There should be no reason for a "quality" problem.
"I reproduce in full (and uncorrected) a splendid piece from someone who styles himself as an “Advanced Practitioner” – whatever that is. Cheaper than a doctor, I warrant.
For information:
ADVANCED PRACTITIONERS:
Here is what they are and what they can do...
‘Advanced Practitioners’ are experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. Non-clinical staff at Level 7 will typically be managing a number of service areas."
So, An Advanced Practitioner (Level 7) ie the meat in the sandwich between Senior Practitioner/Specialist Practitioner (Level 6) and the almost elite Consultant Practitioner (Level 8) .
The consultant Practitioner is not quite elite because Level 9 Practitioners are "More Senior Staff. They have ultimate responsibility for clinical caseload decision-making and full on-call accountability."
These represent the higher levels of "National Practitioners"
At no point in this framework for the NHS is the word "doctor," "nurse" or medical practitioner mentioned.
Make of this what you will...
The Witch Doctor thinks that ultimately they will not be cheaper than doctors.
John - trust me, your posts do not come across as being 'with some humour'! You actually come across as being rude, offensive at times and very bitter!
Monday, June 18, 2007 7:54:00 PM
Delete
++++++
Sorry you missed the humour.
Rude? Give me some examples
Offensive? Give me some examples
Bitter - well, yes, very bitter at the destruction of the NHS
John
Paid a third of what a doctor earns said... says
"Matt asks what economics has to do with it."
I didn't actually. I was asking why should politics have anything to do with it.
No need for armour plating! My economic arguement is that HCPs are not neccessarily "cheaper" than Doctors.
As regards your economic arguement, I think you are being naive.
"Doctors can have the roles back that the HCPs are taking off them, and the autonomy that they think the managers are taking away. The quid pro quo will be that they henceforth earn "upper half graduate salaries" rather than "very top end graduate salaries."
Wouldn't the Government love this. Are you seriously suggesting that we as a profession go to the DOH and say please pay us less. They would say "thanks very much", pay us less and employ even more cheap labour.
And what other professions do you think should be instructing their professional bodies to negotiate less pay?
I am paid what the DOH thinks I'm worth. I didn't threaten to strike or blackmail them into paying me what they do. You are suscribing to the peculiar British arguement that nobody should make money out of healthcare - even those working in it. It is a vocation. Maybe we all should pay the NHS for the privilage of working for it!
The myth "If only those nasty Doctors were paid less and didn't spend all their time in private practice, the NHS would be wonderful!" is alive and well.
I agree on the divide and rule bit.
Actually nick its not that bad... we will be earning £20574 as of next year :)
Oh shit i just realised with my debt i won't have enough to pay my rent and bills each month.
I never went into medicine for the money but bugger me i thought i would be able to afford to go to the cinema once a week :(
Oh asked housemates missus (she of the just graduated as a nurse) and she started her new job (4 weeks ago now!) on 24K
Well i will have to be nice to my nursing friends...the beers are on them for a while.
Funny Pseudonym - that would put your housemate's newly graduated wife on top Band5/middle Band6 - or in pre-Agenda for Change Grade F (Sister/Charge Nurse). Where does she work? I'd like a job there!!
Excellent. Thank you for a definition of an Advanced Practitioner. To repeat it:
ADVANCED PRACTITIONERS:
Here is what they are and what they can do...
‘Advanced Practitioners’ are experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. Non-clinical staff at Level 7 will typically be managing a number of service areas."
So, An Advanced Practitioner (Level 7) ie the meat in the sandwich between Senior Practitioner/Specialist Practitioner (Level 6) and the almost elite Consultant Practitioner (Level 8) .
The consultant Practitioner is not quite elite because Level 9 Practitioners are "More Senior Staff. They have ultimate responsibility for clinical caseload decision-making and full on-call accountability."
These represent the higher levels of "National Practitioners"
++++
Er...I still don't understand what they do. Do they work for Dynarod maybe? Or Marks and Spencer? What skills to they have?
This is a classical new Labour hierarchical description of...nothing.
John
John see definition below
“Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed.”
Advanced nurse practitioners are highly skilled nurses who can:
take a comprehensive patient history
carry out physical examinations
use their expert knowledge and clinical judgment to identify the potential diagnosis
refer patients for investigations where appropriate
make a final diagnosis
decide on and carry out treatment, including the prescribing of medicines, or refer patients to an appropriate specialist
use their extensive practice experience to plan and provide skilled and competent care to meet patient’s health and social care needs, involving other members of the health care team as appropriate
ensure the provision of continuity of care including follow-up visits
assess and evaluate, with patients, the effectiveness of the treatment and care provided and make changes as needed
work independently, although often as part of a health care team
provide leadership
make sure that each patient’s treatment and care is based on best practice
The NMC states that only nurses who have achieved the competencies set by the NMC for a registered ANP are permitted to call themselves by this title.
Dr C - you asked for examples of being rude and offensive - these are from the last 2 days:
"What an ignorant arrogant arsehole"
"You really are a fuckwit, arn't you."
"dumbed down fuckwits"
How's that for starters?
Sounds like the plot is being lost...
"take a comprehensive patient history"
Read a pro-forma (as they do at my local DGH)
"carry out physical examinations"
I wonder how many systems they know more than a few clinical signs for? As a student i can stump an SHO/ Reg when asking about signs outside their fields
"use their expert knowledge and
clinical judgment to identify the potential diagnosis"
Isn't the point that they are not "experts".
Unless they have taken up one very small area i would think ANP's are lacking in expertise.
"refer patients for investigations where appropriate"
Well can't argue with that, i just think it's wrong that the doctors can't do the same thing in hospital
"make a final diagnosis"
Really? well ok they can, however after doing a large audit of patients notes the specialist nurses seem to have the worst "correct" diagnosis of any group.
decide on and carry out treatment, including the prescribing of medicines, or refer patients to an appropriate specialist
"work independently"
Unlike juniors who are supervised.
"make sure that each patient’s treatment and care is based on best practice"
Do ANP's have journal clubs or any teaching time for EBP?
Funny Pseudonym wrote: "after doing a large audit of patients notes the specialist nurses seem to have the worst "correct" diagnosis of any group."
Interesting - is this published or otherwise publicly available?
Nope sorry it was looking at who filled out KMR 1 forms, may be published i don't know yet...
Bet they don't put the needy medical students who did the grunt work on the list (grumble grumble).
It was mainly the gastro clinics that seemed to have the problem.
I should point out after going over it that the forms should be filled out with "actual diagnosis" when maybe someone was actually just putting down the "provisional diagnosis"...
So not sure if it was a naughty mistake or really a lack of clinical skill.
verb aspects - your point is a pertinent one.
On a number of ocassions now I have heard whisper of an authorative study that will finally prove that NPs are guilty of the sort of gross incompetence that has been alleged time and again on this and many other medical threads.
But where is it - given the examples cited above surely it must be very easy to prove ?
A&E C/N
Yes, good point.
Where is the study which shows how incompetent NPs are, and while you're at it, where is the study which shows doctors have high IQs.
Show me the proof, man!
What did you say?
Using 'studies', by which you supposedly mean an evidence base, before implementing drastic changes to our professional structure and training.
Revolutionary!
The idiotic evidence argument
Logical problem- just because there is no scientific evidence for something does not make it false.
There are many surgical treatments that are undeniably of benefit to patients (appendicectomy) but they cannot be trialled. This doesn't make these treatments useless!
If the way a medical system is run is to be drastically changed in its structure then there should be some evidence that what is to be done is going to be of some benefit and that it will be safe.
There is no evidence that NPs, PAs are safe in practising independently and prescribing.
In fact the small volumes of research done (see the comments on the above thread with links) show that these practitioners are of very little benefit and are arguably not cost effective.
The only evidence for NPs, PAs comes from small anecdotal studies run by those who introduced the reform, and none of it has been published or peer reviewed.
People knew smoking was harmful to people's health way before it became scientifically proven.
In fact I know several doctors who have done studies on NPs with audits etc which have shown some rather revealing results.
where is the study that shows professors of physics are cleverer than bin men?
where is the study that shows consultants are better at diagnosing that their juniors?
where is the study that shows monkeys cannot practice medicine?
FFS
just because something has not been scientifically proven to be likely, it doesn not mean that is not likely!
In fact I know several doctors who have done studies on NPs with audits etc which have shown some rather revealing results.
***************************
Then show me the evidence Garth
anonymous said...
Dr C - you asked for examples of being rude and offensive - these are from the last 2 days:
"What an ignorant arrogant arsehole"
"You really are a fuckwit, arn't you."
"dumbed down fuckwits"
How's that for starters?
Sounds like the plot is being lost...
Tuesday, June 19, 2007 7:07:00 AM
Delete
+++++++++++
Oh! yes, those remarks. I remember them. Yes, I do get angry and rude in the comments occasionally though mostly I ignore the abuse, disagreements and personal criticisms.
However, I do regard the comments more as a chat room, a night in the put, whatever, where more or less anything goes. And a lot does.
Sorry if it upsets you. You don't have to read it
John
Absolutely, I don't have to read them and you don't have to make them! :-) But thank you for the apology.
I saw your side bar which says: "... are often of a light hearted nature and must not be used as a basis for medical treatment." Um, where's the 'light hearted nature' bit? Not much of that at present!
Regarding some people being 'cleverer' than others - people can be 'clever' in different ways. My husband is 'clever' he has a high IQ, a good job etc, etc. However, he's most certainly NOT clever when it comes to anything practical! Can he organise - nope! Can he 'do' DIY - nope! Does he know where things go in the house? - nope. Can he work the washing machine, tumble drier, central heating system. NOPE. *sigh* Believe me I have tried to train him, it's like having another child around sometimes. The point being that some people are academically good but crap at 'doing'. So being 'clever' or 'intellegent' are quite subjective because it's not what you've got, it's what you do with it that counts!
I am having difficult following this thread because of all the "Anon-e-mouses", especially when they are posting to each other.
No need to be so timid - just make up a name!
Actually no its not subjective.
This is where the modern PC brigade come in... "everyone is intelligent in their own way" la la la la
in·tel·li·gence
-Noun
The capacities to reason, plan, solve problems, think abstractly, comprehend ideas and language, and learn.
Physical aility has nothing to do with intelligence, i bet he could tlaka good game of "put up the shelf".
I do agree though that not using what you do have effectivley is better than being more intelligent.
I am a triumph of hard work over lack of grey matter :)
Dear John,
I normally love your blog but your rant on the NP's command of English struck me as a childish and snobbish. It certainly does not add weight to your arguement with regards the relative strengths of our nursing colleagues compared to the medics. The standard of the use of English by junior doctors is appalling. I had been forced to give up moaning about the use of e(acute) in the word mane (nobody cares old man) and was becoming relatively sanguine on ward rounds when the 'word' 2morrow began to be found in the overnight PRHO review. As for replacing 'cardiology review' for a love heart...
Pass me my betablockers.
Dr 7iron
Sorry, should have read with a love heart.
No spell/grammer checker you see.
Dr 7iron
Ulnar nerve instead of Ulna. Yes, yes, it's pretty bad in the medical ranks, but the 'attack article' highlighted by Crippen was shocking.
Total shit.
anon, anon, anon, etc... at least have the decency to make up a name
John,
Is is not possible to "ban" anonymous postings, i.e. make them adopt a "handle."
I do not propose this in any way as to discourage debate or intimidate posters.
It's just that I haven't a fucking clue who is talking to who!
Seriously! It's difficult to engage in debate when you have to keep going back to try and discover who you are talking to.
Especially after several glasses of wine!
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