Dr Frankenstein? No, Dr Nurse.

As so often, via Kevin MD, I have just discovered the Covert Rationing Blog in the USA. How did I miss it? This excellent site is, not surprisingly, dedicated to monitoring the covert rationing of medical care in the USA. There is no better and more successful form of covert rationing than dumbing down. I note with a cross between horror and amusement that a new medical Frankenstein has appeared in the USA. The Doctor-Nurse.

The June 16 issue of AMANews reports that the National Board of Medical Examiners will begin offering a certification examination this fall for graduates of “doctor of nursing practice” programs. Revealingly, the test will be based on Step 3 of the U.S. Medical Licensing Exam. Doctor-nurses will soon be Board Certified, just like, uh, doctor-doctors. Mary Mundinger, the leading spokesperson for doctor-nurses says, “While a primary care physician went to medical school and did residency, a nurse practitioner with a DNP has achieved many of the same competencies but through nursing education. They have the same skills in identifying a disease state and treating it, but it’s a different hybrid of care.”

The Covert Rationing Blog - here come the Dr Nurses

Neologisms and new use of old words are two of my obsessions. Bullshitters are particularly prone to butcher the English language when they endeavour to give their psychobabble some specious credibility. The current fashion amongst medical bullshitters is to pluralise the word “competence”. Doctors are competent. Pretend doctors have “competencies”. Sounds better. Actually it doesn’t sound better, but the amaurotic twerps who churn out the psychobabble are not skilled in the use of English and so do not notice. And, for God's sake Mary, what exactly does "it's a different hybrid of care" mean? I know you are American, but surely you still speak some English.

So, if you see the word competencies, you know someone is bullshitting. Meanwhile, I am in a semantic quandary. I want a simple way to convey the following concept:

“A person who was a high-flyer at school, achieving a large number of GCSEs mainly at A* grade, followed by three or four top grade A levels, who then fought off competition from ten similarly qualified students to win a place at university where over five or six years (s)he studied anatomy, physiology, biochemistry, pharmacology, sociology, psychology, general medicine, general surgery, obstetrics, gynaecology, psychiatry, orthopaedics, otology, ophthalmology, traumatology and several other disciplines, then passed demanding exams in these subjects and then spent at least a year under supervision seeing hundreds of patients with problems falling within one of the aforementioned sub-specialities at which stage and subject to satisfactory completion of the supervised year was then deemed to have satisfactorily completed the course.”

The simple word I used to use was “doctor”. Unfortunately, that word has now been appropriated by people who drill teeth and by others who have done a three year course in making beds, emptying bed pans and taking blood pressure with electronic machines. We need a new word. All suggestions gratefully accepted.

When can we expect the Dr Nurses to take over? Sooner than you think. They are ideal for our micro-managing penny-pinching Prime Minister

Doctor-nurses (the healthcare system fervently hopes) will be more malleable than today’s Primary Care Physicians, less encumbered by tradition, attitude, and delusions of autonomy, and more likely to follow whatever guidelines the “experts” choose to hand them.

The rise of the Dr Nurse

Just what the government wants.  And they are already with us. For the moment in the UK we call these people with their "competencies" HCPs and nurse-specialists or, if we really want to take the piss, Consultant Nurses. We are not calling them Dr Nurse as yet, but what the USA does today...