----- Original Message -----
From: "ae_res"
Subject: Re: Fw: Fw: GPSI
> It is the only study I'm aware of which is in anyway
> relevant Adrian and I notice you haven't come up with
> any evidence either[...]"Because docs are better" - which
> is essentially what your argument boils down to is not
> evidence.
I don't buy this "where is the evidence?" argument, Fred. For example,
there's no evidence that surgeons can do heart bypass procedures better than
nurse practitioners; there's no evidence that airline pilots can land
airliners better than stewards etc etc. Yes, doctors are better, at
diagnosing and treating illness in general, though I accept your argument
that medical training is increasingly being "dumbed down" (vide infra).
> Our nurse practitioners have already
> demonstrated that they are better at interpreting
> X-rays than our junior doctors!
Now that's old news, Fred. Big deal, they may be better than first year
SHOs, whose average A&E experience is no greater than 3 months. But what
does that prove?
> Notice how protocol driven junior doc training is these days!? ALERT,
ATLS, ALS, EPLS are all basically protocol driven. On our hospital intranet
are protocols for heart failure, MI, ACS, Asthma, COPD, DKA, Stroke and so
on! Just how much are our junior taught to think outside the box now?! We
are moving to a tick the box, medicine by numbers system. I fear nurses will
prove they can tick the boxes as well as anyone else..[Fred]
I fear you may have a point there! While on my latest MMC workshops, it was
depressing to note that the new foundation doctors will have day release
for - wait for it - such critical matters as "communication skills", "law
and ethics", "team building" etc etc (as if they don't get enough of that
during their new undergraduate curriculum). The SpRs of the future will be
even more junior, and the CCST is to become a CCT, with all the implications
of junior consultants that that brings. Yes, medicine is getting "dumber"
while nursing is getting "smarter", I can't deny that. Still, my argument -
and Brian's, I believe - is that there will always be a need for "smart"
doctors who can work things out without a tickbox.
You know, I'm a pretty experienced practitioner, yet almost every week I
still see presentations and situations that I've never really seen before in
precisely that way, and I have to work my way through these problems to some
sort of satisfactory conclusion. In many of these cases I never reach a
definitive diagnosis, but I adopt a pragmatic approach that attempts to
limit potential harm yet optimises limited resources. And all this against a
challenging diversity of patients' personalities! It's essentially
intellectual "guesswork", but the bottom line is that I have to take risks
and accept responsibility for my actions on a regular basis. I can't see
many nurse practitioners doing that, or junior doctors for that matter.
Adrian Fogarty
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