After several interventions...
>>> How long will it be before there is a study showing that Nurse Practitioners
>>> are cheaper, do less investigations,do less referrals and are prefered by
>>> patients than the average GP?
... ... ... ...
>>There was a famous randomised trial in Canada in the early 1970s
>>(Spitzer WO, et al. The Burlington randomized trial of the nurse
>>practitioner. (... ...)
>>
>Yes it was widely quoted as a "scientific" study. However it did not lead
>to the implementation of nurse pracitioners in the province, since the real
>determinants and the final call has to be political. (... ...)
(etc, snip)
Frankly, I think all the talk about nurse practitioners is a dead end, or
will be for many years to come. First there was the witch-doctor, the
shaman, the healer and the likes. In Western culture this figure was
replaced by the doctor. Society sees the *doctor*, not the nurse or anyone
else, as the person to go to when things get wrong. Sure, people take advice
from neighbours/friends, the pharmacist and the nurse (usually by this
order) but they know we (docs) are the ones who spent years banging our
heads on medical books. Of course nurses are essencial in a lot of areas.
Our work would loose a tremendous amount of quality if we didn't work with
nurses - be it team work or whatever organizational model you want. However
the central role in health care is the doctor's. Any politician who tries to
change it is doomed to failure, not by medical pressure but by population
pressure - if they are ill they want a doctor. Period. And the day nurses do
the job of doctors with the same knowledge and skills, then they will have
become medical doctors themselves...
Armando
(Donning quickly is anti-fire suit!)
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Armando Brito de Sa'
Lisboa, Portugal
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