Saturday, February 23, 2008

Midlevel maddness!

With the explosion in the number of minute clinics as well as NP and PAs in many offices we have seen a huge jump in the number of consults that we see. I guess this is a good thing in the business sense for us but I am concerned at what it means for healthcare in general. We are used to seeing routine things as part of the "CYA" crisis that medicine is in, but this is different. I can't tell you how many "pulsatile neck masses" we see are the carotid artery and thyroid masses are the cricoid cartilage. The midline abdominal mass on the thin gentleman was the xiphoid! I guess if bothers me as the patients went to someone who charged them and then sent them to a specialist where there was another charge. Whats worries me even more is what are they treating that isn't what they think? How many back pains are disecting aortas? Belly pains are colon ca? Headaches are GBMs?

I know that there are great midlevels and I am rapidly getting to know who is who but at the same time I really can tell that a consult from one is not the same as one from a MD or DO. I was talking with a friend of mine who is also my PCM. He has several pas in his practice and they are great and run cases past him. They are fantastic! I worry when there is no one reviewing what is going on. One thing that I learned in medical school and residency is that the art of medicine is sperating the mundane from the serious.

1 comment:

SeaSpray said...

Excellent post! i would hate to be one of those patients with the missed diagnosis.

you may really appreciate this post written by the Happy Hospitalist called "I am an Artist" which he posted on 11/7/07.

I loved it so much that i got his permission to post it in my blog which I put up on 11/08/07.

It speaks to just what you are saying here.

At my orthopedic docs office you see the PA first but then he always comes in after her. it must work for them but I wonder why they do that? I guess it saves him time from gathering the details or writing them but then he still asks me the same questions.