Friday, February 20, 2009

Bilateral Queckenstedt's sign

When you are on call it seems that all too often you are called in for the dumbest reasons and it is important not to blow up and check from Queckenstedt's sign on the poor sod who called you in. Lately though, it seems that that calls are coming far to often. Rather than just complain I decided to investigate the matter. In my groups case, the vast majority of the calls are from nurse practicioners who are now manning some ERs and many Fast Tracks. These nurse practicioners are nurses with 17 months of extra training. I guess the idea is that they can replace a MD or DO who has 4 years of medical education and then 3 to 4 years of speciality emergency medical training. Anyway, stuff that usually could be seen in the ER that is treated and streeted can not be taken care of because the NPs either can't do it or don't know how to do it so you get called in. What is even worse is many times that I am called in I find that there is something totally different going on with the patients. Then I wonder, how many of the patients that they have sent home had something bad wrong! I called up one of the hospitals administrators and asked why the NPs are not discussing the patients with their supervising MD and he informed me that all the supervising MD has to do is review their charts later. Further the NPs can act independently. I asked why they dont hire MDs and the answer was easy, MDs cost too much because of their liability insurance. Nurse Practicioners are cheaper and have minimal insurance because they are not held to the same standards! You put EMTALA in the mix and there you are. You get called in for everything.

1 comment:

SeaSpray said...

"Queckenstedt's sign" Throckmorton?

You're making me google again! :)

That must be truly frustrating/maddening and disconcerting for you.

I don't understand tho... why the hospital isn't more liable for lawsuit if the NPs misdiagnose and patient suffers dire consequences because of a bad call.

Of course if they call the specialists... then the burden transfers i guess... but like you said..what about the ones sent home?

Do the patients realize they are getting NPs? So...what DOES the MD do? I assume the MD is on the life threatening cases...although... ED nurses could run a code, etc... they are in that environment all the time.

Seriously the NPs do mostly fast track and ED doc the big stuff? And why don't they consult with the ED doc prior to calling on call docs?

Sound like you and your colleagues need to unite and take a stand if it is detrimental to your practices. Administration sees the docs as customers and they want the good docs to draw in the patients. Of course... everybody is looking for the cheapest route these days. I just hope quality..or in this case patient safety isn't sacrificed. Sure... most people will be fine... you guys/gals get over worked on call,and the hospital is just happy it saves money... but at what price in the end?

You docs probably don't know if you should be insulted, disgusted or laugh at the idea that so much faith is entrusted to someone with so much less training. And I don't mean to knock NPs. But I always thought of them as professionals that work with supervision... more hands on than you describe.