Medscape Oct 21, 2021: By Alok Patel MD.
“Patients want docs, not NP’s or PAs, leading their ER care:”
“Everyone has an opinion about the ED — the wait time, the workflow, the resources, whatever. As a hospitalist, I talk to ED staff and to patients about the ED on every single shift. Patients tell me everything. They tell me about their ED experience, how long they must wait, and worries about the cost. And recently, some of them told me that they couldn’t tell if they were being treated by a doctor or not.
“Nearly 80% of people said they most trusted a physician to lead their medical care, with 9% saying nurse practitioners, 7% saying physician assistants, and 5% saying nurses. This percentage increased as medical conditions became more severe, with more than 80% saying they preferred physician-led care for a heart attack, a stroke or after a car accident.”
When a close relative wound up in the Jersey Shore ER after a bad car crash, his care was turned over to the Trauma Team. But during the early hours of his care no physician saw him. He was fussed over by unidentified personnel who neglected to obtain xray reports. They said that he might be discharged.
But they misdiagnosed the seriousness of his injury and they missed a pelvic fracture that required major surgery that day. The diagnosis was finally made by a physician assistant to the trauma surgeon who showed up after too many hours and told us the truth, and still no physician saw him. He was finally seen by an actual surgeon just before being wheeled into the OR.
I was hospitalized recently, and I couldn’t be sure who was coming into my room and what their qualifications were. The attending physician never came in at all, and a couple of doctors came in who were residents and who were clueless about my problem. Most doctors or other personnel who came in were in a hurry, and everyone ignored my request for a consultation with a specialist. I know what a quality house-staff is like, and the residents who I met are not that.
On another occasion at the same hospital, Eileen presented in the ER with a swollen knee. A person in a white coat came in and began an assessment. He was doing a sloppy job and I asked for his credentials. He said he was a physician assistant. I told him that I wanted a physician to see her. He pointed to another white coat down the hall and said, “He is a physician and he could see her, but he won’t add anything to my evaluation because I can do what a doctor can.” He spent 5 minutes with her and ordered an xray. But it turned out later that he was wrong—inadequate history taking and failure to consider the correct diagnosis.
These mid-level practitioners make mistakes and may overestimate their usefulness. And they cannot compare to a physician in quality.
When you visit a physician (inpatient or outpatient) make sure that you know who is evaluating your care. I have called a doctor’s office and found myself being questioned by some secretary who wanted to know why I wanted to see the doctor, what my symptoms were, etc. This is inappropriate.
In my cardiology group practice, if a patient called with a medical issue, the phone was handed to an RN—CCU trained. If she determined that a physician needed to get involved, she would make sure that we were apprised of the situation, put us on the phone with the patient, and she saw to it that one of our doctors saw the patient, either in the office that day or at the hospital where one our doctors was available as needed. And that RN would followup the next day .
Much of the time I interact with the healthcare industry, I have something to complain about—-and not trivial complaints. Technology these days is remarkable, but physicians are being forced to follow the guidelines of efficiency experts. As a result, quality is often compromised in ways that patients may not detect. Patients don’t know how dangerous medical practice can be these days, and unfortunately, only 30% of physicians run their own practices. A pulmonologist I know was ordered by management to limit his office visits to 10 minutes. He ignored the order and wound up 2 hours behind.
One of the biggest areas of trouble are failures of communication. And then there are shortages of healthcare workers including nurses and doctors. Office staff is trained to prevent patients from actually speaking to or seeing a doctor. Efficiency experts try to finesse the resultant problems, but they know little about medicine. I don’t know why there isn’t a tsunami of malpractice suits across the country.
Maybe I will start a series of “medical process complaints of the day” as seen thorough the eyes of a physician.
So be alert and ask questions of everyone you see. Have an advocate with you if possible.
Paul Goldfinger, MD.