Patients at Risk

 In our previous podcasts, we have focused on the differences in scope of practice between physicians and nurse practitioners. But other medical practitioners are also wading into the diagnosis and treatment of conditions that have previously been the domain of physicians.  Today we are going to discuss care provided by chiropractors, specifically when chiropractors step outside of their traditional role in providing spinal adjustments and into medical treatment for neurological conditions.To help us understand this topic, we are joined today by two special guests, patient Nancy Murphy and her neurologist Dr. Dhrupad Joshi.  Dr Joshi's website:  https://wecareneuro.com/PhysiciansForPatientProtection.org

After the brain, the human eye is the most complicated organ in the body.  It is for this reason that a graduating doctor must spend at least another four more years after medical school to become an ophthalmologist.Unfortunately, some states are passing laws that allow optometrists to provide eye treatments that they aren’t qualified to do, and this can put patients at risk. Today, we are joined by Laurie Barber MD, an ophthalmologist and the chair of Safe Surgery Arkansas, to explain the differences between types of eye doctors and to help patients know how to protect their vision and their health.  PhysiciansForPatientProtection.org

Dr. Toni Manougian has done it all.  Starting as an RN diploma graduate, Dr. Manougian obtained her bachelor's in nursing, followed by a master's degree as a clinical nurse specialist and then a degree as a critical care nurse practitioner, become deciding to become a physician.  Dr. Manougian explains the differences in training between the professions and tells aspiring physicians that it's never too late to become a physician if that is your dream.PhysiciansForPatientProtection.org

Jennifer Bryan, MD, a family physician and the chair of the Board of Trustees of the Mississippi State Medical Association,  discusses how her state created a coalition to block nurse practitioner scope expansion.PhysiciansForPatientProtection.org

Patrice Little DNP discusses limitations in nurse practitioner education and explains why she created a platform to better prepare NP students.  Doctor of Nurse Practice Little shares that while she wrote her scholarly project on "full practice authority" for NPs, she realized that many NPs who prioritize patient safety - herself included - don't want independent practice.Patrice Little DNP's site: https://www.npstudentmagazine.com/PhysiciansForPatientProtection.org

Many advocates of nonphysician practice argue that we need to allow nurse practitioners and physician assistants to practice independently because of a “provider” shortage.  The mantra “access” seems to supersede all other arguments – including concerns over patient safety.  But is ‘access’ really all it’s cracked up to be?  The answer is no, and here is why. A 2018 Lancet study analyzing 137 countries found that more people die worldwide due to POOR QUALITY care than die due to a lack of access to care (reference below). Linda Anegawa MD, an internal medicine and obesity specialist, discusses concerns over safety when non-physician practitioners provide healthcare independently without physician supervision, and describes her own story of how a trigger point injection by a nurse practitioner resulted in a punctured lung. Rather than sending her to the emergency department, the nurse practitioner told Anegawa that her shortness of breath was just "procedure anxiety."  The truth was that the NP had caused a pneumothorax, or punctured lung, which can be fatal if left untreated. Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Lancet articleM.E. Kruk, A.D. Gage, N.T. Joseph, G. Danaei, S. Garcia-Saiso, and J. Salomon. 2018. “ Mortality due to low quality health systems in the Universal Health Coverage era: a systematic analysis of amenable deaths in 137 countries.” The Lancet, 392, 10160, Pp. 2203-2212 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext?fbclid=IwAR1uwXVAsi-pOXSTEzJRTyX9nbdLtf8V-cGYMK6BuK_p77lTpNegyaCuUaICommentary: https://www.npr.org/sections/goatsandsoda/2018/09/05/644928153/what-kills-5-million-people-a-year-its-not-just-disease?fbclid=IwAR352fPMuZ9Z482Qb6_nFGQ-2bkcovCA3UdARsJDCvdbiHrLvhUasl0VxLoPhysiciansForPatientProtection.org

Health policy experts note that there is a shortage of registered nurses across the nation and that 11 million nurses are needed to avoid a future shortage.[i] A lack of nurses puts patients at risk, with a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations noting that “inadequate nurse staffing has been a factor in 24 percent of the 1,609 cases involving patient death, injury or permanent loss of function reported since 1997.”[ii] One of the reasons for the bedside nursing shortage is the growth of the nurse practitioner model. It is estimated that the transition of nurses to nurse practitioners has reduced the number of practicing registered nurses by 80,000 nationwide, without a clear plan to replace those positions.[iii] While organizations such as the Institute of Medicine have called for nurses to expand their education to become advanced practice nurses, little emphasis has been placed on how these bedside nurses who go on to become nurse practitioners will be replaced. The COVID19 pandemic has created a particular urgency for more nurses. In fact, so much so that Adventist Healthcare recently posted a call for physicians to be trained to act as nurses. We are joined again today by Dr. Natalie Newman, a California emergency medicine physician, patient advocate, and blogger to discuss the bedside nurse shortage, and the unimaginable call for physicians to work as nurses.Follow Natalie Newman, MD at: https://twitter.com/SuburbanbellaGet the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/[i]Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2020 Mar 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/[ii]Ibid.[iii]  Auerbach DI, Buerhaus PI, Staiger DO. Implications of The Rapid Growth of The Nurse Practitioner Workforce in the US. Health Aff (Millwood). 2020;39(2):273‐279. doi:10.1377/hlthaff.2019.00686PhysiciansForPatientProtection.org

On September 29, 2020, the state of California passed AB 890, a bill allowing nurse practitioners the right to practice without physician supervision. The bill received widespread support from groups that benefit from the use of non-physician practitioners, including hospitals and community health centers. Despite opposition from physicians and other patient advocates, the bill was passed with large margins and was signed into law by Governor Gavin Newsome.Today emergency medicine physician Dr. Natalie Newman joins us to discuss the implications of nurse independent practice in California, one of the largest and most populous states in the Union.  Dr. Newman is not only a practicing physician in California but also an outspoken patient advocate and prolific writer who blogs at Authentic Medicine.com. Follow Natalie Newman MD:  https://twitter.com/SuburbanbellaGet the book "Patients at Risk!" PhysiciansForPatientProtection.org

In April 2020, Beaumont Health, Michigan’s largest healthcare system, made the decision to terminate its established anesthesia group in favor of Texas-based NorthStar Anesthesia, a private equity firm that promised the health system lower staffing costs.  According to reports, more than a dozen physicians and surgeons resigned from the hospital system due to concerns over NorthStar’s reputation.NorthStar’s contract began on January 1 of this year, and on January 25, Eric Starkman, a reporter at Deadline Detroit, reported the death of a patient due to an anesthesia-related complication during one of the most routine medical procedures: a colonoscopy. Did the replacement of Beaumont's anesthesia team by a private equity firm contribute to the death of this patient?  Not only is Beaumont not talking, but according to reports, staff members are being threatened and intimidated into silence.To help us we will discuss how private equity takeovers in medicine may be harming patients, and what you can do to protect yourself, we are joined by Karen Sibert MD, Clinical Professor in the Dept of Anesthesiology and Perioperative Medicine at UCLA, and a past president of the California Society of Anesthesiologists.Dr. Sibert's advice to all patients undergoing anesthesia: "Ask, 'who is my anesthesiologist?' And if the answer is, 'there isn't one,' they should leave."  Further, "if there isn't a physician overseeing your anesthesia care, I can't reassure you that's going to be a safe situation. I think that every patient has a right to know who is taking care of them. There should be complete transparency, and I think physician-led care is the safest care."Get the book!  https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Dr. Karen Sibert's blogs:  https://apennedpoint.com/how-could-a-patient-die-from-anesthesia-for-a-colonoscopy/ https://www.kevinmd.com/blog/post-author/karen-s-sibertOne of our personal favorites, which we cite in our book: https://www.kevinmd.com/blog/2011/11/unsupervised-anesthesia-care-nurse-anesthetist-threat-patient-safety.htmlPhysiciansForPatientProtection.org

In our last episode we discussed the rapid growth of nurse practitioner training programs and some of the challenges this has caused in ensuring that nurse practitioner graduates receive adequate clinical training to care for patients. Today we continue to explore concerns about nurse practitioner quality of education, as well as a new trend for nurse practitioners to seek work in cash-pay type practices, including opening medi-spas, infusion centers, medical marijuana clinics, and so on.To help us explore these issues, we are joined again by Rayne Thoman, a registered nurse and former NP student who works to expose unethical nurse practitioner training and practice. Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/Physicians, join us at physiciansforpatientprotection.orgPhysiciansForPatientProtection.org