Knowing what you don’t know.

Contributed by Adele L. Carroll, D.O.

"Who is your doctor?" 

"It's so and so."

"So and so is a nurse practitioner/physician's assistant, not a doctor."

"Oh, that doesn't matter."

 

In the eyes of some areas of the public sector, little thought is given as to who is actually providing primary care to the patient. That is, unless there is a poor outcome. Oftentimes the physician extender does not correct the patient when called "doctor", allowing the misrepresentation to continue. There is a major difference in training, knowledge, and skill that is being ignored.

Having been a physician assistant and then a nurse practitioner for about 20 years prior to becoming a physician, I feel that I have a unique perspective in understanding the role of the physician assistant or nurse practitioner. Let me say that individuals in both positions contribute significantly to the delivery of healthcare and need to be commended and respected for that. When I practiced in those roles, I had to be sure that the patient understood that I was not a doctor, but that I had access to a doctor for consultation if necessary. Consultation with a physician was a necessary part of making sure that the patient got the best of care.

Everyone that participates in patient care needs to know what they don't know. When I practiced in the physician extender role there were times when I thought that I could handle most cases without physician input. That was probably true for some routine medical issues, but not for more complicated issues. I was mistaken and I can appreciate that now. But it became apparent to me after going through medical school, internship, and residency that more was demanded of me than I had anticipated. That was when I learned to know what I didn't know. I clearly see now just how important that knowledge is.

In the area of northern Maine where I live there are numerous physician extenders providing care to patients, most of which is good. Although I am now retired and volunteering, I do know of instances when some patients are not getting the expertise that they need in their care when they do not see a physician. One example that I know of is the treatment of an elderly woman in her 80s with a history of GI complaints and anemia. The GI complaints have been worked up by a gastroenterologist, but the anemia is being treated with iron pills based on routine blood work. Any physician caring for elderly people would understand that that treatment is most likely not correct and that further exploration would be necessary.

Nurse practitioners and physician assistants are an integral part of health care delivery in the state of Maine, particularly in areas that are underserved. However, with their educational background and training, physicians need to be the ones leading the health care team in the delivery of care

 

About Adele L. Carroll, D.O. - Dr. Carroll received her medical degree from the University of New England in Biddeford, Maine. She operated a solo family practice office in the underserved area of Limerick, Maine, for 10 years then worked as a locum tenens for four years at Northern Maine Medical Center in Fort Kent, in the family practice and internal medicine units, and Fish River Rural Health Center at Eagle Lake and Fort Kent. She is now retired and resides in Eagle Lake with her husband, Arthur.

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