Well now, there’s a surprise

The AMA is opposed to a pharmacy chain’s plan to provide walk-in clinics staffed by nurse practitioners.

How much of this objection is being fueled by the fairly obvious prediction that a lot of people off sick from work would rather spend the minimum of time outside a comfy bed and would be willing to pay out of their own pocket to be quickly seen by a nurse practitioner to get that employer-required medical certificate rather than wait for hours to see a GP? I can see how cutting into that particular income stream would be irksome, but being irked is not a sufficient reason to block an expansion of healthcare services.

The idea that nurse practitioners would necessarily miss things that a doctor would note and send on for further diagnosis strikes me as ridiculous. Nurse practitioners have a system of note taking that would uncover where a need for further tests and referral for a more specialist opinion were required, just like GPs do. The threshold of where in the diagnostic process the need for referral up the specialist chain was required probably would kick in at a slightly lower threshold for nurse practioners than for GPs, but the system for referring up the chain would be otherwise exactly the same. An entirely valid parallel system for feeding patients needing specialist care into the specialist system, in other words.

Categories: ethics & philosophy, health, medicine, Politics

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8 replies

  1. As a person who has a child at home today because I have to get a letter from a doctor to prove she is well before she can go back to day care, I’m struggling to sympathise with the AMA’s position. I’m having a hard time imagining how a nurse practitioner would be any less capable of determining that my child doesn’t have conjunctivitis than a doctor.
    My doctor is also very much in demand, it would be excellent to be able to reserve her time for people who really need her, and keep the script refills for a service such as this.

  2. OK, hold on, this might be the ONLY time I ever get to say to YOU guys, “Well, in the US actually…” 🙂
    These already exist in the US, and I’ve always thought them clever. Clearly the practitioners at the mini-clinics would know where to refer away cases that needed more care than they could give. And in the meantime, people who need care are more likely to go get it if they can just walk into the pharmacy rather than having to call for an appointment with the GP and deal with all that fuss.
    They can’t fill every role, but they certainly have *a* role to fill!

  3. Pharmacists are supposed to be able to give out medical certificates, but a lot won’t do it because of not being trained in diagnosis the way doctors and nurses are. Doctors were upset about that, too, but honestly, nurse practitioners are an awesome idea, especially in rural areas where there are no doctors, or appointments are extremely hard to get. My workplace doesn’t require certificates because we don’t want to waste a valuable appointment slot that someone might really need (we’ve had only locums for over 2 years now, and are severely understaffed) and because it’s a stupid requirement for minor ailments.

  4. I don’t see why this would upset doctors so much – they’re always going on about the GP shortage and how GP’s offices are clogged up with the “small” (implication: “boring”) stuff, aren’t they? This is exactly the type of thing which would re-route smaller or totally obvious problems out of GP’s offices so the GPs could do “interesting” cases!
    Or am I wrong about the reasons GPs always seem overworked and overbooked?
    Also, since it’s basically impossible to get a GP to do a home visit I’d be all for nurse practitioners on the basis that they might actually be slightly realistic about my complete inability to actually go to an office and be willing (for reasonable payment) to come to me. Interesting, I’m assuming a nurse practitioner would be more empathic on the basis of gender bias in the nursing profession – is it time to examine the inside of my own head for sexism, or is this actually borne out by science?

  5. The sensible doctors I know want well out of medical certification altogether – but the AMA doesn’t represent them, of course. Let employees sign stat decs or the equivalent for their employers, and keep the cold, flu and gastro germs out of doctors’ waiting rooms except where absolutely necessary.
    On the other hand, and this is a completely separate issue, doctors are barred from dispensing (except in extenuating circumstances) for a reason, and it’s a very good reason: commercial conflict of interest. I’m wholly unimpressed with many pharmacies’ approaches to the pharmaceutical and/or “natural medicine” upsell, as well as their complete lack of reasonable privacy provisions. I have significant concerns, which I think are reality-based, about NPs being based in chain pharmacies. Already pharmacies have pushed their way into the “child health nurse” market, weighing babies and recommending unnecessary or harmful pharmacy products like formula and bottles and gripe-water and such; is this merely an extension of that from a commercial point of view?

  6. Now I’m being accused over at LP of sneering at GPs when the whole post was directed at the AMA. What proportion of medicos, and especially GPs, do they represent again?
    I do see your point about the potential conflict of interest. and that’s a good one. If the AMA stuck to that they’d be arguing in good faith. But no, they have to bring out the denigating nurses card yet again.

  7. As BBB pointed out, it’s Michael2 who is doing the sneering, at “Nurse practicioners with their clipboards and algorithms”.

    • Yes, when he’s the one who’s introduced the whole checklist idea in the first place.
      Two things:
      1. I said “system of notetaking”, meaning exactly the same sort of system of notetaking that doctors use when discussing signs and symptoms with a patient.
      2. Most doctors (and other health practitioners) would probably do better if they did use an actual checklist to ensure that they didn’t forget to ask a necessary question. It would free their mind to concentrate on what the patient is actually saying instead of having to concentrate on remembering what the practitioner should be asking next.

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