Over the last few weeks a number of mailings have crossed my desk or email in-box. Many are for CMEs, many are for databases, many for contributions and such. Some are actual news like the PA name change initiative (http://www.associatenamechange.com). Some things have stuck in my mind a bit too long which caused me to stop and wonder. I thought I’d take a moment to share. 

A month or so ago, a friend had their teenage daughter threaten suicide. She is 16 and felt “misunderstood” by her family and friends. He called me and said he did not believe her threat was serious and asked my opinion. I said what I always say “Take her to the ER” even if it is to show her that this particular threat can never be an idle one. He called me the next day and told me he did what I said. He waited for hours there, his daughter was spoken two by two ER physicians for 30 seconds two different times and hours later interviewed by a person who was some sort of a “suicide counselor” who was on call. At the end the “expert” said to the dad “I am not sure, what do you think we should do?” I was shocked when he told me. I know I have been out of the ER for years but if this is the “norm” for ER psych care, I guess that the quality of mental health services in many parts of America has gone down. The counselor was not a psychologist, psychiatrist, MSW or a psych NP or PA? My friend is a professional and generally asks everyone what they do (which sometimes gets me a bit nuts). I know these things are never easy to really predict or even diagnose but decisions to admit or not should never be left up to the parents of the kids involved. Clearly, they don’t have the training and secondly even if they did, they are too emotionally involved. Is this normal in most ERs today? 

Speaking of summer you have got to see the mailings the plastic surgeons are doing. My wife has had Botox and Restylane from one of the best plastic surgeons in town and my town has quite a few. All of them are in a major PR war. The latest mailing she received looked like a beautiful large hard bound Chinese food menu. There were all kids of things being sold, all kinds of creams and of course many different “anti-aging” treatments; laser peels, botox, chemical peels and much, much more. Summer specials which will take years off your face and leave your skin smooth as a baby’s behind. Speaking of behind, plan on leaving some of your 401K behind at the office if you get these treatments. All well and good. I am a capitalist and this is capitalism at it’s best. Not sure if it is all medicine? 

Another sign of late summer is flu shot mania. This summer I find it amazing that everyone gives flu shots. You used to have to go to either a physicians office (if you had one) or the town Health Department if you did not. Then came Costco and other large chain stores where they cut out the physician but included the nurses. Now CVS, Walgreens and a number of other chain pharmacies have cut out the nurse and the pharmacist gives the shots. Not sure how I feel about that, but you can’t argue that most people can now get a flu shot almost any time in multiple places. That’s good for patients and bad for private offices. 

Unfortunately we were also reminded throughout the summer that we live in a country where too many people still must line up for days just to get basic primary care and dental care. A number of “free medical care” days have been in the news, many with PAs and NPs participating. All continue to attract many more people than the experts expect will show up. Don’t even get me started on dental care which is usually pay up front and “you battle the insurance company”.  And through it all, the AMA continues to worry and speak negatively about the two hundred thousand NPs and PAs that 50% of all physicians in America work with. They continue to assert that we PAs and NPs will misdiagnose sore throats or even worse will continue to “not know what we don’t know”. Maybe one day they will realize that we do know exactly what we need to and that even their own profession is telling them that. That we “highlevels” can really contribute as clinicians in our own right to our considerable problems of medical care distribution that will plague our country for years to come. Maybe they willl even realize all of us can do some things very well, especially without the silly barriers they place on us. Shame on them. Shame on a system they designed and captained with so many holes for people to fall through. 

Another summer of American medicine gone by. Can’t wait for the Fall. 

Dave

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