|
 Provided by Clinician 1
OK, so what will you do my trusted PA or NP?
You know that if we look at populations in aggregate, the new guidelines on mammography and BSE work for the good of the majority of patients but not all. The scientists ask “If we can spend less money and save more people per dollar spent, why not?” “Of course some people will be missed, but that is OK on a national public health level”. The guidelines are written in the spirit of public health and science. An actuary would argue they are the best thing for society, but are they the best decisions for a smaller group? The best for the individual? Well, let me give you my primary care PA two cents. The answer to “why not” is really “why?”
If it is you, your Mom, your sister or wife, WHY do we try to save their life? Because we love them. If it is our patients, well yes, we would like to think we would treat them the same as Mom or our sister or ourselves. We do say it all the time and I think we really mean it. Why would we stop ordering mammography’s at 40 instead of 50? Why would we stop instructing BSE? When a teenage girl comes in to see us for a college physical, why would we not teach her BSE?
The recent guidelines have pitted the scientists against the clinicians. Over the last 20 years, the clinicians and many fine organizations (Susan B. Komen for one) have finally made women realize that BSE and mammography find cancers. We HAVE changed behavior and done a damn good job doing it. Are there a bunch of other problems associated with that change? You bet. Are there false positives, unnecessary worry? Yes. Even surgery done when not needed, yes. BUT, in spite of all of those negatives, we still save lives. More lives than we would save without these tests. Does it cost the system? Yes. But what is the price of a life? Sorry to disappoint the bean counters, but every life has a cost that is immeasurable.
This is not like keeping a 92 year old in an ICU for 3 months at $1,500 a day hoping for the best. Wishing we could keep her alive for 2 more months. For what? Why? We can’t do everything for everyone. But, we can teach BSE. It’s almost free.
The scientist or the actuary is not the clinician. Not the person who cares about each individual patient, it’s not their job. Sometimes they win, sometimes, we do.
Let’s generally keep doing what we were doing. Can we screen better? Yes. Can we delay some percentage of people a year before their next mammography? You bet. Should we try to, yes.
Should we follow the new guidelines with all our heart? No. Why do anything that we would not do for our loved ones or for all of the other people who come to us for our guidance and support? Why, when we would not do it for ourselves? Why?
Dave
 Dave has been a PA, and later NP, leader for thirty years. He strongly believes that NPs and PAs must work together to insure a better future for both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. In October 2008, Dave was honored by the New Jersey State society of PAs with its “Lifetime Achievement Award”.
RECOMMEND THIS ARTICLE
You must be logged in
to recommend articles
| 
