Trail Mixers Say: The Trouble with Doctors

CT, our resident Trail Mix Nurse Practitioner (NP), offers analysis about some of what ails our health care system, especially the reliance on drugs that might not be necessary:

“Nurses are educated differently than physicians. We had a lot of education re: health, not just pathology. I think that we are more holistic. We also had education, how to teach, as part of curriculum. Not all nurses will become NPs. Even NPs didn’t always have the ability to write prescriptions. That was a good thing. Drugs aren’t always the answer but they are easier and faster. Now that we do have prescriptive authority, I see many NPs who are trying to mimic physicians. That makes me sad.

I do want to point out one thing. It’s often the patient who encourages medical practitioners to practice bad medicine. Over the years, I’ve watched young docs start their practices with high ideals. They try to do things differently but if they want to stay in business, they have to please their patients. Patients want drugs, whether they are good for them or not. Even TV commercials tell you what to go in asking for.

You ought to try to convince a patient that they don’t need an antibiotic, even patients who are intelligent and have a medical background. You are very likely to lose a patient. Medicine is a business. One reason that so many antibiotics have lost their efficacy is because of prescribing them when they aren’t needed. That has become a serious problem but patients demand it.”

– by Trail Mixer CT

Also by CT: The trouble with doctors following the lead of drug companies (“It’s very scary that many docs do get their main drug education from the drug reps.”)

American Association of Nurse Practitioners

Letter from Hillary Clinton to ct (1992)
Read About It

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96 thoughts on “Trail Mixers Say: The Trouble with Doctors”

  1. And if perchance, that other meteor due today decides to make an unexpected landing, and wipes any of us out, I’ve enjoyed knowing you guys. I know that I’ll see ya on the other side, for a wonderful adventure, where I know Craig will have a new blog, one that will never give him any problems.

  2. Wait, we can’t be having the end of the world here. I’ve got to clean house yet. The wife is on her way home, after being gone for 10 days.

    Jack

  3. The cruise ship story and cnn yikes…tabloid tv where was Rita Cosby? this is her milieu fast,sensational and wrong

  4. On NPs. So far I’ve been very impressed with the quality of those I’ve run across and they are certainly less likely to trip my bullshit meter. But they are human so I’m sure they have their share of jerks too. Maybe nurse training teaches them to hide the jerkitude better than doctor training does.

    Jack

  5. Speaking of antibiotics — one of the most ridiculous interviews was with the mother who was showing up with a bag of antibiotics to give her child.

    Dr. Gupta pointed out the folly of that but her story was on the endless loop his response once.

  6. to hide the jerkitude better than doctor training does.

    Jack

    I think doctors are taught to emphasize their jerkitude it’s part of the induction into the fraternity..that and don’t turn your incompetent colleagues in

  7. I don’t have problem with doctors as individuals (usually); I have problems with doctors as an organized group, selfishly lobbying for its own interests to the detriment of society.

    Staring in the 1940s, the AMA fought for years to prevent “socialized” medicine (government finance of the system as they have in Europe and Canada.)

    Now that the big greedy insurance companies have taken over, and are gradually reducing MD’s obscenely high fees, the doctors are complaining again. They STILL don’t want “government control,” but they want the government to (somehow) get the insurance companies to pay them more.

    Good luck with that

  8. Thanks Sen. Harry Reid.. You had the chance to change the filibuster but you wimped out as usual..

  9. Wait, we can’t be having the end of the world here. I’ve got to clean house yet.

    jack, but what a great excuse. beats the dog ate the vacuum cleaner.

  10. Jack, who put those docs on a pedestal? So many patients, not as many now, go to their docs and treat them like gods. Nurses have never had that kind of experience. Someone given the god status has a tendency to take advantage of it. As nurses, we really have to work to get your approval.

    And yes, there are some awful nurses, like with any other profession.

  11. I’ve spent 40 years pondering what’s wrong with the health care system and what could be done to fix some of it. If Hillary and I could get together, I think we could make a significant dent in it. She would have to come out to the camp though. I do have a nice guest room.

  12. More proof that government austerity measures retards growth and leads to recession. Europe, including the U.K., is now in a double dip recession with a good possibly of a triple dip if they continue to ignore the benefits of doing stimulus versus their beloved government austerity measures. Even the United States with its inadequate stimulus has produce growth. Not great growth but we avoided a double dip recession which Europe and its continued push for austerity did not.

    Flash estimate for the fourth quarter of 2012
    Euro area GDP down by 0.6% and EU27 down by 0.5%

    -0.9% and -0.6% respectively compared with the fourth quarter of 2011

    GDP fell by 0.6% in the euro area1 (EA17) and by 0.5% in the EU271 during the fourth quarter of 2012, compared with the previous quarter, according to flash estimates2 published by Eurostat, the statistical office of the European Union. In the third quarter of 2012, growth rates were -0.1% and +0.1% respectively.

    Compared with the same quarter of the previous year, seasonally adjusted GDP fell by 0.9% in the euro area and by 0.6% in the EU27 in the fourth quarter of 2012, after -0.6% and -0.4% respectively in the previous quarter.

    During the fourth quarter of 2012, GDP in the United States was stable compared with the previous quarter (after +0.8% in the third quarter of 2012). Compared with the same quarter of the previous year, GDP rose by 1.5% in the United States (after +2.6% in the previous quarter).

    Over the whole year 20123, GDP fell by 0.5% in the euro area and by 0.3% in the EU27.

  13. When I was a diabetes educator, I wrote Hillary a letter, It outlined some of the significant problems I saw with health care.. She and Bill weren’t even moved into the White House yet. I figured Bill wouldn’t have time to read his mail so I wrote to her. She sent me back a hand written note thanking me for my input and saying that Bill and her would consider my suggestions. I still have it. It wasn’t long after that she was put to work on fixing the health care system. I fantasized that maybe I might have made that suggestion.

  14. ct, get that note protectively framed. it’s worth a whole lot now but will be even more valuable in 4 years.
    here are examples of what a mere autograph goes for in this memorabilia market site.

  15. Re: Monsanto and our discussion a few days ago:

    U.S. agriculture wary as Monsanto heads to Supreme Court

    “The highest court in the United States will hear arguments on Tuesday in the dispute, which started when soybean farmer Vernon Bowman bought and planted a mix of unmarked grain typically used for animal feed. The plants that grew turned out to contain the popular herbicide-resistant genetic trait known as Roundup Ready that Monsanto guards closely with patents.”

    (…getting “database errors” and “internal server” errors, on your site, CC)

  16. Tony….
    oh yeah…. someone really needs to give Harry Reid an enema… ;-)

    ps… I’d also include Lindsay Graham and Grumpy Grampy on that list…

  17. I tried every which way to upload an image of that note, from my iPhone, from my camera. It wouldn’t work. It’s almost like it has something blocking it.

  18. The plants that grew turned out to contain the popular herbicide-resistant genetic trait known as Roundup Ready that Monsanto guards closely with patents.

    I think that has to be the funniest thing I’ve read today.
    Like those seeds just magically turned up. lol
    The old farmer was a thief and he got caught.

    Jack

  19. Problem of CNN on in the background:

    What Huh? Wait, the Pope shot his girlfriend after a meteor hit a cruise ship?

  20. Carol make sure the upload image box is checked before you post the comment.

    Jack

  21. In big cities like Houston, where I went to grad school, the docs are very different than they are in smaller cities, where I live. In big cities they aren’t full of themselves, too much competition.

  22. Or you could say Monsanto contaminated Bowman’s elevator seed and are trying to blame the victim

  23. One of my nieces is a doctor of nursing--she specialized in lactation therapy, and two of my granddaughters in Korea are BSNRNs. When I asked them who the founder of modern nursing is, they looked at each other and, without missing a beat, chorused, “Florence Nightingale.”

    My Welsh grandmother studied under her in the late 1800s.

    That said, I prefer my care to be provided by MDs as I have a high demand for research-based knowledge which I expect a competent doc to be able to provide on demand.

    I’m inclined to believe that the chief medical officers of group medical practices should be nurse practitioners or MDs, both with executive MBA qualifications.

    Preferably, they should be generalists rather than specialists. And their primary focus should be centered on the practice’s patients; financial success will result from the actual and perceived level of care that the patients receive.

    And I totally subscribe to everything Nash says about the high-level financial structure of this vital service industry.

  24. The bloated republican’t ego hangs like a poisonous gas over Congress. And they have located that ‘old man smell’ in the Senate as John McCain. The loathsome dude along with the other Arizona Flake is supporting a company with Iranian ownership.

    The ever ungracious McCain should retire and have some fun with his wife’s money. Move over so another deserving Arizonian can take over his seat!

  25. With all eyes skyward because of the impending close passage of the asteroid, no warning of the the meteor hitting Russia?

    One camera caught the meteor hitting the atmosphere. Supposedly, the shock waves caused much damage. It is a learning event for science heads everywhere.

  26. ct, like jack said, are you click the “upload image” box?

    no CNN today, with the cruise ship story (and now exploding sky) could tell it was gonna be one of those days you sit there forever waiting to get squeezed in

  27. Yes, I did check the upload box. I tried many different things and nothing worked. The Universe does not want you to see my Hillary letter. I can’t fight the Universe. If you want to see it, you’ll have to come by for coffee.

  28. Not home now Craig. I’ll try that later. Your server says they have it and I made new pics, renamed them. It worked for me before but not this time. Maybe your server has a problem with Hillary. Kidding.

  29. I just want to say that advanced practiced nurses Flatus probably have as much if not more experience in seeking and using medical research. Maybe you should discuss that with some of your family nurses.

  30. I worked house supervisor one weekend years ago. A moonlighting job because I couldn’t make finacial ends meet as a nurse educator. We had a patient in ICU with symptoms that stumped a sizable group of physicians, including nephologists, internists, hematologists, etc. It was the night shift and I had the time so I went to our medical library and found a research article in a medical journal that was exactly what we were dealing with. I made a pile of copies and brought it to all of them.

  31. I had a visit with a new-to-me NP this AM. She was really good, really thorough, and I hope I get to keep her. The practice through which she works can be pretty tough to deal with; they go through a lot of NPs.

  32. “…world without end, Amen, Amen.”

    Maybe not in Russia…and Putin “thanked GOD” no one was killed by the meteor?
    Old ways die hard; I assumed Putin is an atheist.

    And…a bus broke down, ferrying Carnival passengers from Houston to New Orleans. I could not make this up! I saw it on msnbc’s Facebook update.

  33. CT,
    I’ve never been to a group practice where the nursing staff were given library or research hours.

    The only place where I saw a genuine, collegial partnership was at the Medical College of Georgia in the Dept of Neurosurgery. And, it worked.

  34. well ct, i too could not upload that letter here, but did get it onto the post above. very nifty.

    comment image uploader works for other pics i tested, can’t understand why not this one, even tho it is on the server. It is very unforgiving when trying re-post an image, even if it is renamed. This feature is kind of clumsy but the only plugin i could find anywhere that allows images in comments. Still, i guess it works well enough to keep it.

  35. from grinning planet, saving earth one joke at a time

    UNLIKELY WAYS TO STOP A KILLER ASTEROID FROM COLLIDING WITH EARTH:

    Blanket the earth with a protective layer of trampolines.

    Give away a big stuffed animal to the first person to successfully Shoot The Asteroid!

    Use nuclear weapons to destroy the earth in a preemptive strike.

  36. Sounds like Facebook again. They broke the internet once already and I would guess that they made another change with their program which will cause issues as well.

    After all they are (Facebook) doing a lot of data mining and no doubt I would also hazard selling it under the table.

    Also Craig…

    I notice that there are many times were I get a error message when first loading your site on the “Howdy Partner” on the top of the left side of the screen.

    That’s were it tells one what “api’s” one can use to log in with. It also appears at the bottom of the screen as well if ones not logged in.

    Next time I see it I’ll write it down and post it in a comment.

  37. conspiracy folk probably are starting to work themselves into a frenzy about the meteorite really being a failed nuke test from iran, no.korea, bho or all the above.

  38. And, just to prove that I’m the oh so damned bright medical observer, here I was sitting here, waiting here, delaying my nap, waiting until it was time to take my early afternoon meds.

    As I picked-up the dispenser, it became clear that I hadn’t yet taken my morning meds.

  39. Aww, thanks Craig. I treasure my little note from my girl, Hillary. It was because of her that I found you.

  40. Hmm, it will allow this ‘<' and it's closing half in typing and editor but not when a comment is saved.

  41. anon, yes i’ve noticed that. sometimes the social login feature doesn’t load as quickly as the rest of the page (usually when any of those social sites are running slow, because it directly connects to them). i set it to just stop trying when taking too long, so that the rest of the site functions. nothing to worry about. regular wordpress login buttons still work when that happens, which is not that often

  42. one other thing: when you’re logged in with our inhouse wordpress login, those social net buttons don’t appear unless you logout — so best way to avoid their occasional glitchiness is stay logged in with wordpress

  43. Flatus, the only html tags it reads and publishes are the ones listed above the comment box — bold, italics, link, blockquote, smiley — allowing unlmited use of tags could create a bigger explosion than that meteor

    what tag/function are you trying to include?

  44. Wasn’t an html tag per se, just an alternative to a set of parentheses. I suppose neither brackets nor braces will work either. <Let me try this]

  45. Oh I see. Yes, ‘<‘ is the open tag for html code. When used with its reverse closing tag, the system deletes them and anything between them. Brackets and most other symbols should be fine. I’m glad to see that it is doing its job, keeps unfriendlies from causing trouble.

  46. One med makes you bigger,
    And one med makes you small.
    But, the meds your mother gives you
    Don’t do anything at all.

  47. Curses!

    I’m home alone tonight and tomorrow night as well.Cheryl is traveling with students this weekend.
    Third weekend out of the last five, with two more to go.

    I sure wish I was married to one of those overpaid teachers who only work eight to three thirty and have 3 months vacation. ;-)

  48. My Dr. is amazing. I go in every 6 months for a check up. The nurse does everything.
    Blood pressure, blood draw, you name it.

    Then the doc comes in and asks the same questions he asked last time, tells me to quit smoking, asks me if I need any scrips refilled and pronounces me healthy for at least the next six months. I’m so lucky to have him.
    He is a miracle of modern medicine. ;-)

  49. If modern medicine is so good, why haven’t they come up with something for what ails McCain? :???:

  50. Maddow is touting a special that will deal with the lie that was the war in Iraq, to be aired Monday night.
    Perhaps it will ruffle a few feathers.
    I think that by now, anyone who cares knows the broad outlines of the story, but perhaps it needs retelling in detail.
    The fact is it’s history.

    I would much prefer a special on drone warfare. How we came to use them, why we chose to use them,and why it is a bad idea.

  51. This is an old article, but a good one from a reputable source (and it also has charts with future forcasts:

    “ON SEPTEMBER 30th Anwar al-Awlaki and several of his al-Qaeda colleagues stopped their pickup truck on a remote, dusty road deep inside Yemen’s interior. He can have had only a split second to realise what was about to happen. But the missile strike that killed al-Qaeda’s most effective propagandist was no real surprise. It was just the latest example of the way America’s armed Predator and Reaper drones are changing the terms of combat with the country’s enemies, leaving them able to run but with nowhere to hide.

    American officers, with their passion for acronyms, prefer not to call the machine that killed al-Awlaki a drone…….

    Over the past decade UAS have become the counter-terrorism weapon of choice. Since 2005 there has been a 1,200% increase in combat air patrols by UAVs. Hardly a month passes without claims that another al-Qaeda or Taliban leader has been taken out by drone-launched missiles. There are now more hours flown by America’s UAS than by its manned strike aircraft and more pilots are being trained to fly them than their manned equivalents. While taking a knife to other cherished defence programmes last year, the defence secretary, Robert Gates, went out of his way to exempt drones from future cuts.”

  52. oliver stone’s movie had some of that too. it will be good to see what she has to add

  53. Just as surely as torture begets torture, drones will beget drones.

    When they are aimed at us, whom will we blame?

  54. Ashleeee Banfield yuck
    CNN continues with its inflamatory coverage of the cruise ship

  55. I am alone this weekend as my wife is away babysitting in the capital city.
    I made angel hair spaghetti but didn’t feel like cooking my sauce so I dumped some Ragu on top, seasoned with a few spices.
    I haven’t had any hoagie bread around for sandwiches lately, but last night I bought some egg bagels and have been making sandwiches with them.
    So…toasted bagels or do you think toasting a bagel is akin to dumping ketchup on a hot dog?

    Craig, I wish I had a dollar for every Subway tuna sandwich I have eaten. I bet it’s over a thousand.

  56. “so…did I miss anything?”

    Yep Sturge, death by astroid. You probably appreciated that.

    I celebrated with spicy Popeye’s fried chicken.

  57. jace, you’re a baby back rib man in the great debate vs. St. Louis ribs? I go back and forth, after all these years still can’t decide for sure. baby back tastier I suppose, but st. Louis meatier

  58. Truth be told I am something of an outlier.
    If I buy ribs I go baby back. If I am cooking ribs at home, I go for big beef ribs and it is a labor of love.
    Half dry rubbed, the other half slathered in sauce. All marinated in bourbon.
    What can I say, I’m a bit of a heathen. ;-)

  59. sturgeone says: cc….are we cool with teleonomous?

    sturg, absolutely. Welcome teleonomous! Sorry about the spam filter grabbing you earlier, standing her down

  60. she made the mistake of asking me, offhand, what is truth…..I of course took it to pilate and the trial and tolstoy and……Luke, 17; 20, 21……Mohandas Gandhi wrote in his autobiography The Story of My Experiments with Truth (Part II, Chapter 15) that this book “overwhelmed” him and “left an abiding impression.” Gandhi listed Tolstoy’s book, as well as John Ruskin’s Unto This Last and the poet Shrimad Rajchandra (Raychandbhai), as the three most important modern influences in his life.[2] Reading this book opened up the mind of the world-famous Tolstoy to Gandhi, who was still a young protester living in South Africa at the time.

    In 1908 Tolstoy wrote, and Gandhi read, A Letter to a Hindu,[3] which outlines the notion that only by using love as a weapon through passive resistance could the native Indian people overthrow the colonial British Empire. This idea ultimately came to fruition through Gandhi’s organization of nationwide non-violent strikes and protests during the years c. 1918-1947. In 1909, Gandhi wrote to Tolstoy seeking advice and permission to republish A Letter to a Hindu in his native language, Gujarati. Tolstoy responded and the two continued a correspondence until Tolstoy’s death in 1910. The letters concern practical and theological applications of non-violence, as well as Gandhi’s wishes for Tolstoy’s health. Tolstoy’s last letter was to Mohandas Gandhi.[4]

    1910….tolstoy and twain

  61. Texas beef ribs can stay in Texas. Memphis ribs, so smoky and dry-seasoned, are wonderful. Carolina ribs, with the vinegar tang, also great. I’ve had so many styles of ribs I just can’t remember the St. Louis ribs style.
    I’ve had great ribs in Chicago (Leon’s Ribs) and Market Barbeque in Minneapolis.
    Market BBQ was great. In 2000 we ate there and the owner came over and chatted. There are photos all over the walls. Jay Leno did casino shows there in the summer then, and he would come in after hours, the cooks would cook special ribs for him and his entourage, and Jay would take care of everybody…huge tipper, everybody on staff got a C-Note when it was all over.

    I eat at Famous Dave’s too, a few times a year. Pretty good.

  62. Agree with you about the Texas ribs, Dex. Never have liked them.

    I usually only get ribs at Chile’s or Applebee’s… and there both nation wide (I believe). The ribs we got on the west coast were a lot better than here, imo. Maybe it’s because that’s all I knew. (?)

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