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Confused

Discussion in 'Medical School Interviews' started by Confused Future Medic, Jun 7, 2015.

  1. Confused Future Medic

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    Hi all

    I am new here and hope that this is posted in the right section!

    I have worked for the NHS in a Band 4 clinical role (non nursing) for the last 18 months. In that time I have come into contact with healthcare professionals of all types. My interactions have confused me...a lot!

    I have had NP's/ANP's/Specialist Nurses telling me that they know as much as Dr's, can do anything a Dr can and they can prescribe any drug. If this was the view of a single NP/ANP/SN then I would balance that view against the views of the others. However, every NP/ANP/SN held the same view.

    I have also had Specialist Paramedics/Advanced Paramedics tell me that at the scene of incidents they can do everything a Dr can.

    Then there is the introduction of PA's and the recent discussion that, in order to address the GP crisis, PA's will be introduced to General Practice. Whilst I haven't come into contact with any PA's, I have read their views on forums. They believe that because they come from nursing, paramedic, physiotherapy backgrounds and because they have completed further training, they are as knowledgeable as a Dr and that they are able to do everything a Dr can, including prescribing.

    All of the above believe that they hold the autonomy for their decisions, that they don't 'answer' to Dr's, and that in reality their roles/decisions are not overseen by Dr's.

    I have applied to Medicine but have started to wonder whether Dr's have a future with the increased introduction of these roles. Will I find in 10, 20 or 30 years that I have been replaced by these roles as a cheaper way of delivering healthcare (although the NP's, ANP's, SP's and AP's I have spoken to joke that they are on more money than Doctors (excluding Consultants)).

    Overall, I am confused as to the difference between the roles, especially based on the views of those I have spoken to. From my conversations, in order to prepare myself for a medicine interview, it appears there isn't any! Dr's have told me that the lines have been blurred and they can't really tell me what the difference is!

    I thought that the difference was between the nursing model and medical model, however, the nurses tell me that they are trained in both.

    Is there really a difference? Have or will Doctors become obsolete?

    Oh, i'm confused...!
     
  2. Martigan

    Martigan Super Moderator

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    It's not true that they can do anything a Doc can do. Nor do they have the same knowledge.

    After several years experience, they may have more expertese )in a narrow field) than a jr doctor, but they won't have breadth. They will also have limitations that a Doc doesn't.

    For example, in an accident/ emergency outside hospital, I would rather have a paramedic treat me than any type of Doc, other than an A&E doc or one from Anaesthetics. However, the paramedic can't cover anything other than the immediate management.

    They can do a lot thought, but it's within a limited area and very protocol driven. For example, a paramedic can only Intubate, when the patient is virtually dead. However a doctor can RSI the patient. A paramedic can only give so much morphine, a doctor can do more, and has a wider array of pain relief in his/her arsenal.

    In short, an experienced non-medic, can often be better in their field, than a jr medic. However they are limited to a narrower field and constricted by protocols. But a medic can achieve a broader, deeper and more independent expertise.
     
  3. Martigan

    Martigan Super Moderator

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    It's not true that they can do anything a Doc can do. Nor do they have the same knowledge.

    After several years experience, they may have more expertese )in a narrow field) than a jr doctor, but they won't have breadth. They will also have limitations that a Doc doesn't.

    For example, in an accident/ emergency outside hospital, I would rather have a paramedic treat me than any type of Doc, other than an A&E doc or one from Anaesthetics. However, the paramedic can't cover anything other than the immediate management.

    They can do a lot thought, but it's within a limited area and very protocol driven. For example, a paramedic can only Intubate, when the patient is virtually dead. However a doctor can RSI the patient. A paramedic can only give so much morphine, a doctor can do more, and has a wider array of pain relief in his/her arsenal.

    In short, an experienced non-medic, can often be better in their field, than a jr medic. However they are limited to a narrower field and constricted by protocols. But a medic can achieve a broader, deeper and more independent expertise.
     
  4. Confused Future Medic

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    Hi Martigan

    Thanks for your reply which actually reflects what I had thought about the differences between the roles.

    The lines do seem to be blurred and it appears that even the people in these roles may be unsure of their limitations.

    There was something on a well known medical website where a PA was telling a GP that because he had a medical background (I think he was Paramedic or Physiotherapist) and had done a 2 year course, he was as good as a GP. He cited how he had gone to medical school alongside medical students and as such his education was as good as theirs, however, he had further experience which put him ahead. He was indignant because GP's were suggesting that their jobs couldn't be done by someone with 2 years training when they will have spent 10 years to become GP's.

    As for the nurses/paramedics who have achieved senior clinical positions, they told me that if you tally up their initial diploma or degree, plus their masters degree they have studied for as long as Dr's "if you take out the rubbish even they don't need to know".

    I know this will be controversial but my fear is that if the government continually look to provide healthcare 'on the cheap', that Doctors move from being practitioners to simply being a figurehead of clinical responsibility and managing these 'cheaper' healthcare professionals.

    I am not saying that these people aren't competent. My concern is that the nurses and paramedics I come into contact with are pushing for more and more autonomy, skills etc. They cite the availability of doctors as being a reason why they should 'progress' and when I say this would indicate the need to train more doctors, they become defensive and say that they're just as capable as doctors.

    If you look to the USA, in some states it appears that their version of GP practices are now predominantly run by nurses. Nurse anaesthetists in the USA run their own lists and from what I can find they require no supervision from a doctor.

    If the push to drive down costs in the UK continues and these roles continue to push for progression, will there be a need for Doctors? At present you train at University as a Nurse (Adult), Nurse (Child) or Nurse (Mental Health). However in 10, 20 or 30 years time could you also train as a Nurse (Anaesthetist), Nurse (Surgery) etc etc? What will doctors do?
     
  5. MattKneale

    MattKneale Member

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    How many nurses are competent with ophthalmic or vascular surgery? Transplantation? How many deal with advanced radiology procedures? There will always be a role for medics; it simply isn't feasible to promote all nurses to fill the rolls. For a start they don't have as thorough training in anatomy as required to become a surgeon. If you start training them in that way, will you really save money compared to training a doctor (who can act more widely)?
     
  6. AussieBoy

    AussieBoy Member

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    As my old friend NHS Blog Doctor Crippen said before he removed his blog:

    Does David Cameron go and see a nurse practitioner or PA when he is unwell?

    Does he bunnies.
     

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