Comment by wirrbel | Hacker News Reader

Comment by wirrbel | Hacker News Reader

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What has always confused me is that the perceived gap between doctors and nurses is so big. I have the impression that nurses could benefit a lot from better training and there could be a good case for positions somewhere between a nurse and a doctor. Considering the effect that _care_ (time with patient) has on patients the current model with a demi-god in white just does not scale.

My optometrist (the guy selling glasses) measured my eye sight and found that I needed a correction for some corneal irregularity (pardon me if I did not translate the terms right). I had never been given such a reading from my ophthalmologist (eye doctor) who just wrote down dioptry corrections. My optometrist then told me that the specific doctor never wrote down these numbers (i.e. ignoring a condition). This tought me a lot about medical professionals and highly educated doctors. My doctor probably is just a little bored to measure and monitor visual acuity changes in a person with small eyesight issues. That ophthalmologist also had very good reputation working with accident victims, etc.

Here in the UK, in addition to Nurse Practitioners we also have Surgical Care Practitioners - non-doctors who are trained to perform a specific subset of routine surgeries, or to assist in more complex surgery. It really doesn't make much sense to have a highly trained cardiac surgeon spend half an hour stitching up a patient after a surgery.

Our National Health Service benefits from substantial levels of integration, allowing for Fordist division of labour. The per-capita budget is much lower than in the US, but we can use that budget very efficiently.

Another example is the National Institute for Clinical Excellence, which develops evidence-based care pathways and makes key decisions on drug prescribing and purchasing. Because our drug buying is done centrally (giving the NHS considerable negotiating power), and because NICE are prepared to reject a drug on the basis of an inadequate cost-benefit ratio, we pay far less than most industrialised nations for medicines. It is my understanding that competition legislation would prevent insurers and HMOs from implementing such a system in the US.

> positions somewhere between a nurse and a doctor

They call that a physician's assistant or nurse practitioner. The latter has the nurse's more user-centric approach but can do pretty much everything a general practitioner does, including writing prescriptions (though not in Texas, yeehaw).

Not to be too pedantic, but the profession is "physician assistant", not "physician's assistant." They typically have master's degrees (and all will be required to have master's degrees by 2020), can practice medicine in most specialities (including surgery, pediatrics, etc.), and can prescribe medicine in all 50 states.

Note: I work for the Physician Assistant Education Association.

"positions somewhere between a nurse and a doctor"

I think this is what a physicians assistant and nurse practitioners are. At least that's my understanding. They don't have an MD but are able to do a number of diagnostics and can prescribe medicine.

I have relatives that are nurse practitioners. Even at that level, there are a lot of doctors that view nurses in the way that you would expect a character on Mad Men to view a female secretary (below them, just there to do their bidding, don't know anything, etc).

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