How can I represent nursery skills?

[Anaraxes]

Originally Posted by Rupert

From what I've seen here, NPs in community health centres usually prescribe medicine that you could get over the counter.

Regulations for NPs vary by state. Different states also often have various levels of NP with different authority.

There's often several categories, including a list of drugs NPs can prescribe, drugs they can prescribe but only with an MD's approval (whether a rubber stamp or more conscientious), and a list that only MD's can prescribe. Much the same goes for procedures that are allowed to NPs.

[Rupert]

Originally Posted by whswhs

Here in Kansas, my wife is seeing a psychiatric nurse practitioner. She has cancelled or reduced some of her former medications and introduced at least one new one. I suppose there's a psychiatrist in the background, but C hasn't seen them, if so.

Kansas? I know you mentioned moving from where you were (Southern California, if I recall correctly) somewhere, but that's quite the change.

[Rupert]

Originally Posted by Tyneras

I wonder if some confusion is caused by medical dramas that make the doctors far more hands-on than they are in reality, often combining a doctor and multiple nurses into a single character. Not to mention not strongly differentiating doctors and surgeons a lot of the time.

When I was being diagnosed for my heart condition, the cardiologist (a doctor, not a surgeon) did the angiogram, which involved making holes in me and running probes down my blood vessels, and so involved surgery.

The one who did the bypass op, or rather headed the team who did was a cardio-thoracic surgeon. I think he was the first doctor or surgeon I've seen in decades who was overweight.

[Rupert]

Originally Posted by johndallman

When I had eye surgery in July, I saw several nurses who were preparing patients and looking after them for recovery. I saw my actual surgeon for a final check and to sign the consent form before surgery, and the anaesthetist, who seemed to want to make sure there were no errors in transmission of information. They were the responsible people and did the surgery (I was under general anaesthetic). I talked to them for five minutes each in a six-hour stay in hospital; everyone else was nurses.

I met my heart surgeon once before surgery. He made some jokes, but left before I had time to come up with an appropriate response. I saw him twice afterwards, once because one of the medications was doing something weird and the nurses felt he should see for himself, and once when he was discharging me and he made some more jokes and I made some back, and then he disappeared again. I get the impression that he was kept very busy.

[Fred Brackin]

Originally Posted by Rupert

I met my heart surgeon once before surgery. He made some jokes, but left before I had time to come up with an appropriate response. I saw him twice afterwards, once because one of the medications was doing something weird and the nurses felt he should see for himself, and once when he was discharging me and he made some more jokes and I made some back, and then he disappeared again. I get the impression that he was kept very busy.

With neurosurgeons it's always at least once before surgery, once the day after surgery and then again for one or more follow up visits at 30 day intervals. At least once though I saw a junior surgeon in that practice for follow up.

For cardiologists you first have a nurse or tech do the ekg and then you see the doctor. Mine was busy enough he told me I didn't need a cardiologist and I haven't seen a full MD since last November.

I've never seen the dermatologist who heads the practice I go to. It's always an NP who checks my skin and prescribes for simple skin problems.

You only see any given anesthesiologist once (before the operation) and you never see the radiologists who interprets your x-rays though I did once have the Head of the local Radiology dept perform a particularly complex and/or rare test himself.

Right now at my primary care place it's 1 to 3 months to get an appt. to see an MD but you can see an NP the same week you call and the NP can at least renew any prescriptions you have.

Specialists can actually be easier to see with it being about a week in most cases. It was about hat long for my last opthamalogist and I beleive I saw a junior MD after a nurse/tech did all the tests. It's about a month for a consult with an eye surgeon about relatively routine things like cataract surgery.

[Rupert]

Originally Posted by Fred Brackin

With neurosurgeons it's always at least once before surgery, once the day after surgery and then again for one or more follow up visits at 30 day intervals. At least once though I saw a junior surgeon in that practice for follow up.

I was to see the surgeon in the followup, but saw one of his team instead. As my recovery was going well, the next checkup was with the cardiologist, and from then on back into the normal syste,, seeing my GP as normal.

For cardiologists you first have a nurse or tech do the ekg and then you see the doctor. Mine was busy enough he told me I didn't need a cardiologist and I haven't seen a full MD since last November.

Oh, I had tons of ECG/EKGs before the angiogram, after the angiogram, shortly after the op, and long after the op. Half of them were, in the words of one of the cardiologists "of no diagnostic use", because apparently the way my EKG results come out during and after exercise is odd and obscures things they need to see on the graph.

I've never seen the dermatologist who heads the practice I go to. It's always an NP who checks my skin and prescribes for simple skin problems.

You only see any given anesthesiologist once (before the operation) and you never see the radiologists who interprets your x-rays though I did once have the Head of the local Radiology dept perform a particularly complex and/or rare test himself.

It works like that for some things here, but my ~6-week post-op chest x-ray was interpreted on the spot by the tech to took it.

[The Colonel]

Worth noting that a theatre nurse should probably have some significant degree of surgery skill - they do a lot more of the work than you think.
Speaking of which, a lot of minor procedures are actually done by nurses - and in my experience if you are having any bloodwork done, try to get the blood drawn by a nurse or phlebotomist … letting a doctor try usually leaves you with a nasty bruise and may cause all sorts of other problems.

[AlexanderHowl]

Would phlebotomy be a specialty of Physician or Surgery?

[DangerousThing]

Originally Posted by AlexanderHowl

Would phlebotomy be a specialty of Physician or Surgery?

I would say Physician. It's just drawing blood (OK, it's probably a lot more than that to a professional, but I've always been the patient).

Nurses used to do this, but now it's a specialty all it's own. And they are able to take blood from me who used to run from the mere mention of a needle.

[ericthered]

Originally Posted by AlexanderHowl

Would phlebotomy be a specialty of Physician or Surgery?

I'd allow it as a technique of both: surgery almost has to have it, but I don't think its actually invasive enough to require surgery, and I really don't think a phlebotomist (who doesn't have to be a nurse, just a tech) should have the surgery skill: they just do so little else with it, and its really not that invasive.