Titles in the ED: "Doctor...Nurse Practitioner, Physician Associate...Physician Assistant"
Also: ED violence out of control; ChatGPT continues to learn; trust issues with hospital leadership; and a reason to smile
Top of the week
What’s in a name?
This topic is a sensitive one. The M.D. degree has a rich and colorful history. In the early 1700’s a Scottish university issued its first M.D. credential. The first US MD school opened in the early 1800’s. The M.D. degree is a distinguished title. It confers expertise gained through years of hard work and dedication.
I don’t blame any profession for being protective of their hard-earned titles, like “doctor.” It is believed that a professional title should clearly communicate a universal understanding of one’s achievement and capability. But is that always the case? For example, the first D.O. school also opened in the 1800’s. Though they were also called “physicians” and “doctors” there was not clear, universally understanding of achievement and capability. “Turf war” conflict existed between those two professions. It appears there is still some conflict today.
Of course, NPs & PAs using the title “doctor” is a different type of conflict. Opinions about this can be varied and strong. Some feel that an NP/PA with a doctorate degree should not use the title in the clinical setting because it can be misleading and cause confusion among patients. Patients may think that they are being caredfor by a physician versus an NP/PA. The state of Georgia recently passed legislation barring NPs & PAs from using the title “doctor” in a clinical setting.
Others feel that when an NP/PA earns a doctorate, that an NP/PA should be able to use it in any setting. One argument is that some pharmacists who have a Pharm D use the title “doctor” in clinical settings, but no backlash against that practice exists.
The Society of Emergency Medicine Physician Assistants recently published their position on the matter. They state that the term “doctor” should not be used in the clinical setting.
The American Academy of Physician Associates has something to say about titles, too. They also chose to pursue clarity and understanding of what a title conveys. They did not feel that “assistant” met the objective. AAPA also cited a survey that patients found “physician associate” more fitting given a PA’s job description. However, the American Medical Association and American Osteopathic Association strongly oppose the new “associate” change.
It’s likely that the title debate is intertwined with the NP/PA scope of practice conflict. Quality of care is at the center of that conflict. The conflict is a complex one and it appears it will go on for a while. However, Dr Katie E. Golden, MD at Mid-Atlantic Emergency Medical Associates says “As APPs gain cumulative experience and training, very little supervision is often necessary, and they can practice largely independently…our APPs typically require very little supervision thanks to their advanced emergency medicine training…”
Though the “title” debate will continue, EM NPs & PAs will continue to work hard to provide quality care.
Emergency Medicine
What does it take to be safe in the ED?
In July 2017, a 19-year-old male stabbed a hospital worker in the neck while in a Philadelphia ED. In January 2022 a person was shot and wounded in a New York city ED. In June of 2022 two ED nurses and one emergency physician were stabbed in a California ED. Most recently, an elderly male patient stabbed an ED nurse in the neck on June 12 in Massachusetts. This occurred while the nurse was trying to adjust the patient’s nasal canula. Also, this month, a patient in Florida hospital shot himself with pistol.
What will be done to improve hospital worker safety? One hospital is considering stringent measures. A Massachusetts hospital will greatly restrict its visitation policy. It will also perform visitor screening with a security wand and the visitor in a gown. In another case OSHA is proposing financial penalties to hospitals who have unacceptable policies and procedures to protect staff from violent patients.
There may not be a one size fits all solution to protect healthcare workers from violence. However, every hospital should have a task force/committee that discusses this topic monthly. A Virginal health system has developed a good example. We need to get a handle on this now.
House of Medicine
What can ChatGPT do for you?
When ChatGPT became available to the public in November of last year, applications of the technology were being explored in all markets. In the world of medicine attempts were made to see how good ChatGPT was at diagnosing patient. The technology did not perform great, but it did showe some promise. Efforts continue to explore how else ChatGPT can be used in medical practice.
Using the technology to communicate with patients seems to be low lying fruit. Physicians are finding they can improve empathy when they communicate with patients through digital formats, like patient portals. There are other applications such as helping providers with clinical documentation and communication with other healthcare providers.
Hospitals, health systems, and more
Can physicians trust their hospital leaders?
A recent study found that about 20% of physicians are dissatisfied with the support they receive from their leadership. Physicians, NPs & PAs often feel that administration is not actively engaged in provider concerns. This can easily lead to trust issues. This trust issue is not new. During the pandemic, physician trust in its leaders fell sharply.
Imagine if the CEO started his day in the early morning in the ED. She/he could see in person how many admission bed may holds there were in the ED. What if she/he could see the impact of ED nursing shortages? Perhaps if the CEO conducted daily visits to the ED to see the problems firsthand, then maybe providers might be willing to trust a little more. A 2022 article suggested a list of specific strategies to improve trust.
The Good Stuff
Check out this quick read about Loki, a therapy dog. This calming canine rounds at the University of Maryland Medical Center. She provides comfort to waiting room patients, providers, nurses, first responders and custodians. How can you look at that face and not smile?
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