Retail Health Affects the NP Community and Healthcare
I was going to write about the dumbledorffs, who seem to think retail clinics are the invention of the devil, sent to lead NPs to perdition. But I think I managed to say what I thought about in earlier comments and I doubt they bothered to read my comments. Basically, everyone has the right to say what he or she thinks within the rules of the blog. And there are concerns that need to be addressed with retail clinics. Our scope of practice can be widened. We do need more representation either on the boards of retail companies or at the minimum among the administration. And while it is good to have health care people involved the NPs or PAs in the field need to be strongly represented. We should not have our practice developed without our input. And our input needs to be heavily weighed. I don’t know much about other companies but this is a concern I have for my company. I think it is an issue that has been decided but has never been fully implemented. At least, we seem to be going in the right direction.
So, retail healthcare is not perfect. It is a young concept and all operations are still in early childhood development. I believe that with some good guidance, we will flourish and be a significant positive influence on health care in general but that is only my opinion. What I don’t deem appropriate is to be disrespectful of my colleagues in retail healthcare. It is here that I draw the line. To generalize that we are poor clinicians is beyond right. To question our ethics is something that the AMA has been excellent at doing. I do not think it is reasonable for other NPs to do this. It plain makes me mad and I will not sit quietly and let it happen.
So, I was going to write about something else. Right!
What I wanted to think about is the use of drugs like Singulair for control of seasonal allergies. I do not use this medication in the retail healthcare setting. The potential for harm seems to out weigh the good to me. I wonder how other clinicians feel about this? The other drug that I have problem with not having is an IM steroid for severe contact dermatitis. I know this too has many significant side effects but using it within standard guidelines seems safe. Perhaps, because I have used it in the past and know how to use it, I am not as hesitant. In fact, I know other companies have this and feel stupid that we do not. When someone have poison ivy spreading near their eyes, I think IM steroids are often called for and oral meds don’t work as rapidly. Again, this is my opinion. and I don’t understand the difference in ordering oral steroids and not being able to give IM. Can anyone help me out with this? Perhaps, with my questions I have proved that I am not such a great clinician? I don’t think that way as I believe it is when you fail to question, even the small stuff that you fail your self and your patients. Anyway ask me something about hypertension or ADHD or tinea.
Does anyone have a better way than to ‘Just say NO” to antibiotic use? If all we managed to do is educate people on the misuse of antibiotics we will be immensely helpful. One thing I do use is trying to get my patients with 2-day-old sinusitis to become part of the prevention of an infection. With a good toolbox of education on what is happening in their head, the right kind of meds, nasal hygiene and lots and lots of fluids, it becomes their job to prevent getting an infection and getting rid of sinus pain. For some, they just have no idea of what is happening or they have the old ideas we taught them. An idea, like green is for virus and yellow is for bacterial infections. Did I get that right? I do remember being taught that as fact and instructed to teach that to patients. With the feedback, I get from a lot of people, we sure did a good job of teaching. Now we have to start all over. Is this the joy of evidence based medicine? I guess I am so old that while I think it is important to follow scientific evidence, I keep in mind that science once taught that the earth is flat. What I mean is nothing is concrete and we must be fluid in adapting to new evidence.
And in speaking of antibiotics, I know I err on the side of caution with children and strept throat. If I get the idea that a parent will not follow up a negative strept screen with a throat culture, I think hard about not treating. I am already hearing about cases of rheumatic heart disease after a child was not treated. I am also hearing, about ampicillin resistant strept throat. And this is not so antidotal. All this concerns me. I think children with symptoms of strep throat and negative screens must have follow up throat cultures, despite the cost issues. And I teach this and often have to recommend the child go to the ER.
I am afraid this will become more common with our economy.
I am praying daily for a change in the health care system. It is kind of funny, but being in the business of retail healthcare, right up front, only makes me want some kind of universal healthcare more and more. As a taxpayer, I don’t want to pay for the expensive healthcare coverage those in Congress get any more. I think that until everyone has basic healthcare, everyone in Congress should get the kind of healthcare we get. Let them into the Medicare/Medicaid system instead of the fancy coverage, we pay for as their employers. I bet Medicaid and Medicare would get the funding they really need PDQ. Don’t think it will happen and I really hope that everyone will get the healthcare they need. I don’t know of anyone, no matter their politics, disagrees and frankly don’t care what they think if they do. That people have the health care they need is part of who healthcare providers are and why we entered healthcare. I wish more people could see the reality of buying and selling healthcare in the way we in retail health see it. It seems a long time ago I could hide in the back office and let the front office take care of the money.