"Nurse clinics are 'supermarket medicine'"
August 13, 2009 -- Today the Western Australia news site Watoday.com ran a story by Julian Drape about the Australian Medical Association's (AMA) criticism of one company's plan to open more than 180 pharmacy-based clinics staffed by nurse practitioners, who would treat "common medical conditions" like infections and the flu. Predictably, the AMA does not think the NPs are qualified, branding the clinics "supermarket medicine" and claiming that NPs can't diagnose more serious conditions, despite countless studies showing that NP care is at least as good as that provided by physicians. Less predictably, AMA president Andrew Pesce (below) is quoted as saying this: "Nurse practitioners tend to be highly trained in a narrow area of health care and are not skilled or experienced in providing holistic care." That statement is false, since NPs are nurses who are trained in a care model whose core focus is holistic, but it's also pretty ironic coming from a physician, trained in a care model that often seems a bit less holistic, and, well, more focused on intense technical training in one area of health care. Watoday.com should have provided NPs or their professional associations a chance to respond to the AMA's baseless claims. Instead, all it included was an inadequate response from Health Minister Nicola Roxon who (like many retail clinic CEOs) made no defense of NP skill, but emphasized that the NPs would be required to practice under collaborative agreements with physicians. Sadly, readers of this article will likely come away with the false impression that NP care is pretty marginal.
The piece's headline sets the tone: "Nurse clinics are 'supermarket medicine.'" Yes, the phrase "supermarket medicine" is in quotes, indicating it's someone else's view. But when that someone is a prominent physician (Pesce) who is the only one quoted on the subject of NPs' actual skills, it's a pretty unbalanced bit of journalism. The article reports that the Perth-based "Revive Clinics and the Pharmacy Alliance Group" plan to open the clinics over the next three years, and that they can do so because the Australian government recently moved to permit NPs to "request pathology services and prescribe certain medications." The clinics will treat some 30 common conditions, "including sore throats, ear infections, colds, flu and bladder infections."
But the AMA says that (in the report's words) "a nurse plus a pharmacist doesn't equal a doctor." Pesce, in addition to his "supermarket" and "holistic" statements, is quoted as follows
The Revive clinics are being promoted as a one-stop shop for diagnosis, treatment and prescribing for common or minor ailments, which is a dangerous claim by practitioners not qualified or experienced to identify when symptoms may be due to more serious or complex illnesses.
Of course, a great deal of research shows that qualified NPs are indeed competent to identify and manage serious and complex illnesses. NPs have advanced training and experience in dealing with patients, and they generally take the time to listen to patients' concerns. Not surprisingly, there is also a great deal of anecdotal evidence of NPs making difficult diagnoses others have missed. And in fact, NPs are very willing to consult other health professionals and to refer patients when needed; another common physician criticism is that NPs practice too cautiously in this respect. It often seems that organized physician groups will use whatever argument they think will limit the scope of NP practice in any given situation, without regard to whether the arguments are consistent (or the actual research about NP care).
As is often the case in press reports about retail-based clinics, this story consults no NPs--even though it is their care at issue--and there is no real defense of their qualifications. This common tendency appears to reflect the false assumption that only physicians have true expertise about health care, even when the subject is the care of other health professionals.
In any case, Health Minister Nicola Roxon says she is (in the report's words) "not interested in adjudicating a turf war between nurses, pharmacies and doctors." That comment at least suggests that the AMA's complaints may have something to do with protecting professional or even economic interests. And the report also notes that earlier in 2009 the AMA protested plans to have "nurse teams...take over some responsibilities" for emergency patients in hospitals, which suggests that there is a larger pattern at work here--physicians resisting the expansion of nursing practice. However, Roxon also stresses the "collaborative arrangements" with physicians that the government will require in order for the NPs to prescribe and order tests.
As the AMA are aware, we are setting up an advisory group to determine the appropriate collaborative arrangements. We know that doctors are an essential part of our primary care system and we value them highly.
In other words, we won't claim the NPs actually have much skill or knowledge, we just think they won't cause much harm if physicians are watching them closely. That is, to say the least, an incorrect view of NP practice.
On the whole, the WAtoday report is likely to reinforce damaging misunderstandings of NP care.
See the article by Julian Drape "Nurse clinics are 'supermarket medicine'" posted on WAtoday on August 13, 2009.
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