NeonRedHerring

A worn out queen to see

Some of the funniest shit I've ever seen on here

Hey /u/ZDoggMD, what are your thoughts on the big nationals (Team Health etc.) replacing retiring ED docs with mid-level practicioners to save money? Do you have any qualms signing off on a 20 charts at the end of your shift for patients you never saw that you have liability for? How about NPs introducing themselves as doctors to patients?

Agreed and thanks for answering. I'm not an ED doc, the wife is. I'm in the legal field. Watching doctors sit on their hands as scope of practice completely erodes and people with a 2-year online NP degree pass themselves off as doctors while doctors hold all the liability seems completely bonkers to me.

Lawyers, vicious animals that we are, would never tolerate paralegals representating themselves as lawyers for the "whole person," or taking on "the easy" cases, or allow MBAs to take over, only to demand we give inferior care to our clients by exposing clients with legal problems to a person without qualifications because they have an easy case. Docs, you sweet souls, are letting your profession get eviscerated before your own eyes.

If you have the time, take a look at the doctrine of respondeat superior. This is the doctrine that holds doctors liable for the actions of nurses, techs, and mid-levels. Back when doctors hired and fired nurses, maybe there was a case for holding docs accountable for the actions of nursing staff. But does this make any sense whatsoever in the modern health context? Where supervision is a sham and nurses are hired and fired by the hospital? Where mid-levels and nursing staff answer the orders of the charge nurse, not the doctor?

From a liability perspective, there are two sensible things docs could do.

One, allow mid-levels to practice independently, but refuse to play along with the sham that docs are giving meaningful oversight. Then incorporate NPs and PAs into the medical profession (limit to their scope of practice) and as they are independent practitioners hold them to medical doctor standards of practice and liability.

Two, accept that NPs and PAs are an important part of your team, but start vigorously studying and communicating that they are NOT doctors, they are not qualified to give independent medical care, and prove this up by tracking stats for outcomes/ bounce-backs/incorrect diagnoses. If Team Health and other players demand EDs operate with more and more PAs, have them hold the liability bag. If the companies are the ones mandating PAs and NPs be incorporated, they should be liable when a PA kicks a dying patient out the door. Then crack down on defensive medicine practiced by PAs and NPs.

Letting mid-levels pose as doctors with doctor knowledge and responsibility while covering them with your umbrella of liability is the dumbest possible outcome for doctors, and exactly what is happening now.

Looking forward to your episode addressing this

https://en.m.wikipedia.org/wiki/Respondeat_superior

Former prison guard here. Big Mac won't get in trouble, unless he's still sitting on those motors, which is very unlikely. Inmates can't be punished for hearsay that some dude posted on the internet, and shit like this happens all the time and isn't that big of a deal anyways.