Now Viewing: Primary care

Advanced Practice Nursing: Providing Care and Promoting Health

Jul 29, 2014, 10:50 AM, Posted by Susan Dentzer

Check out an August 1 Google+ Hangout with the Campaign for Action and RWJF.

The U.S. population is growing, getting older and suffering from more chronic disease. Thanks to the Affordable Care Act (ACA), more people are gaining health coverage and the means to obtain care. And there’s a widespread view that the country faces a drastic shortage of doctors—and primary care providers in particular.

So why are so many states seemingly determined not to let advanced practice registered nurses deliver the primary care they specifically trained to provide—and help millions of patients in the process?

Across the country, 31 states impose varying limits on the ability of nurse practitioners (one of the four types of advanced practice registered nurses) to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage many treatments, including prescribing medications.

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We’re All in This Together: Let’s Bridge the Gap, Not Widen It

May 12, 2014, 4:14 PM, Posted by Beth Toner

Kathleen Hickey

At the end of April, the New York Times published an op-ed by Sandeep Jauhar, a cardiologist who—reacting to a New York bill granting nurse practitioners the right to provide primary care without physician oversight—argued that in primary care, “there will always be subtleties and complexities that demand a doctor’s judgment.”

His conclusion? “If we want more primary care providers, let’s have them be doctors”—and, he added, “let’s find a way to increase their pay.”

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The World’s Biggest Expert In Me

Mar 24, 2014, 2:03 PM, Posted by Anne Weiss

Flip the Clinic Graphic for Advances

I've worked at the Robert Wood Johnson Foundation for almost 15 years, and it’s still thrilling (and a little intimidating), working with some of the world's leading experts, thinkers, and innovators, not to mention colleagues who are brilliant, passionate, and kind. While I’ve never admitted this before, as a long-time fan of television medical dramas the people from clinical backgrounds, the “white coats,” especially fascinate me. The doctors, nurses and other health professionals I work with seem part of some mysterious club, survivors of years of arduous training who have the ability to improve peoples' lives in a way I simply can't.

But it turns out that I am an expert, something I learned from a new Robert Wood Johnson Foundation initiative called Flip the Clinic. Flip the Clinic aims, quite simply, to help patients and their doctors (or other providers) get more out of the medical encounter: that all-too-short office visit that leaves both parties wishing for more time, more information, more of a relationship. You can learn more about the history of Flip the Clinic, including its intriguing name, here.

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If Patients Are Flipped Out by Today's Physician Encounters, Why Not "Flip" The Clinic?

Mar 3, 2014, 5:34 PM, Posted by Susan Dentzer

“I am stressed.”

“I am feeling pressured.”

“I have been through all this before.”

“Why is it taking so long?”

If you’ve ever had any of these feelings while biding your time in a doctor’s office, you’re not alone.  There are a myriad ways in which the classic physician visit can often be sub-optimal: Spending a long time in a waiting room before a too-short doctor’s visit; barely understanding or absorbing what the physician says before he or she rushes off to see the next patient.

The experience could try the patience of the most self-confident of patients—and positively overwhelm the more nervous among us.  Small wonder that some patients experience “white coat syndrome,” or elevated blood pressure during a clinical encounter.  It’s believed to be brought on by some combination of apprehension about a potential disease or diagnosis, or even intimidation at the sight of the doctor in a white coat.

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Flipping the Clinic: The Beginning of the Beginning

Sep 25, 2013, 5:13 PM, Posted by Thomas Goetz

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How do you turn an idea into something bigger? It's necessary, but not sufficient, to start with a good idea, of course. But it also takes a community of supporters—people willing to step out of their busy day-to-day, and contribute time and brainpower to turning that idea into something closer to reality.

That was the goal of the first Flip the Clinic workshop, held in mid-September at the Foundation’s headquarters in Princeton, N.J. We invited 15 amazing thinkers and doers from various perspectives—doctors, nurses, patients, policymakers, entrepreneurs—and asked them to spend a full day (and then some) helping us turn the Flip the Clinic idea into something substantial, or at least substantiated.

The idea was to get some honest feedback on whether the idea has legs, and some expert input on where it might go. The result, by all measures, exceeded our expectations. Not only does the Flip the Clinic idea seem to meet a clear and broad need for new thinking about health care delivery, but it may just offer a necessary inspiration for doing some hard but necessary work in changing it.

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Flipping the Doctor’s Office

Jul 18, 2013, 10:42 AM, Posted by Thomas Goetz

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Consider the doctor’s office: the sanctum of care in American medicine, where a patient enters with a need—a question, or an ailment, or a concern—and leaves with an answer, a diagnosis, or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It’s where health care happens.

But in a less sentimental light, the doctor’s office doesn’t seem so exalted. Yes, it remains the essential hub for clinical care. But what occurs in that room isn’t exactly ideal, or state-of-the-art. The doctor-patient encounter is fraught with tension, asymmetrical information, and flat-out incomprehension. It is a high-cost, high-resource encounter with surprisingly limited value and limited returns. It is too cursory to be exhaustive (the infamous fifteen-minute median office visit), too infrequent to create an honest relationship (one or two times a year visits at best), and too anonymous to be personal (the average primary care doc has more than 2,300 patients).

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My Doctor Used the "F" Word

Jun 26, 2013, 12:38 PM, Posted by Najaf Ahmad

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He made a remark that I found deeply cutting and hard to digest (no pun intended). “You’re overweight. You need to do something about it”. OK, he didn’t use the word “overweight.” He actually used the “F” word. Fat.

I was taken aback. I was upset and hurt. I really didn’t believe him. Sure, I’d gained some weight, but not that much. I certainly wasn’t gorging on cronuts, sconuts and cookie dough batter. (Although I guess I had rekindled my affair with Ben and Jerry.)

Besides, was a doctor really supposed to be saying this to me? “No!” my friends reassured me. “You’re not fat. Besides, you just had a baby! Dump your doctor and find a new one!”

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