[EXTERNAL] Re: [IMPROVEDX] Ideas on improving rates of missed/delayed diagnoses in PCP type visits.

Vic Nicholls nichollsvi2 at GMAIL.COM
Mon Jan 20 15:44:51 UTC 2014

A very intuitive, insightful post. Are there NP's and PA's here that
would know what groups or systems to "engage" to get this avenue explored?

Our experiences are different. I, and others, seem to have an issue
because we're discussing doctors and not NP's/PA's, there is a
disconnect from diagnostics at that point. If we review the statements,
most are discussing MD's. We've got a number of good NP's that I've
dealt with (only 2 PA's) and only once did I see something that I
questioned. That was that IV saline solutions could be treated like a
drug and that I wasn't dehydrated when I clearly was. NP's have a
reputation in at least one center for spending more time with the
patient and the one I'm thinking of had more medical research she
presented than the doctor. That could also be due to the fact that 3
days out of the 5 day workweek she wasn't in surgery.    :)


On 1/20/2014 10:17 AM, Von Feldt, Joan M. wrote:
> John
> I totally agree with your focus on improving opportunities and
> focusing research efforts  for improving /physician/ diagnostic
> decision making, and providing technology, when appropriate, for
> improved decision making.  But I think a great number of diagnostic
> decisions are made my mid-level practitioners, ( NP's and PA's) who
> have more limited and targeted training, and yet are the front line in
> Emergency Departments and primary care practices.  I think it is for
> this population that the computer assisted technologies  may be /most/
> useful.
> Joan
> Joan M Von Feldt, MD, MSEd
> Associate Chief of Staff, Education
> Philadelphia Veterans Medical Center
> Professor of Medicine
> University of Pennsylvania

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