17 year gap (was change with 1 day training)

Lyn Behnke lynbehnke at GMAIL.COM
Mon Jun 4 13:59:09 UTC 2018

I just read Michael’s article on Kaiser and change.  One thing that I keep noting.  Nursing is not included in any of this and certainly should be.  Although diagnosis doesn’t seem to be in the realm of nursing, it truly is.  Especially in behavior change, patient education, patient support, care coordination, home care, hospice - and in rural care.  Many places where physicians aren’t involved as deeply because of the physician shortage in rural areas, palliative care, hospice and the like.  For example, we have 1 internist in the county now.  1 general surgeon, no resident orthopedic surgeons and no hospitalists from this community.  We have 4 full time family Doctors, 2 part time family Doctors, 5 nurse practitioners and 5 PAs providing care in our community.  Anyone presenting to the emergency department is shipped 120 miles down state.  Imagine how happy you would be if you received a 5,000.00 ambulance bill for a ride in the back of an ambulance for GERD.

So, in that background, nursing does most of the heavy lifting in health care.  Particularly in long term care, the palliative care, hospice and home care situations.  We have few hospitalized patients.  When I was doing transitional care, anyone who coughed received albuterol.  Didn’t matter that they had HFpEF.

So, we can bemoan these errors and frustrations, or we can dig deeper and look at who the stakeholders are.  I think we are on a good track with patients, but what about the community and the nurses?  I think we can move things along more quickly if we have a larger provider base.  Nursing is the largest base in health care.  Consequently, leveraging their numbers, knowledge and expertise can help the diagnostic process become more fluid and correct.

Back in the day, nurses were trained in diagnosis because physicians came and went and nurses were at the bedside  for 8-10 hours.  We had to have a differential diagnosis brewing all the time.

I could go on and on but I have grading to do.

> On Jun 3, 2018, at 7:24 PM, Michael H. Kanter <Michael.H.Kanter at KP.ORG> wrote:
> <A Model for Implementing Evidence-Based Practices More Quickly.pdf>

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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