Off the Charts

With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.”

That’s the start of an MSNBC story called “Doc Deficit? Nurses Role May Grow in 28 States.” Much of the article is about nurse practitioners (NPs)–and the different ways they are (or are not) allowed to practice in different states, as well as the ongoing efforts of physician groups to limit their practice (even as the health care overhaul increases the demand for primary care physicians and invests in nurse-managed clinics). We’ve posted on scope of practice issues here more than once—what’s your take as nurses, or patients?

HAIs persist. Also today, as described from a number of perspectives in a collection of articles on Kaiser Health News, the Department of Health and Human Services (HHS) released a report stating that the rate of hospital-acquired infections did not improve in 2009, despite ongoing attention to this issue in studies, IHI initiatives, nursing journals, and nearly everywhere else. What gives?

Does getting sick make you an expert? Elsewhere, at Covering Health (the blog of the Association of Health Care Journalists), Andrew Van Dam is critical of tennis star Martina Navratilova’s public advocacy for yearly mammograms for women over 40.

In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.

Tort reform, redux. Lastly, today the Wall Street Journal Health Blog reported on a new study that takes a fresh look at the question of whether tort reform–making it harder to sue health care providers for mistakes or perceived mistakes in your care–is really that important or not. During the health care reform debate, Republicans often held it out as the single most important solution to our health care system’s ills, arguing that doctors ordered so many unnecessary tests because they were praciticing “defensive medicine.” Democrats, on the other hand, were less enthusiastic about tort reform, which was predicted to only save about .05% of total U.S. spending.

The new study found that nearly 24% of cardiologists surveyed said that fear of malpractice lawsuits influenced their decision to order catheterization. As health care reform is implemented, the cost issue is not about to go away; tort reform may not be as important as comparative effectiveness research, but many people think it deserves another look. Nurses, doctors, how many of your decisions are influenced by “non-clinical factors” such as fear of litigation?