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[quote=Anonymous][quote=Anonymous][quote=Anonymous]My training was explicit that you had to see tens of thousands of normal to recognize abnormal reliably. Rashes don't often look textbook, and there is so much variation in presentation of the same diagnosis.

Without that large clinical database in your own mind, you can't reliably tell when to worry. Anemia that is not microcytic and hypochromic, or that doesn't respond as expected to treatment (as per PP)? Dig further. On the other hand, you don't order labs or antifungal treatment for pityriasis rosea when you can recognize it, even on the many varieties of skin type.

NPs can be fantastic. Old school NPs with many bedside years under the belt, or NPs who are well-trained in a narrow scope with good oversight (e.g., L&D) are more likely to be fantastic than others.

[b]And you still need to see tens of thousands of normal before you can reliably pick out abnormal[/b].[/quote]

This is so important. You are going to have trouble hearing a murmur if you haven't heard a lot of hearts without one. Even something simple like distinguishing wheezing from rhonchi requires experience. I had a NP at a Minute Clinic listen to my lungs and tell me I had pneumonia and she gave me antibiotics. That seemed serious so I got in with my pcp the next day who sighed and said "You don't have pneumonia -- so those antibiotics aren't going to do anything and they shouldn't have been prescribed." The NP thought she heard rhonchi and panicked. [/quote]

Medicine isn’t as simple as normal vs abnormal.  Good practioners have to have an advanced understanding of pathology, pathophysiology, and pharmacology.  This cannot be done in a 2 yr PA crash course. NPs are slightly better because they get some of this in nursing school, then again in NP school, but still no where near as in depth and complete as the education a MD receives in 4 yrs medical school, plus residency, plus fellowship.  Their depth of knowledge is not even comparable and goes way way beyond normal vs abnormal.  They are dealing with people with complex issues involving multiple organ systems, on multiple meds, and each situation is slightly unique and individual. There needs to be critical thinking happening and that cannot happen if you don’t have the solid foundation of knowledge [/quote]

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