I wrote this letter to the editor not because I consider nurse practitioners in financial competition with me, but because I am concerned about patient safety. I have a high regard for nurse practitioners, but they have limits. Doctors have limits; that's why there are so many specialists. It's not about money, I refer patients to specialists frequently. I tell the patients that specialists know everything about nothing and generalists know nothing about everything. I'm concerned that nurses may know a little about something and maybe a little about many things; but does she know when to do nothing or what to refer to a doctor. And what backup does she have if the patient has a reaction? Maybe she sends them to the nearest emergency room. It rarely happens, and that's what I would do.
The June 5th L. A. Times Business Section story, “Walgreen, CVS add to clinic services,” worries me as a physician. There are some excellent, well-trained nurse practitioners, who are capable of diagnosing and treating specific problems, but are they capable of handling an unexpected side reaction? Are they equipped to do necessary diagnostic tests when the etiology of the illness is unclear. The article admits that there is usually not a doctor on the premises when the nurse holds clinic.
I agree with Dr. James Milam who the article quotes. He says, “When my nurse gives an injection, I am here.” The patient needs a regular doctor who has their history, family history and allergy history.
A Wal-Mart spokeswoman commented that the company is “always looking for ways to better serve our customers.” Does she mean better services, or more profits.
Melvin H Kirschner, MPH, MD
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