Primary medical care and how it relates to nurse practitioners has once again become an important topic of discussions and articles including Maggie Mahar’s writing on the subject.  Mahar seems to believe that the problem with healthcare today is that doctors are over-qualified once they have graduated from medical school.  She thinks that the care they provide patients once they become doctors is focused on coordinating various treatments instead of being focused on using medical science to improve the health of the patients.  Mahar asserts that primary care doctors no longer care for their sickest patients but instead play the role of a coordinator between the patient and whatever medical specialists are needed.  She presents an argument that many primary care doctors do not count their training to be as important as it should be in their role as a physician.


While Maggie Mahar’s assertions not only seem to be accurate but are actually accurate in many cases, the true problem with healthcare lies in the fact that medical professionals focus most of their time and energy on treating the patient instead of focusing appropriate attention and time on careful diagnosis first.  Proper medical care emphasizes two important areas.  The first part is diagnosis which is loosely defined as pinpointing the medical problems that are causing the patient’s symptoms.  The second part of medical care then comes into play once the diagnosis has been made and involves figuring out what needs to be done to help the patient feel better and following through with a plan.


But a troubling belief often expressed by those who are not medically trained is that making a diagnosis is relatively simple.  Many think all they have to do is enter symptoms into some type of sophisticated computer program and the accurate diagnosis will automatically show up…just like what can happen with WebMD or any other similar site.  At this point, doctors reading this article are pretty much frustrated by such patients and chances are, they have had a patient or two come to an appointment today or this week with a diagnosis they are sure of because they searched for it on some medical website.  Medical professionals are fully aware of how erroneous and even dangerous that patient belief can be.  Reality is that medical diagnoses are rarely so cut-and-dried even though an occasional case is diagnosed easily because of the clear symptoms from the patient and the doctor’s genius IQ.  In truth, medical diagnosis is not determined merely from scientific facts but is actually a learned art combining training, scientific facts, and medical experience and expertise.  The skills taught in medical school include the ability to ask the right questions to get both the important as well as the seemingly unimportant details that can then be used to reach a correct diagnosis.  It takes time and a lot of practical experience before a physician is able to use the physical examination skills learned in medical school and the results of such exams in order to reach an accurate conclusion and diagnosis.


In order to be a great doctor, a physician must also be great at diagnosing correctly.  Every bit of the education and training obtained during the years of medical school is what allows a doctor to be a great diagnostician.  Those who advocate for the nurse practitioner positions often refer to those many years and in-depth curriculum of medical education with disdain believing a good part of it to be unnecessary and “over-training”.  But the value of such “over-training” is evidenced quite clearly when analyzing the supposed diagnoses that an online website offers.  Those who have not had the medical training physicians go through will often find it difficult to know not only what information to focus on, but also what information to ignore.  In obtaining a correct diagnosis it is vital to have the skills and experience necessary in order to recognize the information that is not important and discard it.


Mahar wrote of a study that presented an imaginary scenario of a patient suffering from an acute case of gastritis.  The study results indicated that nurse practitioners were more likely to spend enough time with the patient to develop a more-rounded medical history of the patient.  The study also seemed to indicate that they would prescribe fewer medications for treatment than an actual physician would.  But even though the study results were not flattering to doctors themselves, it doesn’t necessarily support a belief that nurse practitioners are better at diagnosing than physicians.  Instead, the overall take-away from the completed study is indicative of the deterioration of skill with doctors in American medicine today.  Just as important as recognizing what information is unimportant in a supposed online diagnosis, it is just as important to have the knowledge to make accurate diagnoses because you learned about the specifics in medical school.  It is impossible to form a diagnosis (or reject one for that matter) if you’ve never heard of the symptoms and diseases involved because of a lack in medical education.


Consider this hypothetical situation…the patient is an adult who has had a worsening sore throat for 3-5 days but has gotten a negative result from a strep throat test.  Will a nurse practitioner who is not as well educated as the physician think of one of the least common diseases that might be indicated such as Lemierre’s Syndrome?  From my experience with nurse practitioners, I have found them usually to have a very limited educational background to refer to and often tend to rely on consultations along with controlled substances and other medications requiring a prescription being offered much too frequently.   


For many medical issues, quite often the treatment necessary to resolve the issue is clear and a cut-and-dried treatment plan works fine – but only if an accurate diagnosis has been made.  Even though treatment plans often require customizing to fit the unique circumstances of the patient involved, doing so is rarely as intricate as making sure the correct diagnosis is found in the first place.  This is an area where medical care in America has really dropped the ball so-to-speak.  Even though we may be able to offer great treatment options to our patients, our skills for diagnosis are seriously lacking.  To explain from another direction, consider gas stations and car batteries.  It is a great convenience to have gas stations that you can access while traveling on a highway, but those gas stations being there won’t help you a bit if your car battery dies in between stations.


Way too many physicians from both the primary medical fields as well as the specialists’ various fields are sadly deficient with their diagnostic expertise.  The cause may be a matter of not taking enough time with the patient or simple laziness in doing the work needed to give an accurate and complete diagnosis.  But regardless of the reasons why, the fact is that way too many medical professionals fail to make adequate diagnosis which is wrong and unacceptable.


When medicine is practiced properly, it includes both accurate diagnosis and developing an appropriate treatment plan.  Coordinating and implementing the treatment plan can then be done by those who are not doctors themselves, but are quite willing to follow the doctor’s instructions.  Physicians must be respected as the best ones to practice medicine with diagnosis and treatment.  While Maggie Mahar believes that the careful and comforting characteristics of the typical nurse practitioner are more valuable and appropriate than the “over-trained” physician, having that without a correct diagnosis will result in a lot of heartache and difficulties for the patient as well as the nurse practitioner and physician involved.