Let’s give Kimberly Hogan the benefit of the doubt and do some quick math. She points to a briefing that says a nurse practitioner can “manage 80-90% of the care provided by a physician.” (“Nurse practitioners are essential to fill the health care gap” — July 17). Let’s use the higher figure of 90% for our calculations.
In my practice, I would see about 100 patients a week. That means that 10 patients a week would have issues that a nurse practitioner could not manage. Multiply that by 50 weeks and you get 500 patients a year. There were 12 physicians in my practice. That means that even if the figures are correct, 6,000 patients a year would get inferior care. That is in my practice alone! How many other practices are there across the city? State? Country? Is that figure acceptable? Would it be acceptable to you if you were one of the 6,000 patients?
This also assumes that the nurse practitioner is well trained, experienced and “board certified.” By a nursing board or a medical board? Certified to do what? What about the practitioners with online training or those from diploma mills? Can they manage 90% of what a physician sees? If not, that 6,000 number becomes even higher. Managing patients is more than just caring for those with known diagnoses. Can a nurse practitioner make diagnoses and determine treatment plans as a physician is trained to do? That is not part of nursing training, but it is the focus of medical training.
Despite the rhetoric, this is a simple common sense argument. Five hundred hours of clinical training for a nurse practitioner does not equal 15,000 hours for a physician.
Nursing training and medical training are not interchangeable. Neither are nurse practitioners and physicians.
Mark Lopatin, MD, Jamison, Pennsylvania
A case for civil discourse
I respect the right of others to disagree with me. My research as a scholar of rhetoric is anchored to the idea that argument is both a way of knowing and a productive tool for persuasion. As a regular user of Facebook, my posts often result in vigorous arguments from multiple sides of an issue — all conducted, I hope, in a constructive and respectful manner and frequently leading me to change my position.
This is important to me as a teacher who for over 40 years taught a course in argumentation and promoted the concept of “self-risk” — the notion that one must enter an argumentative exchange open to reflection and the possibility of changing their mind. My own positions on academic and political issues articulated on social media as well as in newspaper op-eds reflect this principle.
Nevertheless, when I first joined Facebook, I pledged that anyone who engaged in ad hominem argument (attacks to the person) would be de-friended. This was not a threat. Nor a punishment. So, when I de-friend someone they know why. I tell them: Feel free to say negative things about me and call me names on your own pages. But as a rhetorician committed to conducting argument “con amore” (with love) and a human being expecting people to be respectful, I choose not to be exposed to hurtful and unproductive discourse.
Imagine how wonderful it would be if politicians and ordinary citizens followed this practice.
Richard Cherwitz, Ph.D., professor emeritus, Moody College of Communication, University of Texas at Austin
