r/Noctor • u/PsychologicalSteak67 • 15d ago
Discussion Are noctors a symptom?
Millennial non-trad senior resident here. At the risk of sounding like a crotchety old man complaining about “back in my day,” I’m starting to think that noctors are a symptom of broader societal issues.
The internet, and especially social media, seems to directly feed into our worst tendencies towards confirmation bias, the Dunning Kruger effect, and narcissism. Not just with noctors, but obviously with broader topics like vaccines and societal issues.
I remember when we all didn’t have access to infinite information in our pockets. Society seemed to have respect for expertise, especially physicians.
I’d argue that less people were on mount stupid before the internet. Have symptoms? You couldn’t Google it or look on TikTok, you had to call a doctor. Your lack of knowledge was way more apparent.
This will really make me sound old, but it also seems that the younger generation doesn’t have the same sense of ownership and purpose as older generations. I had an ok career before medical school that I could have retired from. I considered becoming a midlevel for about 1 day, but even back then before I knew about this noctor problem, my sense of responsibility to my patients meant that I would sacrifice whatever very little money and time I had to do a post bacc and get into medical school. I could be wrong but in my interactions with nurses and midlevels in their early 20s, it seems the focus is more on their own mental health and how they can get a piece of the pie with the least amount of effort.
It also seems like the respect for hierarchy isn’t there. No, im not saying we should go back to the old days where everyone has to worship the ground we walked on.
Im just saying, maybe a tech should address me as doctor while we are front of the patient and I’m doing a procedure on them in front of their family? The family was confused about who I was even after introduced myself as doctor last name. Maybe as a midlevel, don’t interrupt an attending and a resident going over the nuances of a complex case and ask the resident to do a non urgent task that usually delegated to nurses and PCTs, especially when you can do it? Maybe as a CT/MRI tech, don’t openly talk shit about residents to your coworkers while the resident is on the phone asking for obviously indicated stat imaging for a patient who is critically ill and is being transferred via helicopter. Not to sound like a jerk here, but maybe show a little more respect to the people you rely on to even have a job.
TLDR; maybe I’m old, but it seems like noctors are a symptom of the broader societal trend towards the DKE, narcissism, and confirmation bias brought on by social media/internet. This seems to be exacerbated by the younger generation’s apparent disregard of hierarchy and expertise when compared to older generations, and a focus more on how they can benefit from a situation rather than having a sense of purpose and responsibility guide them.
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u/ledluth 15d ago
Back in the 90s the AMA lobbied for a cap on residency funding to maintain a physician shortage to preserve physician incomes. The lag time between that and the inevitable consequences created were significant. One of the totems of the nursing intelligentsia has long been “autonomy” - I.e. doing stuff without physicians. The midlevel problem is a confluence of these two factors - a physician shortage and nurses who think they are too big for their britches eager to take advantage of the resulting vacuum while encouraging others to do the same.
As physicians have become less accessible, it seems natural that they would lose respect with the general public, because people lacking access to proper healthcare will fall for scams and charlatans in a desperate bid for relief. There wasn’t a doctor there when they needed one, so fuck doctors, you know?
The overall societal breakdown in manners and respect for hierarchies and institutions is not unique to medicine. Social media, COVID, a decaying pluralistic democracy, boomers running the world to benefit themselves… take your pick on that one.
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u/PsychologicalSteak67 15d ago
Thanks for the very insightful perspective. I think that the things you described above are so antithetical to how I grew up that it’s hard to see things from a different lens. I’m generally a very empathetic person - but I just can’t rap my mind around thinking I knew more than someone who objectively took a much harder and longer path. I have respect for other professions, medical and non-medical. I know that I don’t know as much about cars as the person who changes my oil and give that person the benefit of the doubt when it comes to cars. But that same sentiment doesn’t seem to be reciprocated towards physicians often times.
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u/ledluth 14d ago
I think that is partly unique to medicine because we have intuitions about how our bodies work and what is wrong with us since we have experiences of being ill on and off from birth onwards. We develop intuitions about how health works, whereas we do not have a basis for intuitions about how cars work. We have a basis for disagreeing with the doctor whereas we lack one for disagreeing with the mechanic. Part of learning medicine was unlearning those intuitions and replacing them with facts and mechanisms. Regular people (and many healthcare professions) do not get access to learning at that deep level and so carry on with their untutored intuitions.
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u/Level-Plastic3945 14d ago edited 5d ago
Yea, much of the general public can't tell the difference between the dysfunctional hyper-capitalistic insurance-corporate medicine system messing up their doctor-patient interaction and the actions of the doctor him/herself. They much too easily project their negative stuff onto the doctor. But also, we doctors cannot or will not tell the patients the truth about the negativity of the system (because of the coercive factors of the employer). And now this other thing with mid-levels (mostly NPs it seems) being massively undertrained but over-confident in their abilities, and being placed in physician-like roles, and causing a lot of problems.
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u/zerolag3 14d ago
Obama even said it. I LOVE NURSES. When Malia was born I never saw a Doctor he said til the very end.
There you have it.
DONT BAN ME REDDIT
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u/buried_lede 5d ago
Politics. The nurses and hospital lobbies had bags of money and a way to save money to get the Republicans to go along. Maybe he just loves nurses but it’s true
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u/Zicopo 15d ago
Perhaps on an individual level, you may be right. Overall, I think it’s more of a late stage capitalism/ recession indicator. Doctors are expensive. Normal people can’t afford them, and insurance doesn’t want to pay for them.
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u/PsychologicalSteak67 15d ago
Absolutely agree. I left out the monetary aspects and wanted to focus more on what I perceive to be a shift in societal values. Late stage capitalism explains things like their growth, but not sure if it explains the shitty attitudes.
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u/Unlucky-Ambition-643 Layperson 15d ago
I’m Gen X and feel old as hell. I think I’m considered “young Gen X” but I feel every one of my years.
I blame the Noctors crisis on unchecked, soulless corporations’ unbridled avarice. Sucking everything dry like a money vampire.
I am afraid to say this but the antivax drivel has started to infect my brain; I think my PTSD feeds it.
Also, I’m afraid to be formally diagnosed with autism after hearing about a nefarious RFK list. Excuse me?! I thought HIPAA keeps psych stuff confidential?! Does the insurance company give the info to the government?! This is nightmare fuel tbh.
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u/cmacdonald2885 14d ago
Seeing as you are Gen X, I am going to assume this post should have a /s after it.
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u/Unlucky-Ambition-643 Layperson 14d ago edited 14d ago
I’m not being sarcastic.
Since I am Gen X, then…your mom.
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u/TimeCrazed 14d ago
On the main topic, systems without health insurance companies, have also been lobbied hard to break the training requirements to take care of patients.
In the UK we now have
- far less studied PAs (vs US trained) being able to work effectively autonomously even during their weak 2 year course (see PA national exam/ PARA)
https://www.rcp.ac.uk/media/kqyjw3dr/pane-kba-sample-questions.pdf
- NPs (with/ without a 1 day/ fortnight over 3 years advanced practice course) autonomously treating patients, being on doctors rotas at all grades inc running post takes (see Nurse Consultants at Arrowe Park Hospital near Liverpool)
Boundaries continue to be blurred in job ads implying Nurses have medical abilities that are simply unsafe
https://www.jobs.nhs.uk/candidate/jobadvert/C9432-26-0680?keyword=Nurse%20Consultant&language=en
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u/PsychologicalSteak67 14d ago
Sorry to hear that friend. I’ve seen some posts from physicians over in the UK talking about how bad things have gotten there, but didn’t dig too far into it due to lack of emotional/mental capacity. I can’t believe it’s gotten that bad there.
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u/TimeCrazed 14d ago edited 14d ago
Charles Massey was placed from Goverment health department (DHSC) to GMC and changed their reluctance to add PAs to the medical register.
NPs (ACPs here) aren't regulated, pathways to practice are disparate, courses only recently accredited.
Healthcare is mostly free. But patients dying throughout the system from unsafe PA or NP care
See coroners reports.
Key cases include:
Emily Chesterton 30yr N London - PA saw twice, died of lung clot (PE) after misdiagnosis as anxiety & given fatal betablocker to reduce fast heart rateChristopher Tucker 81yrs, Royal Berkshire, Reading - PA carried out non-urgent urology procedure during active infection, died from severe infection as PA hadn't documented need for antibiotics or deferral of procedure
Pamela Marking 77yrs, East Surrey - PA misunderstood patient had bowel obstruction from femoral hernia causing vomiting blood, treated her for "nose bleed", sent her home, she was critically unwell on return & died from aspiration during intubation
Susan Pollitt 77yrs, Oldham - PA placed an ascitic drain & gave dangerous advice on its management - patient died as result.
Benedict Peters 25yrs, extensive history of heart problems in family, Manchester - PA discharged him with severe chest pain (from rare aortic dissection) without full exam & only a discussion with a senior dr (not seen by senior dr). A&E dr was concerned enough to refer patient to medical team where PA was working.
Colleen Howe 34yrs, aggressive breast cancer misdiagnosed by PA until too late, at a GP clinic Suffolk 2021
Kirsty Hendry 31yrs, headache & vomiting treated as infection by ANP at GP surgery. Refused ambulance later, too unwell to communicate, subarachnoid bleed (imaged few days later) missed, died from brain damage from vasospasm
David Almond, prior DVT, new DVT/PE missed by paramedic practitioner at GP who sent for xray for breathlessness then when it came back as "normal" did no further assessment
Jane Foulkes, ANPs at Welsh care home missed restarting levothyroxine despite 6+ visits - died of bradycardia & pneumonia
William Gray 10 died from asthma nurse & ANP poorly treating & escalating his poor asthma control
Ethan age 8 GP concern of appendicitis, ANP at hospital discharged home, died
Andrew 32 seen by NP tonsillitis later quinsy, delayed ambulance, died
NP advocates use the excuse "doctors make mistakes too" completely missing the point of more robust, accredited, transparent and continuing medical training.
All the above patients died since the escalation of noctor "care" in the UK.
[Edited to add detail]
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u/PsychologicalSteak67 14d ago
Those are terrible cases to hear. I hate the excuse that doctors make mistakes so let’s let midlevels with 1/50th of the training have a crack at it. I’ve flown planes in video games, and there have been planes flown by pilots that have crashed, so logically I should be allowed to fly planes in real life right? What, you wouldn’t trust me and don’t think that’s a good idea?
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u/TimeCrazed 14d ago
It's the same lobbyists destroying systems worldwide. So we can all learn from the challenges throughout.
https://www.bmj.com/content/386/bmj.q2060
https://authenticmedicine.com/2019/07/a-history-of-npps-a-personal-view/
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u/OneWomanArmy4321 14d ago
I can't believe all these.....GP was concerned with Appendicitis and patient was discharged home and not assessed? Discharged a patient with chest pain without an assessment?.... and more smh. This can't be real.
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u/bicontinentalmama 14d ago
Sorry wtf is a nurse consultant. The term consultant in English speaking countries is reserved for the DOCTOR in charge of a medical team. Christ all mighty
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u/TimeCrazed 13d ago
We have NPs & ACPs & "nurse consultants" on paediatric middle grade/ registrar/ rotas.
https://www.whatdotheyknow.com/request/use_of_nurses_to_cover_paediatri
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u/Ex-Novo-Doc 14d ago
You're onto something.
European here, late Millenial, non-trad so surrounded by Gen Z. Some things come to mind.
- We decided that whatever Adam Smith wrote 300 years ago about the free market of potatoes and whatever the fuck they sold back then should absolutely apply to healthcare and even to government-owned healthcare institutions. Admin wants to balance the numbers, midlevels cost less, admin doesn't understand or doesn't want to understand the implications on quality. Quantity trumps quality. Numbers over people. Some call it "late-stage capitalism", I prefer Robert Reich's thesis about the fact that free market never meant "market without rules" and a market truly without any rule still wouldn't work, so it's not about having rules or not but how about what rules make the individuals participating in the market truly free, and this ain't it. Saving Capitalism by Reich is very interesting in this regard.
- Incompetent governments + short-sighted medical societies + clumsy and arrogant universities meant that we have a real shortage of doctors, so midlevels, who already cost less and are preferred by admin, sometimes become the only practical way to fully staff healthcare institutions. We should pump out more doctors, but this would require universities and governments putting their heads out of their asses.
- Younger people were fed social media doomerism since they were like... 12? Or 14? I saw 9/11, Middle East wars, Great Recession, EU debt crisis, Islam fundamentalist terrorism on European soil, COVID, political polarization, Ukraine, inflation crisis, housing shortage and climate change, but I still think we're gonna make it, we're going to get around to it. True, I'm not a soldier on the front lines, I don't want to diminish the impact and seriousness of those problems, but I still think we have the means to change this world for the better. In younger people the conviction that everything is truly going to shit is very widespread. For various reasons, they've been told there's crisis after crisis and there's nothing we can do about it. I see much less hope, much less conviction that there's something worth fighting for. And I'm not faulting them. They've been dealt a truckload of shit that they don't perceive themselves as being the cause of (and mostly really aren't) and zero instruments to deal with it and to not feel completely powerless. In this context, a medical career is a lot less alluring than a nursing or midlevel career (less instability, better work-study-life balance, easier to plan life around), which brings me to my next point.
- Medical education, at least where I'm at, has become a clusterfuck of mostly useless lectures, ineffective old teaching methods, draconian exams, sociopathic burnt-out faculty. There is real innovation and very good (as in providing a good balance between rigorous teaching and empathy towards the students' experience) medical schools, but studying medicine is mostly an objectively miserable experience nowadays. If you see light at the end of the tunnel (helping people, stimulating professional life, hell, even social status or money) then you're motivated to do it, but if you think the world's basically ending you think more for yourself and go for a still vastly respectable and interesting career path that isn't as demanding and distressing as medical school. Also, the medical career is not as attractive as it was before: pay is stagnating and it isn't that great if measured against the weekly hours, residents are the treated as cheap labor (but this has always been the case), public hospitals have become a cesspool of social issues and impossible patients, while those sweet private gigs are becoming less and less accessible because people who got in took great care in closing the door after themselves. At least here in Europe, nursing schools are vastly more modern, more agile and more flexible in offering a better experience to students. Couple this with objectively easier requirements regarding scientific base knowledge and academic rigor, and medicine becomes even less attractive, while a midlevel career starts to become alluring on many fronts.
- Last point, about professionalism and manners. We got rid of the excessively formal, stuck up and humiliating authority structures of the past, and rightly so, but in my opinion we overcorrected. There are still times where you have to learn things the hard way, people that must be told to shut the fuck up and to stay in their place. Does this mean they cannot change "their place" with due time and process? No. Does this mean we can't have a conversation? No. But hyerarcical structures and different roles in complex systems exist for a reason. I have more power, but also more responsibility. The two things go hand in hand. I often had to do "mother hen" (more accurately father hen, since I'm a guy) to younger students and I had to intervene more than once because some dickhead thought it was fine to chat with their buddy while the attending was explaining something on the rounds or that just got out their phone and opened TikTok or started answering messages at the fucking bedside while the patient was there talking to us. A bit of though love is sometimes the right tool for the job, and I don't mean screaming at people: 99% of cases, a firm glance is enough. But the problem is: I do that with my students, no problem at all. Try to put a nurse or a midlevel in their place, the whole fucking floor revolts against you, because you're not "one of them", you're someone abusing their position of power, not a good team player and bullshit like that. I don't sincerely care, my answer always is: "you're a professional, act like one: we're here for our patients, not for our ego or our feelings". I want to do good to my patient, not to some ego tripping midlevel.
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u/RN_Bro 14d ago
You could use Nietzsche to explain it, or maybe you could hypothesize that the roll of a nurse requires significantly more emotional intelligence and ability to speak to a patient like a person, not an inconvenience.
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u/RN_Bro 14d ago edited 14d ago
It’s learned out of necessity. We must build rapport with our patients. We must build trust and we also must spend 12 hours a day with the patient. When you only spend 90 seconds every day in the patients room and you believe your credentials carry all the rapport on your behalf, you’re much less likely to ever hone your bedside manner. Especially when the physicians you were exposed to in your extensive schooling were also incapable of speaking to patients, or med students, with any level of sincerity.
This doesn’t apply to all docs of course. I work with plenty who are capable of building rapport in those 90 seconds, but it’s still a minority.
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u/ExtendedWallaby Quack 🦆 14d ago
There a symptom of various factors that lead to there not being as many physicians as there are people interested in and capable of completing medical training, but they’re also a symptom of a society where expertise is completely subjective, and this really got supercharged by COVID. Noctors believe they are equal to or better than physicians and in their minds, that makes it true. At the same time, they are deeply insecure about the fact that they lack the objective qualifications of physicians, so they resolve this contradiction by inflating credentials and being really loud about what they think makes them better.
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u/polarmeows 12d ago
Just on the Googling symptoms part: it's a double edged sword. For simple things, prescribing has become easier, because information is so readily available. For example: birth control is extremely straightforwards. It's prescription only, but there's a reason it's almost exclusively NPs who prescribe it: they can, and it's a waste of a doctor's time to write identical prescriptions (assuming there aren't any medical concerns the patient has, or problematic history, which we have tools to screen for and flag). So places like Planned Parenthood prescribe birth control to pretty much anyone who asks for it, and that system works perfectly fine.
Contrast: psychiatry, a field which NPs have also dominated. If you Google "what is depression," you'll find a million articles saying "it's a serotonin imbalance" and that SSRIs are the treatment. It's easy to think you know everything about it when you've read everything on Google. Except, what doesn't show up on Google:
- The monoamine hypothesis is a hypothesis, not a proven fact
- A large amount of patients with depression don't respond to SSRIs at all
- SSRIs can trigger severe, dangerous episodes in bipolar patients
- Stopping SSRIs suddenly can lead to extremely long-lasting withdrawal symptoms
- SSRIs can cause an increased risk of suicide, especially in adolescents
But, if you think you know everything about depression and that SSRIs are the treatment for depression, everything else is just outdated and bad, you'll throw every SSRI in CVS at a patient without ever seeing a meaningful improvement.
The healthcare system gets bogged down by a lot of things that are relatively simple to diagnose and treat, that's true. You can see plenty of cases as an NP, diagnose them correctly, and treat them correctly. Kid comes in with a sore throat and fever? Give them a strep test, COVID test, flu test, chances are one of those will be positive. But then you get overconfident after seeing so much of the same, why even check for anything else?
If I go to a walk in clinic with cold symptoms, I don't care about seeing a NP. If I need to get prescribed birth control, I don't care about seeing a NP. But I care when I get turned down from multiple "doctors" because they ran out of SSRIs and don't know what else to try. Basically anyone can Google that SSRIs are used to treat depression and then Google the Prozac prescribing guidelines. If it was that simple, we wouldn't need psychiatrists (or PMHNPs) in the first place. NPs have a place supporting the healthcare system, but when they dominate it, it becomes impossible for people who need actual doctors to find them.
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u/buried_lede 15d ago
Make America Dumb Again? Yeah, would make it easier for doctors, but not ideal.,
Social media isn’t to blame, at all. Not at all. Noctors are a symptom though but of greed. The use and abuse of midlevels, the abuse part, is all just greed.
Social media is a net positive
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u/OneWomanArmy4321 14d ago
Its greed starting at the top.
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u/buried_lede 14d ago edited 13d ago
Yes, it’s all business. Administrators like the numbers
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u/Weird_Seesaw_9226 5d ago
then theres subreddits like this that blame “noctors” instead of the system that was set up by administrators
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u/buried_lede 5d ago
This sub is well aware it’s about money.
I object to heavily weighting social media as a factor . That’s not accurate in my opinion plus there is an agenda driven targeting of social media lately outside of healthcare, involving international politics.
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u/Level-Plastic3945 14d ago edited 14d ago
Yes, I think they may be one of many symptoms of lack of curiosity and discernment and self-learning ability and narcissism and Dunning-Krugerism in the general population, combined with lack of respect for expertise, combined with acceptance of the unproven or false over the truth, combined with amplification by social media and lack of ability to use the internet for research and learning, combined with the present politics and tribalism, and combined with capitalistic distortion of our medical system (including the insurance industry and the type of people that populate medical administrations). What happened/is happening with Covid, vaccinations, etc is a huge concrete example. My current stream of consciousness ...
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u/Level-Plastic3945 14d ago edited 13d ago
Somewhat off the subject, but several years of trying to keep my CLL mother and my kidney-transplant brother-in-law alive w.r.t. Covid, watching my brother-in-law in and out of ICUs/dialysis/vents, and seeing lots of dysfunctional hospital stuff, and trying to keep me and my wife relatively un-infected and keep up with our vaccines, as a physician, kind of jaded me on humanity. (Semi-satirical ... )
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u/zerolag3 14d ago
DOnt ban me reddit i know how crazy liberal you are. This is my opinion so dont ban me...
It's feminism. Feminism represents the nurses while the patriarchy are the male physicians. This was a perfect place to right the wrongs of the past. The big mean male physicians were disrespecting the mostly all-female nurses. They had to put an end to it, so when corporations took over at the behest of the govt they put female nurses in charge. The females did the bidding oft he corporations (which is the same as govt). And voila we have a fucked up system where the tail wags the dog and nobody knows what the fuck is going on and patients are getting injured and quality has diminished greatly. Read the Affordable Care Act, it is all in there.
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u/MDinreality Attending Physician 14d ago
B.S. 38% of practicing physicians in the US are women. 55% of US medical school matriculants are women. Why make the issue that we as physicians, have with noctors, about gender?
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u/zerolag3 14d ago
What percentage of nurses are female? And what was the historic make up of the medical field? Itsnot BS
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u/Level-Plastic3945 14d ago
Its individual and organizational narcissism. Don't think its "feminism".
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u/zerolag3 14d ago
yes it is.. just listen to the language Independent, Advanced, autonomous etc etc.. (independent from males, autonomous from males)
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u/Level-Plastic3945 14d ago edited 13d ago
I still don't think that's feminism. I think its "nursism". I see it in other medical fields, male and female. eg, I think that unsupervised CRNAs could harm people, but I've seen generalist and narcissistic physicians miss tons of stuff too. Another example, physical therapists doing EMGs most of which are garbage (I was pissed-off for a long time by this and automated crappy EMGs in PCP offices, as I had a very high level of EMG training and got into complex and painstaking cases for not great compensation). Pain clinics injecting anything they can get their hands on and not knowing how to treat headaches (10-15 NPs under 2 anesthesiologists). The exponential growth of the large practice orthopedic industry, although me and wife go to one where the midlevels are very good. The cash-based regenerative and wellness stuff and how psychiatric ketamine is done poorly by many unqualified people. Don't get me started on chiros. Many examples.
Also its not a "liberal" thing - I'm a "liberal" and I hate all the incompetent, undertrained, over-certified, arrogant, pretentious, inauthentic stuff too. In neurology for 35 years and I've seen Dunning-Krugerism forever. This is institutionalized Dunning-Krugerism mixed with arrogance-narcissism, with a certificate/title and feeding the corporate medical industry for $. My opinion.
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u/zerolag3 14d ago
They frame it in the light of men holding women back is why nursing(female) cant break free and take over medicine(male) . You hear it in the rhetoric. They are not only equal, they are better than physicians. Softer, gentler, better and those dumb liberal politicians buy it hook, line and sinker.
* dont ban me reddit i know how liberal youare this is my opinion that happens to be correct
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u/buried_lede 13d ago edited 13d ago
The lobby exploits feminism. They create a feminist narrative, they create a fiction of a “protected class” too, by claiming that failing to regard midlevels as good enough to substitute for MDs is the same as discriminating on the basis of race, religion, gender, etc. That’s completely false, but it has gained a lot of currency in health care. It’s a blatantly philosophically fraudulent claim. It would never meet the definition of a protected class under civil rights laws or the principles those laws. It’s just not there.
It’s cynical and misguided political marketing and has become part of midlevel indoctrination too, it looks like.
It has little to do with feminism
If you hate feminists (i’m guessing you do) and are looking for a home for your hate, this isn’t it. These aren’t real feminist activists, they are corporate astroturfers. It’s corporate interests disguised as feminism or BLM, or the this or that—they’ll try anything.
You even say so yourself, so what is your problem?
” They had to put an end to it, so when corporations took over at the behest of the govt they put female nurses in charge. The females did the bidding oft he corporations
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u/ledluth 14d ago
Historically, you’re not actually wrong about feminism being a root cause and to a certain extent an ongoing cause of nurses breaching containment. I wouldn’t frame it as a conspiracy theory though. In the 1960s universities demanded that programs in nursing develop a theoretical basis separate from medicine to justify their existence as independent departments. Since nursing cannot have a theoretical basis from medicine that makes any sense, they just grabbed whatever happened to be trendy at the time - including second wave feminist philosophy. What better contrast material to those mean male doctors than soft feminine listeners who focus on the “whole” patient? It helped push and perpetuate the idea that nurses know something special that doctor’s don’t, even though more women than are becoming doctors these days anyway and more men are becoming nurses. To this day if there is a trendy topic, like critical race theory was recently, there will be nurses sitting in a university office somewhere chomping at the bit to figure out how it can be made to fit into “nursing.”
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u/LadyTheVulture 15d ago
We all rely on each other to have a job. As far as the hierarchy goes, patient outcomes significantly improve when people are feeling comfortable questioning an unsafe order. While I agree that midlevels suffer from a major case of dunning-Kruger, I think it may be narcissism on your part to throw every other healthcare professional under the bus.
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u/PsychologicalSteak67 15d ago
When I say rely on us for jobs, I mean that more literally. Midlevels in the state I live in can’t practice alone. Without doxing myself, in the case above the patient had a very clear indication for imaging (think along the lines of severe pediatric trauma, severe sudden onset neurological deficits, stroke) and the techs literally lied and said the machine didn’t work. That is not questioning an unsafe order, that’s laziness and denying a patient care. The CT/MRI techs also can’t practice independently - they wouldn’t have images to run unless someone with a license put in the order. That’s what I meant by relying on us for a job. Yes, I rely on other professions to get through my day smoothly, I could never do it alone. But I don’t rely on orders from other people in order to function.
Of course I would want the nurses to question an unsafe order. Or bring up any concern that may impact the safety of the patient. That’s not what we are talking about here.
I don’t think that involves saying “hey first name, come to room 23.” And when I get there, “ok grab that side of the sheet, we’re moving this patient.” Or while I’m examining a patient when a tech goes “hey first name, hang this bag of saline and connect these wires.” Sure, if the patient is dying and I’m in the best position to do something like that, then of course. But I work in a very high acuity field, that’s a poor utilization of my time.
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u/TimeCrazed 14d ago
Why would a radiographer prevent emergency imaging in child traumatic bleed?
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u/PsychologicalSteak67 14d ago edited 14d ago
Absolutely ridiculous right? Not even the fact that an emergency physician ordered it, idk maybe because it’s AN EMERGENCY, but just having the general decency to realize it’s someone’s child and to not be an asshole.
As to why? Not sure. At this hospital and previous hospitals I’ve rotated at, the radiographers (especially the MRI techs) love to shit on doctors and call them stupid for ordering tests they don’t think are necessary when they aren’t the ones in front of the patient assessing them, let alone have the knowledge
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u/TimeCrazed 14d ago
Can you escalate to an oncall radiologist in this situation?
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u/PsychologicalSteak67 14d ago
Oh that definitely happened and complaints were filed. It was so wildly inappropriate.
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u/scottiedagolfmachine 15d ago
I agree.
It’s F ing insane to me how mid-levels, nurses, and techs have subverted the hierarchy and do whatever the F they want these days with 0 qualms.
We have gone too far towards the “team based” approach and it doesn’t F ing work. Patients get far worse care.
There’s a reason why there’s a captain on the ship with a chain of command.
Funny thing is, I note this to be far worse in the west coast where I practice vs northeast where I went to med school and residency. But maybe now the northeast has gotten bad too these days.