Oh, how I drank the Kool-Aid when I first began practicing as a nurse practitioner. Actually, I was a big believer in medicine when I was an RN. I was fascinated by all the testing and imaging and magical medications.
I am not sure when it changed. It wasn’t like a Copernican revolution. It was more like a tipping point. But at first, I loved guidelines, Epocrates, and oh, how I loved the drug reps. They are so damn smart and brought me presents of pens, and nice suppers, lunches, and endless supplies of paper. They gave me free samples for my patients. They brought me lovely graphs and industry funded studies. And all drug reps are so pretty and fit!
In nursing school, we were taught to follow guidelines and orders. But, mostly we didn’t need to worry our pretty little heads about all those studies. We were taught to critique studies, but who actually had time for that? That is what expert guidelines were for. Of course I believed all those guidelines were written by the best and brightest folks ever. I assumed that they had lots of evidence for their recommendation. Of course they did, right? They are the experts.
Much of graduate school was spent in reading and critiquing research articles and learning to design studies, but once again, following guidelines was important. Now we know that all those rectal exams, PSAs, PAP test, and many other screenings were more likely to do harm than good. I attended Pri-Med conferences faithfully, where I was learning that the whole nation just suffered from a Statin deficiency.
That first year in practice was so overwhelming with all the new skills to learn and those nice drug reps seemed to just truly care about me. They always apologized for taking my valuable time and brought me goodies just to listen for a minute or two and sign some digital scan that I heard them. I drank more Kool-Aid with every free lunch and dinner.
But, I discovered podcasts, audible books, kindles and the inter webs and starting learning that those adorable little drug reps did not care about me as much as they said. I learned that those expert guidelines may as well been coming from a seance as from expert opinion for the actual evidence they presented. The drugs were being recalled because of unforeseen harms. Guidelines were being challenged left and right. The longer that I have been in practice, the more glaring the problems in the whole system of health care seem to me.
This blog is a place to talk about the books, pod casts, patients, providers, nurses, assistants and documentaries that influenced my practice. Sometimes, I may just vent my frustration, but more often I hope to explore some real world solutions to what ails us.