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February 16, 2011

Inbox — Feb. 16, 2011

Letters to the Editor

Love Hurts
OK, we get it — it’s the Me Millennium. The Minnesota Multiphasic Personality Inventory has found it necessary to recalibrate its narcissism scale, and the American Psychiatric Association has decided to drop the diagnosis of Narcissistic Personality Disorder from the latest edition of their “Diagnostic and Statistical Manual of Mental Disorders.” Nonetheless, the gooey pink sidebars in your grammar-free sex survey article highlighting how various members of your staff managed to snag a significant other crossed a lot of lines that seem to be trampled with increasing regularity (LEO Weekly, Feb. 9). When you had certified lunatics like Carl Brown and Sean Garrison writing for you, the answers to the unimaginative rote questions would have at least been interesting.

An alternative publication has perhaps an even greater obligation to distinguish between reporting or commenting on the news and being the news. To become news, a “staff member” needs to be beaten in quest of a story, arrested or appear on a crappy national TV show. You would have been better off sending the Bar Belle out with a tape recorder and a tequila budget than buttonholing employees in the office. Don’t go all Velocity on us.
Vincent J. Callahan, Highlands

Education is Key
I wish to express my thanks and appreciation for the article Steve Shaw wrote in support of Kentucky nurse practitioners and increasing access for Kentuckians to excellent and appropriate health care (LEO Weekly, Feb. 2). In language that we can all understand, you effectively described the turf and financial battle that is being waged against the NP. For three years, I worked in a rural clinic and saw firsthand the medical needs of the poor and rural Kentuckian. I now work in a walk-in clinic, and the need is still very real in our society of the unemployed and under-insured. Helping remove the impediments to reaching and treating these patients is crucial. Educating the public to the problem is key to resolving these issues. Thank you again for being a responsive voice for Kentuckians in need of excellent and cost effective health care.
Dianna Hand, APRN, FNP, Paducah, Ky.

Bad Medicine
Steve Shaw’s “Mad medicine” piece did a fine job of elucidating the economic and political intricacies regarding APRN scope of practice, but failed to address the most salient point: quality of medical care.

To preface, I have great respect for APRNs and other mid-level practitioners. On my family medicine clerkship, I worked with them extensively and would personally trust them with my care.

However, as veterans with years of experience, their level of clinical competence is vastly superior to newly minted APRNs applying for certification, which requires only 500-600 clinical hours.

Now consider that I, a medical student in my first clinical year, have completed 1,415 clinical hours as of this week and more than 2,000 by July. Nevertheless, no one is lobbying to give me a prescription pad. (Not that I want one.) Additionally, family physicians entering practice have a staggering 15,000 hours.

According to a 2009 APRN journal article, the 500-600-hour mandate appears to have been chosen arbitrarily, with no scientific studies to assess its sufficiency. Additionally, a 2004 survey of APRNs found that 46 percent didn’t feel “generally or well-prepared” concerning pharmacology. Why, then, would we rush to grant them greater pharmacopeial privilege?

The need for primary care physicians is indisputable, but the restriction of residency positions by the federal government explains why the number of APRNs is increasing more quickly than physicians. In the end, though, we can’t pretend that APRNs have the same clinical skills as their MD counterparts, because the training hours are just too disparate.
Paul Mick, Highlands

He Said, She Said
As a soon-to-be nursing student and current mental health professional, I was excited to see “Mad medicine” on the Feb. 2 cover. The push and pull between the medical and nursing communities is, as Steve Shaw pointed out, a key aspect of the continuing health care crisis in this country. What I found hard to digest in the article was the sexist language. In almost every quote from the medical establishment, nurses were inevitably referred to as “she/her” while medical doctors were invariably “he/him.” It seems symptomatic of the larger issues at work in this debate. Not only is the medical community protecting their financial territory, they’re obviously protecting their patriarchal domain from what they see as an invasion of undereducated and incompetent females. Shame on those greedy misogynists for standing in the way of improving access to affordable, quality health care in the commonwealth.
Candis Calvert, Old Louisville

Improving Care
I want to comment on the excellent article, “Mad medicine,” written by Steve Shaw. Steve captured the essence of the problem and was able to factually convey the discourse between the opposing sides.

I am a nurse practitioner (NP), and I practice in a medically underserved area in south central Kentucky. I know firsthand how practice barriers prevent NPs from improving access to health care.

Research spanning almost a half century bears out the fact that nurse practitioners and nurse midwives provide quality, cost-effective health care services. These health care providers are dedicated to their patients and want to help improve access to care.

Nurse practitioners and nurse midwives in Kentucky were delighted with the story and happy that your paper helped to get the word out. Thank you. And yes, the link to the article was sent out to NPs and NMs across the state!
Beth Partin, DNP, APRN, Columbia, Ky.

Stepping Out
There is no way to thank you enough regarding your “Mad medicine” article. It was extremely well written and absolutely on the mark in every detail. This article by Steve Shaw could have extreme ramifications for the state of Kentucky — in saving monies for our state now and in the future.

Thank you so much for stepping out and taking a stand on such an important Kentucky issue/cause.
Diane Crawford, NP, Mental Health VA Clinic, Shelby County, Ky.

Support Group
I just read the article in your magazine regarding nurse practitioners, and I just want to thank you for the words for NPs. I’ve been an NP for almost five years, and all I have ever worked in is rural health care clinics, which is the type of patient I love seeing. There are not many physicians around who go into family practice for the money. They come out of school with thousands of dollars in school loans and debts and choose specialties that pay a higher salary. Thank you for the kind words and support.
Denise Gilbert, MSN, NP-C, CEN, Homestead Family Practice, Springfield, Ky.

Whiskey Row Challenge
Downtown Louisville was once our soaring city center, our common ground, our gathering place that gave us a sense of place. Then we handed over our downtown treasure to developers who tore it down to save it.

Those Main Street architectural gems should have been protected and resurrected long ago — not almost saved on the eve of destruction. Putting downtown heritage in harm’s way — letting Whiskey Row and once-magnificent Fourth Street rot for decades — is failed leadership, and our failure, too. Should we now be grateful that a priceless Main Street façade was almost salvaged? Leaders sidestep with face-saving excuses for decades of inept preservation. But our present plight involves far more than troubled Main Street. For half a century, Louisvillians allowed downtown to die and decay. Bulldozers leveled West Chestnut Street and tore the life out of Fourth — the heart and soul of our city. We exited downtown and extended suburban sprawl to far reaches, now unsustainable.

Accept developer Todd Blue’s Whiskey Row challenge: “… go raise money, get some partners, buy the buildings.” Demand that our leaders restore Whiskey Row. Stop accepting a downtown substitute of phony facades and generic replicas in a part-time ghost town. After devastating floods and tornados, our ancestors rebuilt Louisville. Now we need to rediscover our collective civic vision, our talent and our energized determination. We must rebuild a living, breathing, thriving dynamic downtown — a downtown that soars and restores us to that historic common ground and reconnects us to our city’s sustaining sense of place.
Michael Gregoire, St. Matthews