Tuesday, June 9, 2009

Hey Doc, could you look at this...

As previously discussed, my role here is, first and foremost, senior medical provider. The senior part is just to make it sound important. In reality, I am the ONLY medical provider to members of PRT Parwan. I am lucky to have two very experienced and motivated medical technicians, but the buck stops here—with me.

The military is its own animal when it comes to using “mid-level practitioners” (a term I really dislike but it does clarify where we fit into the medical provider picture). In addition to nurse practitioners (NPs), there are also lots of physician assistants (PAs) to be found. And don't get me started on general medical officers (GMOs), medical school graduates with a single year of internship who, for whatever reason, do not enter a residency. They are sent to various assignments in physician billets but are not really qualified for that level.

We NPs continue to be licensed in our state of choice and we carry the required certification, depending on specialty but, within the walls of our military treatment facility, we practice fairly independently. We have full prescribing authority, are empaneled, have our own patients and conduct our own peer review. Some days, I equate it to hanging out a shingle and starting your own practice. I'm lucky. At home, I work with two great physicians who are ready and willing to answer my questions, or help me find answers when none of us have them.

On deployment, the independent practice concept can be taken a step even further. We NPs and PAs are often deployed forward of a hardened medical facility, where the physicians and surgeons stay, awaiting arrival of the really sick and injured. They are a phone call or Internet connection away, but there are no hallway consults. And, with luggage weight at a premium, our reference materials dwindle to what we can load into a PDA or find on a somewhat unreliable Internet connection. You quickly realize that explaining to every last troop what an NP does and what our unique role is is just more than they want to know. They want to know someone is there to take care of them when they are sick or injured, and “Doc” quickly becomes your accepted call sign.

Here at training, I am already getting the request to “take a look at this.” Thankfully, it is usually a sprained ankle, bug bite or, for many, the cold virus that has quickly spread among units (can't be helped when living in such close proximity). My goal now is to build confidence for when we are downrange and the concerns get different. Stress can reveal itself in many forms, including physical and mental fatigue, illness and even thoughts of suicide. As an NP, my strength for that “gut feeling,” when it comes to my fellow PRT members, will be critical, as mission preparedness can often equate to mission success. So, NPs of the world, never fear. I will continue to laud our strengths even while answering to “Doc” for the next year.

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