Home Forums Discussions General Discussion Pop quiz hot shot! What do you do?

Someone essentially invites them self over for Christmas. They bring a friend to dinner. We feed them a meal they would have never had. You give him a brandy snifter of 100 year Gran Marinier (sp). Then he has dessert and tells you "We don't need doctors anymore, pa'sand np's are just as good? ( I was a pa also).

As I with held the urge to front snap kick his testicles, I just waked away In the spirit of not ruining the dinner.

When did people lose respect for who we are?

Pop quiz hot shot. What do you do?

Frank,

Setting aside the temptation to girl-slap him and take the beverage into protective custody ...

I prefer reasoned direct confrontation, thus:

What a novel concept - "good enough". by that measure a skilled metal worker can displace the licensed structural engineer, make changes to the load-bearing components of your home, and hopefully they are "good enough".

How about the desert chef who subs for the meal caterer of your major event? He's far better with pastries, but perhaps he is "good enough" that all of your guests won't get food poisoning.

Someone may be very skilled in a particular area, or specialty, but it is a false equivalence to wave your hand and say "good enough".

That kind of BS goes out the door when someone wants the best they can get/afford, and gets a dismissive "good enough".

I used to prowl the main-spaces in coveralls when I was in the Navy, and would go off on repair workers when I heard "close enough for government work" around major equipment. My rant was some variation of [critical equipment] will operate at ~ 1300 PSI/ 900 degrees F, and my guys and I are going to operate X and stand watch around it for the next 6-18 months. It either passes spec or it doesn't - don't give me "close enough".

Frank,
I would explain: "In some circumstances, a PA or NP can be just as good. There are other times where the difference can be critical. There are times when a lunch at your local sandwich shop is just fine. On the other hand, there are times where you want to eat a meal like the one we were kind enough to have just served you, and I would imagine that you can see the difference."
In the spirit of Christmas, invite him back for dinner next year, but instead of 100 year old Gran Marnier, serve lukewarm diet Coke. If he has the nerve to complain, explain that in some cases it is "just as good".

JBS - the typically reasoned, urbane approach. Notice that JBS is in for the long-game; he is willing to wait a year to let that diet Coke to sit and get warm & flat.

I like this idea, but variation on a theme. What's the worst possible alcohol you have in your house? Ask them to suspend drinking the Grand Marnier and try some of this. Then explain that for some things "good enough" will do, for others, you may need "finesse."
People are entitled to their opinions, sometimes it is not worth the effort to try to explain. They may be looking for a fight.
I am slightly unsure who made the comment, the friend who self invited or the friend of the friend. (I am assuming the latter, but really doesn't matter.) In either case, I would simply not invite either person next year. If friend shows up, simply state that you will sponsor them to a Subway dinner since it is good enough.

Frank,

I think you did the right thing by just walking away. Obviously this person doesn't know what they are talking about and arguing/debating would have been a waste of time.

Myself being a PA, I work closely with my physician and we have a great working relationship. I know my limits and when to refer to someone with more knowledge/experience than myself. We are always going to need doctors.

Thank you for the support!

Happy New Year.
What led up to that remark? Why did he need to say it?
Was he just baiting you?

In any case, it doesn't make any difference what any of us think.
The insurance companies now have all the cookies, and they will decide what is good enough.

I vote for walking away from conversations like that.

"It is by the goodness of God that in our country we have three unspeakably precious things: freedom of speech, freedom of conscience, and the prudence never to practice either of them."

Mark Twain

You are obviously a wise and prudent man!!!!!!

Maybe it was the Gran Marinier or the need to talk about Obamacare?

Another pertinent quote by Twain: "The trouble ain't that there's too many fools, but that lightning ain't distributed right."

Frank,
I would like to respond to you by first Explaining my unique perspective. My training started out as a PA in thoracic surgery and critical care medicine coupled as an AA (anesthesiology assistant). Then after a rush of insanity, I went to medical school. Completed residency and a little extra training and then went to work. As a boarded anesthesiologist in private practice,I have hired and fired many CRNAs. Needless to say I have Experience with all kinds of healthcare providers at all levels.
With all that, I learned how to put all things in perspective when I was on my first few nights OR/trauma/ICU call as an attending in private practice. During those nights, I would look over my shoulder and no one was there. The decisions I made and actions I took were mine alone. It was then that I realized what It meant to be a physician.
Non-Physician practitioners will never know what that's like because they will always have someone behind them.
When someone pulls on your superman's cape, just ignore them because they have no idea what they are talking about. Their In -experienced opinions are not worth wasting your time on.
In addition, it's not the number of letters or the type of letters behind your name, it is the patient care you provide that matters. There are many CRNAs and PAs who I would rather put me or my family to sleep than some MDs.

Nate

Tell him that E&J Brandy is good enough, and give that to him. Hey, he probably can't tell the difference between that and Bran Marinier. And if he can, maybe he will think twice about his statement.

Nate,

I too started as a PA working for two surgeons in a small Kentucky town. One of the guys was also boarded in Internal Medicine so I did a little bit of everything. I was comfortable when I knew they were watching over my shoulder or when they walked out of the OR and told me to close, knowing they were in the doctor's lounge if I needed them. But then they told me to close and left the building and I went "WHOA!!!! I do not know enough. I am not confident enough. I am not trained enough!" Scared the begeesus out of me. So I decided I needed to learn more, develop more leadership skills, gain the confidence needed to "take charge, make the final decision and stand by it". It was medical school, internship, residency that changed me from a follower to a leader. I had most of the skills already, I just needed the mindset. My family still cannot get over the transition in my personality, some for the good, some for the not so good. But, regardless, I am very different from the PA I once was, both in my skills as a physician and my skills as a leader. I know, as a PA, I was not good enough to do what was being asked of me.

Never wrestle with a pig. You only get dirty, and the pig enjoys it.

...sent from the beach at Raja Ampat. Happy new year.

Frank, let that guy who made the comment see a P.A. or N.P. If something in his care gets mishandled by someone with less training, then he probably deserved it given his ignorant comment. 2 years of training after college does not equate to the 7 years of training we did after college. If his idea of "new math" is that 2 = 7.......enough said.

You and I know the value of a good physician. I'll stick with a PHYSICIAN for helping in my personal health care needs.

sounds like you did the right thing by walking away.

Happy New Year

Thank you all, once again.

1/2/2014. And so it begins again.

Taking care of patients. Maintaining lone wolf status.