10-4 Magazine - For Today's Trucker

WHO’S WHO IN HEALTH CARE
By "DocNurse" Norma Stephens Hannigan

Do you ever get confused by all the titles you hear about having something to do with health care? Do you know the difference between a psychologist and a psychiatrist, a DO and an MD, an NP and a PA? It can be tricky, but here’s a basic guide so you can choose the type of health care provider who best suits your particular needs.

What does the title “doctor” really mean? The title doctor applies to anyone who has completed a doctorate, the highest level of academic achievement in an area. A dentist is referred to as doctor because he/she has achieved that level of expertise in the field. An optometrist is a Doctor of Optometry, although not a physician. Some pharmacists are called doctor if they have a doctorate in pharmacy. And now, nurse practitioners are also taking on the title of doctor if they have completed a doctorate in nursing practice. So, to make it even easier (ha ha), not all “doctors” are physicians.

Much has changed over the past 42 years in regard to who is providing primary care to the nation’s people. I say 42 years because that’s when nurse practitioners came onto the scene as a response to the shortage of physicians, especially in rural areas. Unfortunately, most people still do not know what they do or how they provide health care. This column, hopefully, will straighten that out.

But let me backtrack a bit. Most people do know what a physician does, but may get a little cross-eyed trying to figure out all the initials. The most common term is MD – medical doctor. This is a person who completes a bachelor’s degree, goes on to four years of medical school and then does a 3-5 year residency, depending on what the area of specialty is. Residency is the part of training where medical school graduates really learn how to deal with patients and illnesses. So, how are they different from DOs (doctor of osteopathy)? Well, it’s all in the philosophy of the field. DOs have essentially the same amount of training as MDs but also do additional training in osteopathic manipulative medicine, or muscle/tissue treatment believed to aid in improvement of the entire body rather than just one system. It’s difficult to tell the difference between DOs and MDs sometimes, however, because so much of the education and philosophy now overlaps. Both prescribe medicines and may do surgery. A primary care physician is one who usually sees a patient in the office and may also take care of patients in the hospital. Specialists focus on one particular area of health care like neurology or women’s health, among many others.

The difference between psychologists and psychiatrists has long confused many people – even some people who work in health care. Psychologists are not physicians, but do hold a doctorate in their field. So, psychologists are referred to by the title “doctor” but their work is in many ways different from that of psychiatrists, who are physicians. A major difference is that psychologists cannot prescribe medicines for their patients. A psychiatrist does write prescriptions where appropriate and manages their patients’ medications. The mainstay of psychology practice is therapy, short or long term, during which a patient discusses feelings and concerns and, with the help of the psychologist, learns to deal better with challenging situations. Some psychologists do testing to help understand better what the person’s underlying difficulties are. There are many specialties in psychology, just like there are in medicine.

Physician’s assistants (PAs) were added to the health care scene also in 1965 in response to the shortage of physicians and are trained in the medical model – the same style programs in which physicians are trained. They work closely with physicians and are supervised by them in the work setting. As a patient, you may not know that the person caring for you is a PA rather than a physician, because the style of caring for patients is very similar.

This brings us back to nurse practitioners (NPs). Like physician’s assistants and physicians, NPs diagnose, order diagnostic tests, and prescribe medicines in caring for their patients. NPs, unlike PAs, are independent practitioners who practice under their own licenses. The regulations governing NP practice vary by state – in many states there is no requirement for an NP to have an agreement with a physician; in some states, there is a requirement for a “collaborative practice” agreement. Currently, the requirement is for NPs to have completed a bachelor’s and master’s degree in the area of specialty. Some states require a national board certification for an NP to be able to practice. By the year 2015, however, the requirement to begin practice as an NP will be a doctorate. The main difference between the way that NPs and physicians practice has to do with the emphasis on health education, shared decision-making, and prevention that NPs focus on. Many studies have shown that patients do as well, if not better, under the care of NPs. Educating patients to take better care of themselves means longer visits and more talking about issues that impact the patient’s health, like emotional and social issues. Most patients like being able to spend a little more time to share what’s important to them and receive education about taking care of themselves and their families. Some nurse practitioners take care of general patients but many also work in specialties.

No one knows everything. ALL health care providers are obliged to know when they don’t know something and how to get help if they are unsure about how to take care of a patient. Regardless of who we go to for health care, we all have the responsibility of taking care of ourselves; our health care provider can’t do it for us.

Hopefully, you have a better idea of the different styles of providing similar health care services that different disciplines have. Don’t be afraid to compare – you may be pleasantly surprised by receiving your health care from a kind of provider you hadn’t known about before!

~ Dr. Norma Stephens Hannigan, who just graduated with a Doctor of Nursing Practice degree, teaches at Columbia University and has treated many truck drivers at the various clinics she has worked over the years. She currently writes from her home in Newburgh, New York.