Letters to the Editor: Managing chronic disease is one thing; diagnosing is another

July 9, 2010

Midlevels are NOT physicians and do not have the training and or experience to diagnose and treat complicated problems.

Midlevels are NOT physicians and do not have the training and/or experience to diagnose and treat complicated medical problems. In Wisconsin, advanced practice nurse prescribers (APNPs) can legally practice independently (with a collaborative agreement) and may have an independent office or be placed in a remote location by their group practice with the responsibility to see "all-comers," make the correct diagnosis, and prescribe appropriate treatment.

I have had the experience of observing an APNP with less than one year of experience be placed in a remote office to see geriatric patients with multiple diseases. A master's degree in nursing with limited training in physical diagnosis and very limited training in disease management and diagnosis is not a replacement for a family physician or internist.

Midlevels can be valuable in the management of chronic disease but not in diagnosing and formulating initial treatment plans for these patients. Checking medications, patient monitoring, etc., can save physicians time and promote improved care.

WILLIAM E. RADUEGE, MD
Vilas County, Wisconsin