Nurse Practitioners

I would like to commend Sara Fritz on her article (June 28) regarding the role of the nurse practitioner (NP) in health care reform. As a clinical instructor at UCLA School of Nursing in the master's nurse practitioners program, I have had the opportunity to see firsthand the valuable contribution our nurse practitioners have made in the health care arena. Studies have repeatedly suggested that nurse practitioners are cost-effective, have improved access to care and improved quality of care in many settings.

Blurry days for film Re "The dog days of moviedom," March 30 If movies are so bad, how come we are watching them at home, lining our queues with what we want to watch? I think not. The experience of "going to the movies" is just too expensive, lacks value and hence becomes a special occasion only. For instance, last weekend I took my daughter to see "Beastly" for her birthday. The kid ticket cost $9 and a small popcorn and a drink cost $10. When so many folks are spending no more than $5 on lunch or dinner off a value menu, I fail to understand how the movie industry doesn't get that you can't drive frequency with a lack of perceived value.

The article about walk-in clinics by Shari Roan ["Bread, Milk -- and a Diagnosis," Jan. 22] was interesting, but unfortunately focused on a narrow area of nurse practitioner practice. As early as 1971, Kaiser Permanente began educating experienced RNs as nurse practitioners in obstetrics/gynecology, internal medicine, family practice and other areas. I was one of those nurses and can testify to the rigorous, thorough training we received. We worked in "modules" along with physicians -- examining, treating, teaching and planning care for our patients.

Savinh Pouv wears a white coat, treats patients and is considered a primary care provider at the Los Angeles County clinic where she works -- but she is not a doctor. That does not matter to Maria Avalos. What matters, the 55-year-old homemaker said, is that when she comes to the Long Beach clinic to get treated for her diabetes, she always sees Pouv, a nurse practitioner. "Before, they sent me from one to another" doctor, Avalos said during a visit last week. "I like her --she checks me well, she has my records, she checks my medications and changes them if I need.

The studies cited in your article about the quality of care by nurse practitioners looked at nurse practitioners and physician assistants and came to the conclusion that both professionals provide quality primary care equivalent to that of a physician. At a time when the health-care system is failing, nurse practitioners and physician assistants provide existing models of a way to provide improved access to quality care at significant cost savings to society. It really makes no sense to spend money for eight or 10 years of training when the same quality care can be provided after only two or three years.

To those patients who are convinced a doctor always knows best, Columbia University nursing school researchers would argue that isn't necessarily so. When it comes to the common, everyday concerns of medical care, from managing diabetes to controlling high blood pressure, nurse practitioners are as effective as physicians and as well-liked by patients, according to the first large study to compare the merits of the two approaches.

Savinh Pouv wears a white coat, treats patients and is considered a primary care provider at the Los Angeles County clinic where she works -- but she is not a doctor. That does not matter to Maria Avalos. What matters, the 55-year-old homemaker said, is that when she comes to the Long Beach clinic to get treated for her diabetes, she always sees Pouv, a nurse practitioner. "Before, they sent me from one to another" doctor, Avalos said during a visit last week. "I like her --she checks me well, she has my records, she checks my medications and changes them if I need.

Mistrustful of condoms, Pete Barnum-Wood, 26, wanted a more foolproof birth control method. So who did she call? The family nurse. "Mary never talks down to me," Barnum-Wood explains. "Physicians, be they male or female, often do." From her offices in a pumpkin-colored concrete building across from Ventura's Community Memorial Hospital, Mary Jones issues prescriptions, performs cervical biopsies and diagnoses diseases from chlamydia to cancer.

Fanning out through this city's old neighborhoods, doctors and nurses from a local medical center have adopted a practice that harks back to a bygone era: They're making house calls. Surprising as it may seem, this throwback approach may offer a path toward the elusive goal of providing better medical treatment at lower cost. And although the proposal has generated fewer fireworks than the proposed new government insurance plan, experts say it may help transform the nation's healthcare system.

Officials at a clinic that treated Dae'von Bailey six weeks before he was found beaten to death said Friday that their staff had warned social workers he might be an abuse victim, contradicting an account by the Los Angeles County child welfare department about how it dealt with the abuse allegations.

The article about walk-in clinics by Shari Roan ["Bread, Milk -- and a Diagnosis," Jan. 22] was interesting, but unfortunately focused on a narrow area of nurse practitioner practice. As early as 1971, Kaiser Permanente began educating experienced RNs as nurse practitioners in obstetrics/gynecology, internal medicine, family practice and other areas. I was one of those nurses and can testify to the rigorous, thorough training we received. We worked in "modules" along with physicians -- examining, treating, teaching and planning care for our patients.

A trendsetter in many ways, California is behind the curve when it comes to retail-based health clinics. Other states, such as Minnesota and Ohio, have seen dozens of such outlets open and flourish in the last five years, but California has only a few. Now owners of retail-based clinics, plus some healthcare consultants and economists, are pushing for changes in laws that could make the state more accessible to them.

Re "Needs of Patients Outpace Doctors," June 4 As a practicing cardiologist for 30 years, I have seen many colleagues retire early or leave the area to avoid losing their autonomy and pride. They refused to practice HMO medicine, giving their patients inferior care dictated by faceless bureaucrats of the insurance industry. I tried HMO medicine briefly and left it in a hurry. The only way to bring bright minds back to this great profession is to restore the honor and professional integrity by eliminating HMO medicine and restoring doctor-patient confidentiality.

Her face illuminated by the fluorescent white glow of two computer monitors, Dr. Jenna Liu examined a CT scan of a car crash victim's stomach. Liu, a radiology resident at UC San Diego Medical Center, scanned through shots of the patient's kidneys, noting the abnormal fluid around one. It wasn't long before the phone rang. A fax had arrived. "That's NightHawk," Liu said.

Coming soon to a department store near you: medical care. Adding a new spin to shopping centers' all-in-one idea, department stores, grocery chains and other retailers are adding medical clinics that promise to diagnose and treat common ailments such as ear infections and sore throats in as little as 15 minutes. No appointment necessary.

The nation's largest group of pediatricians wants lawmakers to maintain limits on the health care nonphysicians, such as nurse practitioners, can give to children. The American Academy of Pediatrics is encouraging its doctors to work to block legislation allowing people who are not physicians to write prescriptions independently and permit parity in insurance reimbursement.