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Experiment lets patients choose nurses over doctors


'It's the personalized care ...'

February 17, 1997
Web posted at: 8:45 p.m. EDT (2045 GMT)

From Correspondent Christine Negroni

NEW YORK (CNN) -- Renee D'Aiuta takes medical histories, does diagnoses and treats illnesses, and is trained to recognize rare illnesses and complications.

In other words, she does many of the things a doctor does, although D'Aiuta is not a physician.


She is a nurse practitioner, one of 20 participating at New York City's Columbia Presbyterian Hospital in a trial program conducted by Oxford Health Plans. A second insurance company, Prudential, is considering giving its customers the option of choosing a nurse practitioner for their primary medical care.

What prompts people to opt for nurses over doctors?

"They're friendlier, much friendlier," says patient Kirsis Sousa. "They give you better treatment.

According to nurse practitioner Edwidge Jourdain Thomas, "We provide an alternative to patients."(120K/11 sec. AIFF or WAV sound)

Nearly 30 years ago, nurses with additional education began handling routine pediatric care under the supervision of physicians. Certified nurse midwives expanded their role further.

'It's the personalized care....'

"If you talk to someone who's had a nurse midwife, for instance, they are eloquent about what is different from getting care from a physician," says Mary Mundinger of the Columbia School of Nursing. "It's the personalized care, the touch, the listening, the support."


Many physicians, who can have nearly twice the education and salary, are not nearly as enthusiastic about the idea.

"We believe that each brings something unique or special to the relationship and the care of patients," says Dr. Nancy Dickey, a family doctor. "But to suggest that those roles are interchangeable is probably inappropriate."

Columbia Presbyterian is reimbursed for nurse practitioners at doctor's rates. Yet critics charge that substituting nurses for physicians is nothing more than the insurance companies' attempt to improve the bottom line.

"If payers for care see they can decrease their costs by lowering the quality by paying for lesser-trained people to treat their patients, this may spread," says Dr. Stanley Grossman of the New York State Medical Society.

And if a turf war follows, nurses may have a difficult time convincing doctors, "This will only hurt a bit."


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