Stonewalling Patient Choice

Dear Editor:

I found the article, "Stonewalling Patient Choice," in the August 2006 issue of Acupuncture Today rather interesting because, currently, there are already laws on the Texas books that provide for penalties for identifying oneself as a doctor or nurse when one is not.

Second, as a Certified Registered Nurse Anesthetist (CRNA), I have repeatedly had to correct, not only many in the general public, but also doctors and nurses who often call me "doctor." I cannot count the number of times I have introduced myself as a "nurse anesthetist" only to have the patient I am talking to conclude our pre-anesthetic interview with, "Thank you, Doctor Green." Then I have to spend more time explaining that I am not a doctor, but a nurse who specializes in anesthesia. This is a problem that CRNAs across the United States have had to deal with for years. I have had physicians call me doctor and when I correct them, state that they know I am a CRNA, but to them I am just like a "doctor." Sometimes, it doesn't matter how many times I correct the same person; they continue calling me doctor. Most CRNAs pass out business cards explaining who CRNAs are and what we do. Still, CRNAs get called "doctor." No law will change this problem.

Third, nursing is becoming more and more sophisticated in advanced practice beyond the level of "general nursing." Advanced Practice Nurses (APRNs) are providing health care in areas of the country where no physician is available. More and more physicians are relying on the APRN to treat patients when they cannot be available for a growing health care provider shortage. Training for APRNs is more extensive than in any other time in our health care history and include family practice, OB/GYN, anesthesia and many other specialties where conclusion of training currently awards the APRN a master's degree. Nurses are no longer the hand maiden of the physician, simply taking blood pressures.

As the education and training of APRNs become more rigorous and research-based, there is discussion at this time that the APRN will need a PhD degree to enter practice. This is where H.R.5688 is aimed. Many physicians are concerned that APRNs holding a PhD will identify themselves as "Doctor So and So" and the patient will assume they are medical doctors. However, professional nurses have and will continue to identify themselves to patients as their nurse, as our practice act has already stipulated and our ethics have demonstrated. There is no way to control the patient's perception that one is an MD, DO, or Dentist in light of the fact that CRNAs, who are APRNs, identify themselves every day as "nurse anesthetist" and are still called "doctor."

Additionally, patients should be more active in their health care. They need to know the medication they take and why, and they need to question their providers as to their credentials. Shamefully, many MDs who call themselves "anesthesiologists" are not board certified in anesthesiology. Will H.R.5688 include those who "mislead" the public into thinking that they are receiving care from a board-  certified anesthesiologist when they are not? All CRNAs in practice must be board certified or they may not practice anesthesia. Many anesthesiology practices where CRNAs and anesthesiologists work together do not explain to the patient that it is the CRNA who will be providing the anesthesia and not the anesthesiologist, who may only spend time with the patient during the pre-operative interview. Many of these anesthesiologists "mislead" the patient into believing that the anesthesiologist will be with them for the surgical procedure and never mention the participation of the CRNA. Will H.R.5688 apply to these practices?

H.R.5688 is an attempt to disparage the nursing profession that is becoming more and more advanced in health care. With that advancement and education come the credentials earned. I suggest that the people urging passage of this bill are more concerned with the bottom line than true patient care. Nurses have already earned the respect of their patients, as evidenced by the 2005 Gallup poll showing nurses rated number one in the annual poll about the "honesty and ethical standards of professionals." Nurses rated 82 percent while doctors rated only 65 percent. Since 1999, nurses have been rated number one every year except for 2001, when firefighters took the number-one slot.

Mark Green, CRNA, MSN

Support the Profession

Dear Editor:

I am appalled that a magazine that is supposed to support the organization for which it is named would show so little support for that community. The letter written by Eric Smith is a good example. What Mr. Smith said is not only true, but the AMA has actually allocated funds to do away with what they are calling substitutes for real health care. Why is Acupuncture Today hiding letters like this under "We Get Letters" instead of as an article that other practitioners could read and comment on? It is very true if we do not acquire some sort of political savvy, we will be trod under the feet of the AMA in the very near future. I personally do not see NCCAOM as a source of support at all. It currently cost more to be certified in acupuncture than it does to take the exams to be a medical doctor, chiropractor or registered nurse, or any two of those licensure exams. While NCCAOM shows no signs of being more than a testing service. Please show your support for the practice of acupuncture and make these articles available for everyone to read.

Sheryl Roe, LAc, MS, RN, RMT

The Writings of J.R. Worsley

Dear Editor:

I read Neil Gumenick's article in the August 2006 edition of Acupuncture Today with some dismay. I agree very much with Neil's wish to preserve the teachings of J.R. Worsley uncorrupted. However, he appears to base his criticisms more on semantics than substance.

Mr. Gumenick takes issue with the use of the term "Constitutional Factor" as an alternative rendering of Worsley's "Causative Factor" (CF). Many of us who trained with Worsley made this change independently. The reason is that Worsley inherited terminology (Elements, Meridians) from the customary usage of a certain time period. All these terms have been subject to some discussion as to their suitability. Many of us saw in CF an implied Western linear causality that Worsley clearly did not intend. Worsley's CF suggested rather a causal principle. And the term CF is also subject to some confusion with the seven international and six external CFs of disease.

It is hard not to assume that this critique is particularly aimed at the recent publication Five Element Constitutional Acupuncture by Hicks, Hicks and Mole. Anyone reading the book can clearly see that the authors express very clearly the primary importance of C(olour), S(ound), O(dour) and E(motion), which makes Neil Gumenick's critique very puzzling.

Neil Gumenick says that Worsley started training a group of people in 1997 to take over from him. I assume Mr. Gumenick is unaware, or inadvertently overlooked, the fact that Worsley started training people in the late 1960s, many of whom studied with him over advanced clinical programs, and hold advanced degrees conferred by him, of bachelor, masters and doctorates, each of which involved an advanced clinical intensive (and teaching students under his scrutiny) over two-year periods. And many of the holders of the last two degrees (including the authors mentioned above) spent many years working directly with Worsley in his school clinics. To imply that only those trained post-1997 are his true successors does a disservice to his long years of high- quality teaching.

Andrew Prescott, Dipl. Ac, LAc

The Treatment of Pertussis (Whooping Cough)

Dear Editor:

I wish to address the following quote from Jake Fratkin's recent article (Acupuncture Today, September 2006 issue). In that article, he states,

"The DPT vaccine uses neither thimerosal nor live virus."

This quote seems to be very suggestive and mislead the reader to think that thimerosol is seldom used in vaccines, when that is simply not the truth. It is one of the most commonly used substances to kill bacteria and the preferred method due to low cost. Labs would need to improve their sanitation if they could not use thimerosol. Economics is the reason and human safety is the illusion. I suggest that we look at the EPA and understand that thimerosol is a neurotoxin and that no amount is to be considered safe.

A former scientist and researcher at the CDC, Dr. Geier, and his son have undertaken extensive research into the area of vaccines and their safety. At a seminar in the Twin Cities a few years ago, he presented his information about thimerosol and its causitive effect known as ADD/ADHD. In addition, Dr. Geier conducted lab analysis of several commonly used vaccines and found that they contained thimerosol even when they were not labeled as such. He found that even the single dose vials contained thimerosol.

Vaccines would be one thing, but heavy metal neurotoxicity is another. We need to get better educated on this issue.

Mike W. Bowser, LAc

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