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Old 03-24-2020, 02:53 PM
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What exactly do additional medical professionals **do**?


In some of the worst-hit pandemic areas, all doctors whatever the specialty have been called up to treat the ill. In Italy, they have placed psychiatrist on duty in the wards, and not for mental health. I understand a doc is a doc, whatever the specialty, but for say an older psychiatrist, eye surgeon or a dermatologist whose last time dealing with respiratory illnesses and probably are not terribly current on the latest developments, was decades ago as a young Doctor, how would they be best used? Same for retired Doctors.

Some places have called medical students and trainee nurses, the same questions.

Last edited by AK84; 03-24-2020 at 02:54 PM.
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Old 03-24-2020, 03:02 PM
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Originally Posted by AK84 View Post
In some of the worst-hit pandemic areas, all doctors whatever the specialty have been called up to treat the ill. In Italy, they have placed psychiatrist on duty in the wards, and not for mental health. I understand a doc is a doc, whatever the specialty, but for say an older psychiatrist, eye surgeon or a dermatologist whose last time dealing with respiratory illnesses and probably are not terribly current on the latest developments, was decades ago as a young Doctor, how would they be best used? Same for retired Doctors.

Some places have called medical students and trainee nurses, the same questions.
Orders need to be given by a physician, as nurses don’t have licenses to practice medicine. That being said, I suspect that in these situations what actually happens is an experienced ICU nurse makes “suggestions” or “recommendations” regarding things like ventilator settings. The retired psychiatrist or gynecologist who has spent the last twenty years doing office based gyn work and who last dealt with vents for only a few weeks during their ICU rotation in residency then agrees to write orders to carry out those “suggestions.”

Last edited by FlikTheBlue; 03-24-2020 at 03:03 PM.
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Old 03-24-2020, 03:12 PM
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And for the record, if I was a patient in the ICU in that situation, I would feel safer with the ICU nurse managing my ventilator settings than with a physician who has little experience in ICU medicine.
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Old 03-24-2020, 03:40 PM
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PAs and some nurses can prescribe drugs. I think the nurse has to be nurse practioner and work with a Dr. Also the PA must work with a Dr.
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Old 03-24-2020, 04:16 PM
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Also, there is a lot of ancillary work that has to be done in the hospital, even if it is only paperwork.

I am sure that many of the last-year students or retired doctors/nurses are put to work in peripheral tasks that have to be done by somebody with at least some knowledge of nursing and medicine, freeing the rest of the doctors and nurses to dedicate themselves 100% to treating the patients.

As an aside - all the medical and nursing students that happened to be doing their final training and residencies when this thing exploded...... talk about a baptism of fire!! If they get through this in one piece, they are going to be incredibly well prepared......
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Last edited by JoseB; 03-24-2020 at 04:18 PM.
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Old 03-24-2020, 07:02 PM
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Psychiatrists are medical doctors.
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Old 03-24-2020, 09:48 PM
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It’s a tough question because there are many specialties and settings where one might practice. Their knowledge of general medicine may range from excellent to rusty. The amount of assistance they get from nurses would vary - indeed some nurses know a great deal of medicine. But all of the doctors and many of the medical students are skilled at learning and could pick up some things. I’m sure the areas like ICU where more knowledge is required would not be available to all. In remote settings, with no or few doctors, nurses or other professionals basically do their best. As they would here.
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Last edited by Dr_Paprika; 03-24-2020 at 09:49 PM.
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Old 03-24-2020, 10:04 PM
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Originally Posted by Bijou Drains View Post
I think the nurse has to be nurse practioner and work with a Dr.
Nurse practitioner, yes( which these days I believe always requires a graduate degree ) - but prescribing authority varies from state to state. Oddly I was just looking this up for someone the other day.
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Old 03-24-2020, 10:10 PM
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Originally Posted by JoseB View Post
Also, there is a lot of ancillary work that has to be done in the hospital, even if it is only paperwork.

I am sure that many of the last-year students or retired doctors/nurses are put to work in peripheral tasks that have to be done by somebody with at least some knowledge of nursing and medicine, freeing the rest of the doctors and nurses to dedicate themselves 100% to treating the patients.
This is it, exactly.

Got a nurse who can't lift patients any more? They can administer IVs, chart, call the doctor, etc. They could also work in a field that isn't as physical so a nurse who can, may transfer to the ICU or a more acute floor.
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Old 03-24-2020, 11:56 PM
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Psychiatrists are medical doctors.
Yes, yes they are - and chances are very good that during their training they did rotations in the ER, in surgery, in obstetrics, and so on.... but you wouldn't want one removing your appendix any more than you'd want a dermatologist managing your antipsychotic medication.

I suspect that
a) they're there to rubber-stamp what the experienced ICU nurses are saying to do (as others have noted),
b) to quickly learn the basics of what needs to be done for these patients: while managing a COVID case is certainly more than a quick pulse check / heart listen, they can very quickly learn much of what is required to assess the patients. Their first 2/3 days they might be more hassle than help but after that they would be useful.
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Old 03-25-2020, 03:13 PM
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Originally Posted by FlikTheBlue View Post
Orders need to be given by a physician, as nurses don’t have licenses to practice medicine. That being said, I suspect that in these situations what actually happens is an experienced ICU nurse makes “suggestions” or “recommendations” regarding things like ventilator settings. The retired psychiatrist or gynecologist who has spent the last twenty years doing office based gyn work and who last dealt with vents for only a few weeks during their ICU rotation in residency then agrees to write orders to carry out those “suggestions.”
My brother was an Intensivist for a while. Mirroring a well-known Vietnam-war army officer, he would introduce his trainees to the the Charge Nurse, and tell them: "She has been an IC nurse for 20 years. She has no plans to change jobs. When you have made your way to the top and are sitting in an office as head of ICU, she will still know more about Intensive Care than you do. She has my complete trust. If she disagrees with something you want to do, you should follow her advice. If you have any questions, you should call me."

ETA: but if called up doctors are put into an ICU, it will only be watch the patients while somebody else rests.

Last edited by Melbourne; 03-25-2020 at 03:17 PM.
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Old 03-25-2020, 05:20 PM
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There is a long series of provisions for what additional medical "professionals" can actually "do" in the NYC governors declaration:

No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency

Stuff like students allowed "to volunteer at the healthcare facility for educational credit as if the student had secured a placement".

Lots of purely regulatory requirements relaxed.
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Old 03-25-2020, 05:32 PM
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My understanding is in Italy they are calling student doctors to the field to work. The student doctors replace more experienced physicians in places like nursing homes, so those experienced physicians can work in hospitals.
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Old 03-25-2020, 05:44 PM
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These are Interns - 1st year Residents

Quote:
Arkansas Gov. Asa Hutchinson said Wednesday that he'd authorized emergency temporary medical licenses for medical residents who have completed one-year of training.

Hutchinson said in a news conference that expediting the licensing process has added 100 new physicians to the fight against COVID-19 in the state.
http://katv.com/news/local/arkansas-...-test-positive

Last edited by aceplace57; 03-25-2020 at 05:48 PM.
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Old 03-25-2020, 06:16 PM
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My sense is that they allow every one in the chain to work to the top end of their scope of practice.

A hospitalist who now mostly rounds on moderately ill inpatients (managing their fluids and antibiotics and such) is well equipped to quickly move into an ICU setting if needed. The recently retired internist who is a long way away from providing care in an ICU can move into the moderately ill patient care spot and allow the hospitalist to move over into the ICU. A psychiatrist can serve the function a first year resident (intern) doing the scut work and managing patients under supervision of the internist back in service. In a critical staffing circumstance there is even a role for the pediatricians to help out in ED seeing the kids who come in so the ED docs can handle the load of sicker adults.

The idea is not to have a retired psychiatrist do ICU care but to move others up to the top of their ability spectrum.

Last edited by DSeid; 03-25-2020 at 06:17 PM.
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Old 03-26-2020, 02:11 PM
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I guess a psychiatrist would also be useful in providing counseling to patients and loved ones....
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Old 03-27-2020, 01:02 PM
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Friend of mine is a retired orthopedic surgeon. He came back to do rounds for non-COVID patients so that the active doctors that have any sort of competency in the area can be dedicated to COVID stuff.
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Old 03-27-2020, 01:59 PM
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People are still having babies and psychiatric problems during this time. The younger doctors with more recent training are probably dealing with co-morbidities-- I'll bet there are tons of street people with mental illness coming up positive; and pregnant women with routine pregnancies and babies who are vulnerable just by being babies, may be in special isolation areas with the recent-returns; meanwhile the current doctors are poised to handle deliveries for Covid+ pregnant women.
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Old 03-27-2020, 02:04 PM
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Friend of mine is a retired orthopedic surgeon. He came back to do rounds for non-COVID patients so that the active doctors that have any sort of competency in the area can be dedicated to COVID stuff.
Right... Also, specialists like orthopods and plastics are helpful at taken some burden off the ER's, as they can evaluate and treat broken bones and lacerations without the patients ever going to an actual hospital. I believe NYC has set up some special locations for this purpos.

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