Harvard Men's Health Watch

Medical memo: Medical teamwork - it works

In the old days, when you were sick or needed a check-up, you went to the doctor's office and you saw a doctor. Today, though, when you go to the doctor's, you may see a nurse practitioner or a physician assistant. They are specially trained health care providers who are tested and licensed. Often they work under the supervision of an M.D., but sometimes they are independent. And, although they are not physicians, in many states they can order tests, perform some procedures, and write prescriptions.

Nurse practitioners and physician assistants have surely helped to ease the shortage of doctors, particularly in underserved communities. Even in academic medical centers, they speed access to health care. Still, discriminating patients want to know if they provide top-notch care. Health care planners want to know that, too, and two rather different studies have helped answer that important question.

The first report is a systematic review of 34 studies of nurse practitioners in various regions with sophisticated health care systems, including the U.S., Canada, Europe, Australia, Japan, South Africa, and Israel. Each study compared the way nurse practitioners and physicians took care of patients who came to a primary care setting with undifferentiated health complaints. The researchers scored nurse practitioners and physicians on patient satisfaction, health outcomes, process of care, and cost. All in all, patients were actually more satisfied with nurse practitioners than doctors, perhaps because nurses spent more time with their patients. There were no significant differences between nurses and doctors with regard to health outcomes, return appointments, prescriptions, or referrals. The researchers could not assemble enough information to compare the cost of care, but they concluded that the overall quality of care provided by nurse practitioners was on par with the care delivered by physicians, at least in research settings.

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