Start & Run a Medical Practice. Michael Clifford Fabian

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СКАЧАТЬ provinces, the advanced nurses can also prescribe medication, refer patients to specialists, and even admit patients to health-care facilities. Note that not all states and provinces allow advanced nurses to practice independently. For more information talk to your local nursing association.

      Clinical nurse practitioners in North America practice in some ways similar to, and together with, medical doctors. For this reason, the office setup of a nurse practitioner has much in common with that of a medical doctor.

      While working up in Northern Canada’s isolated communities as a visiting doctor, I came across several nurse practitioners who performed amazing work in medically under-serviced areas. The nurses take care of the patients, do the necessary examinations, prescribe medications, and work closely with doctors. Nurse practitioners are an evolving profession, becoming more independent in the urban setting too, with different countries and jurisdictions permitting different levels of practice.

      I will give you a concrete example of how this profession can function. Patient Zen was an infant in a remote area in Northern Canada who had recurrent ear infections in the first two years of his life. He needed antibiotics periodically, and if the clinical nurse specialist had not been practicing there, the complications as a result of untreated ear infections could have been significant.

      One of the consequences of untreated ear infections is a condition known as mastoiditis (i.e., the infection spreading to the bone in the proximity of the ear), something that can usually be avoided by treating ear infections when needed. The nurse practitioner examined Zen’s ears and decided each time whether to give an antibiotic or not. When I arrived there for clinics, the nurse arranged for me to see patients that she felt needed further assessment by an ear specialist, and I would decide on the next mode of treatment. In the case of Zen, insertion of small tubes (known as grommets in some countries) into the eardrums was needed. I arranged for this to be done in the closest city that could do this procedure. Thank goodness for the nurse who was working in this community, contributing in a meaningful way to the care of Zen, avoiding untoward medical complications, and initiating the definitive treatment.

      At every stage in my career, whether it is in the hospital setting, or outpatient setting, I have worked closely with nurses. Another example would be a family practice clinic where I worked for a few years. The nurse was the first contact, and did the initial screening and questioning of the patient. She also did part of the basic examination needed for any assessment including the measurement of the pulse, blood pressure, and body temperature. The nurse would give the injections and draw blood for investigations. She would accompany me and help out with some examinations and treatment that were carried out in the examination room. The nurse was a team member every step of the way.

      2.8 Occupational therapy

      An occupational therapist works closely with physicians and other health-care providers in creating rehabilitation plans for patients, amongst other things. The patients could be in the hospital after a stroke or recuperating at home following a motor vehicle accident. It’s an exciting field that people generally know little about.

      The training overlaps with medicine in much of what is learned and trained, and there is a strong collaboration with doctors and other health-care providers on many levels. While many occupational therapists work in a hospital, or other health-care facility, they could certainly work independently in an office environment, the function being somewhat similar to any other medical office.

      2.9 Optometry

      Optometrists also have a doctor designation in many parts of the world. They usually practice independently in an office setting, or they may be closely affiliated to medical doctors — particularly ophthalmologists working in a medical office, or in the hospital.

      A while back I personally consulted with an ophthalmologist, the basic eye assessment and examination being performed by an optometrist. I have also seen cross referrals between the two specialties. An ophthalmologist might choose to ask an optometrist to do the initial evaluation of patients before medical treatment is considered, as was the case in my experience. In turn, the optometrist can refer patients to the ophthalmologist for more complex examinations or treatment.

      There are limitations with what optometrists can do with many eye disorders. Optometrists do not perform surgery and have limitations in regards to prescribing medication. They do, however, take care of eyes with appropriate examinations, diagnose pathology, and prescribe glasses and contact lenses.

      Obviously, as with any of the health-care disciplines, regulations and boundaries of what the scope of practice of optometrists can entail changes from one country, state, or province to the next. Certainly the running of the office has a lot in common with any other medical-related office, but like their ophthalmologist colleagues, the equipment and initial financial outlay far exceeds what most health-care professionals have to spend to get things up and running.

      Note that an optometrist is not the same as an optician, although in some countries there is some overlap between these two professions. Opticians deal more with fitting of lenses, and have a wealth of knowledge and information as to the best options for a person’s glasses or contact lens prescription.

      2.10 Osteopathy

      While attending a course on the temporal bone at the House Ear Institute in Los Angeles many years ago, I first came across osteopathic doctors in my professional career. The temporal bone is part of the inner portion of the ear, and the surgery can be quite complex and difficult. It is not always something that can be fully mastered during surgical residency, and it often requires further training.

      Osteopathic doctors practice just like medical doctors; for example, they prescribe medicine, do further specialty training, perform surgeries, and take care of patients in a hospital. Their training and practice is somewhat different in that they concentrate on the muscular-skeletal aspect of the body and perform procedures such as spinal manipulations — something that medical doctors do not usually do.

      An office for osteopathic doctors would, for the most part, seem exactly the same as medical doctors and patients might never be able to tell the difference in how the two professions function.

      2.11 Physiotherapy

      Physiotherapy is well known to most people, especially those of us who have had some sort of sports-related injury. These health-care professionals are involved with the muscular-skeletal system — maintenance, diagnosis, and treatment. They can work in a solo or physiotherapy group environment, together with a multi-specialty office, or work full time in a hospital-type environment.

      The set up of a physiotherapy office can be quite costly as there are usually expensive purchases needed; for example, some offices provide fitness equipment in a gymnasium setup and maybe even a swimming pool or steam bath.

      2.12 Podiatry

      It is often very difficult to tell the difference between a podiatrist and medical doctors who specialize in disorders of the foot. Podiatric physicians undergo training similar to medical doctors, but their schooling is more focused on feet. They perform many procedures on nails, toes, and feet including some surgical procedures, which are performed by surgeons as well, particularly orthopedic surgeons.

      Podiatrists usually practice in an office setting, most procedures are performed on out-patients. The set up and running of a podiatric office would be indistinguishable from a medical office.

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