NPs Provide Person-Centered, Comprehensive Care

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Marilyn W. Edmunds PhD, NP T here was a very provocative letter to the editor in the January/February 2010 issue of the American Academy of Family Practice’s Family Practice Management online journal (www.aafp.org/fpm). The letter was written in response to an article suggesting health care reform should be defined in terms of person-focused care rather than disease-focused care. The letter quickly drew the attention of nurse practitioners (NPs), one of whom passed it on to me. The letter, from Sanford J. Brown, MD, in Mendicino CA, said, “Family practice residency programs still train doctors along the disease-focused models, and they don’t teach them how to run an independent practice so they can have the time to do person-focused, comprehensive, and coordinated care. It is somewhat ironic that midlevel providers, who aren’t expected to see as many patients per hour as physicians, are better suited to handle these tasks.” While I see this letter as a backhanded compliment from someone who seems to understand what makes a difference in NP care, a basic assumption here is flawed. In many practices, past research demonstrates that NPs see just as many patients as physicians.1 It is not just a matter that we “take time” to do person-focused, comprehensive, and coordinated care; rather, being person-focused and comprehensive is what we do as NPs. It underlies our whole attitude, our whole approach to what questions we ask and how we ask them. So, we do different things in the time that we spend with the patient than many physicians do. It is true that the original conception of the role would be that NPs work alongside physicians, seeing less acutely ill patients and spending more time with them, providing teaching and counseling. But the reality of the health care system is that there is higher patient demand than there are providers to meet their needs, and no one has the luxury of long patient visits. In some settings, such as university hospital clinics, the sickest primary care patients have gravitated to the NP caseload because patients prefer to have continuity of care rather than seeing a new resident every 3 months. But even with the demands of needy primary care patients and the restrictions of time, NPs still provide as much person-focused and comprehensive care as they can. I realize I am going out on a limb when I make these claims. I’m from the old school, when NP faculty inculcated these role values and behaviors into their teaching. I hope that today’s NP faculty still demands this type of approach from their students, because if NPs don’t really practice in a person-focused, comprehensive manner, we aren’t really practicing any differently than the physicians.