So much easier to refer the patient more than likely, elderly to the local orthopedic clinic, where they will undoubtedly have such a needle and probably also someone who can remember where the bursa is and how to give an injection. The same applies to spinal tap, marrow aspirate, sigmoidoscopy, stress test, management of uncomplicated common fractures, reading EKG s and chest X-rays in the context of the patient s presentation, and basic obstetrical ultrasound. Even the removal of a sebaceous cyst has apparently become a technical challenge for the country that put a man on the moon. In each case, sectarian influences encourage this absurdity, talking in circles about the numbers needed to maintain currency, and cross-transference of skills. All of this is, of course, opinion based.
Credible evidence is astoundingly scant.
There are reports contrasting physician extender skills in procedures with residents or fellows in training programs, and reports of physician extenders successfully performing colonoscopy and esophagogastroduodenoscopy, but nothing that would make the work of a hospital privileges committee one whit easier. I could make most of the common anti-procedure arguments against the pap test special skill needed in identifying the zone, difficulty with precise specimen collection, danger of false negatives etc. But when it comes to sigmoidoscopy or colonoscopy for cancer prevention, the public is largely ignorant and at our mercy. This is not to suggest that our problems are simply the work of nefarious subspecialty organizations, or boards who have been taken over by them, or that this represents the last chance for internal medicine trying to repair the damage of decades of fellowship first philosophy. Sadly, I think the problem is closer to home.