Blogfinger

QUOTE OF THE DAY:

“There are absolutely no credible scientific studies that support the safety and efficacy of non-physicians practicing without physician supervision.  None.”

This quote is from a new book. (2022)  by Niran Al-Agba,  MD and Rebekah Bernard, MD. It is called “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare”

By Paul Goldfinger,  MD, FACC

I was a young doctor in the 1970’s when “physician extenders”   (nurse practitioners and physician assistants) appeared on the scene.  It was a great idea, but I was certain that it could only succeed if these healthcare professionals would work under the supervision of physicians.

Over the years, these “mid-levels” began to push for the right to open their own practices without supervision by physicians.

They have been growing in numbers and they have gotten permission in an increasing number of states to cast aside physician oversight.

These battles have been won due to politics and not medical wisdom or (see above) scientific proof.

Running parallel to these new mid-level rights to practice alone there is a new revolution which will change the practice of medicine forever.

Coming to a town near you, big corporations such as CVS, Walgreens and Walmart will be opening in-store clinics which will be staffed by nurse practitioners or physician assistants who will be on their own without physician oversight.

They will act  like primary care doctors and will mostly see simple everyday disorders such as sore throats, rashes, and musculoskeletal complaints. And they will do well with such complaints, but what happens if a difficult diagnostic problem shows up?  They may miss the problem and leave the patient with the risk of dangerous delayed or absent care.

A related phenomenon is the explosive growth of urgicenters which are usually staffed by doctors, but now, more often, are staffed by PA’s and NP’s.

None of these facilities will accept the responsibility of following someone for chronic conditions as doctors’ offices do.  One shot diagnosis and treatment is a recipe for trouble.

And in some states mid-levels  can open their own offices to diagnose, treat, and prescribe. These “doctors”  are sometimes allowed to do and interpret  xrays, ecg’s and other critical procedures such as ultrasounds.  The PA’s want to jettison the “assistant” name in their title.

I took a relative  to a local ER for a painful knee. A  young man with a white coat and no name tag came into the room, and I watched him carefully. He did a terrible job of taking a history, ignoring her medications and failing to ask necessary questions.

He barely conducted a physical exam and he quickly ordered an xray.  I asked him who he was, and he admitted to be an NP.  I asked if a doctor would see her, and he said that he “can do what a doctor does!”    His approach was amateurish and he was about to miss a serious and unusual diagnosis and waste time with an unnecessary test until I intervened.   An ER doctor came in and corrected the situation.

These mid-levels tend to be delusional over what they are capable of.  Their  training cannot compare to the years and hours spent becoming a physician, where the depth of inquiry into a situation can only be achieved though years of experience   (medical school and residency.)

In some states, mid-levels can get licensed without ever examining a patient—all teaching being done on-line.

Yes they can treat a cold and order a blood test on their own, and they can even order a prescription drug.  But they are more likely to make a mistake and threaten a patient’s life than with a physician in charge.

Lately even doctors offices are having mid-levels take their place in certain situations. I have seen that in action including failure to take a blood pressure properly or obtain  an appropriately in-depth history.

You will hear more about these issues very soon.  We all need to be aware. And these new and unsavory ways to practice medicine will force some primary care doctors out of business.

As a physician, I am horrified. We will soon need more malpractice lawyers.

It used to be said that “doctors bury their mistakes” but there is a great deal of oversight of doctors especially in hospitals. I have long complained about lack of oversight in doctors’ offices, but if I needed an office visit, I will take an appt. with an MD any day over one with a PA or NP.

But turning healthcare over to unsupervised mid-levels will be dangerous to all.  Try to obtain your care from physicians. For example if you want an urgicare visit, call ahead and make sure that your care will be supervised by and provided by physicians.

The two physicians who wrote this book open with this:

Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare “exposes a vast conspiracy of political maneuvering and corporate greed that has led to the replacement of qualified medical professionals by lesser trained practitioners. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for the guardians of our nation’s healthcare continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans.”

So, here’s a truth for those mid-levels in their white coats who want to provide unsupervised care:  “You can’t be a beacon if your light don’t shine!”

2026 Editor’s note:  The situation has worsened since hospitals are now run by huge corporations with tentacles in all directions, and mid-levels playing doctor in many medical functions.  And the same is true in doctor’s offices and urgicenters.  I have seen this in action locally, and I will have more to say about it.

The AMA is on this as well as scope of practice invasions into the work of physicians.  This is a quote from them;

“The AMA defends the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.”

THE BLIND BOYS OF ALABAMA:  (From the Imus Ranch Record II)

Paul Goldfinger photo.  Singing hymns, 9 am. Bishop Janes Tabernacle. Ocean Grove, NJ, USA Paul Goldfinger Blogfinger.net.  9/1/26

Boys Choir of Harlem

Tent Village. Sept 1, 2026

A little dreary.   Just one person visible at 9 am, September 1, 2026.  Paul Goldfinger photo.

KRISTIN CHENOWITH.  From Promises, Promises

“Knowing When To Leave.”

Today the crew from Old Forge is busy ripping the siding off in an effort to expose the original siding which looks like original wood.

Notice the incredible turret on top.  Turrets were common in Victorian times, but this “onion shape” is unusual in OG.

In addition to the siding noise, construction is ongoing in the back to create an addition

If the Historical Society wants to offer some information about this particular house, we would welcome it.  The applies to the Historical Preservation Commission or any Grover with knowledge about Victorian homes.

Old Forge is a New Jersey company about 50 years old in a wide variety of construction projects. It is now best known for the OG Albatross Hotel.

Rooftop accessories like turrets are Victorian.  Our home nearby has two finials on the roof and a second story porch, lacking in most Victorians.

Please send any comment to Blogfinger@Verizon.net   Paul Goldfinger Editor Blogfinger.net

Here is a link to our post about the construction of a new Victorian at the foot of Ocean Pathway:

New OG Victorian

TONY BENNETT and k.d.lang

OG block party. 08/30/26. Paul Goldfinger photo

Ethel Merman:

HMS Chutzpah. Parking  in late afternoon while ignoring our laws  and while another stifling crowded tourist event (Giant Craft Show. 5/15/24)  was fizzling out on the Pathway.   People were driving around town with their eyes bulging and fire spewing  out of their ears while seeking parking.    Paul Goldfinger photo. Blogfinger.net.

The most fascinating sight at today’s emetic-provoking “craft” show.  Does she own that yellow Benz?  Her hat says “New York.”  The Bronx is up and the Battery is down.  Is she going to buy a house today in the Grove for a million bucks?  I hope so. Paul Goldfinger photo. 6/15/24

The “Giant Craft Show” was a big success if you go by the swarms, the hordes, the invasion of tourists anxious to buy earrings for $2.00.  The Chamber of Commercials was sponsoring this giant event.

This is not the first time I have pontificated about giant Craft Shows.   Here is a short link:

https://wp.me/pqmj2-M7s

Before entering the actual sale, I met three Grovers who came to the park on their bikes.   Imagine a wonderful  Ocean Grove where bikes are the most common transportation all summer on our streets.

Ladies who lunch? Going shopping for stuff?  Enjoying their town?    Auditorium park OG. Paul Goldfinger photo .6/15/24

Today parking was horrible. Worse than ever. Illegal parking was rampant.

I spent 15 minutes wandering around the sale, camera ready. But these congested events are a poor backdrop for photography. So I watch the people and the harsh contrasty light. There is nothing beautiful or titillating  about such an event—-except for the girls in their summer clothes, and it’s hard to nail a great shot with a 300 pound grammy standing next to the subject you are lining up for the centerfold of Blogfinger.net.

Is anyone going to buy stained glass?  Probably not her.  Blogfinger.net

Of all people, I met Michael Badger today (former CMA President;)  not among the restless natives, but in Auditorium Park.  He was smiling, relaxed and willing to chat with a reporter, me, without a press release in his hand.

He was so relaxed and free of care that when I asked him where the craft sale was, he didn’t know. Outstanding!   During our brief exchange of pleasantries a woman walked up to him and said, “We miss you.”

Not only did I fail to meet anybody I knew at the sale, but I only saw a few people smiling.   Making one’s way through that throng is evidently a serious endeavor.  Who needs it?

Today, as I walked to the show and then back, it dawned on me that Ocean Grove must have  a limit when it cannot accept any more of these oxygen-sucking mob-inducing weekend summer events.   Is this it?

Sure every shore town has tourists and some parking issues, but not like us. We have forces at play here that other towns do not, such as the money grabbing Chamber of Commercials, Neptune Township which wants our tax dollars and lets all employees go home early every summer Friday,  and of course the Camp Meeting Association which will use every available moment to fill the Grove up with religious programming which can be too numerous to count and religious tourists which other towns do not have.

Neptune Township needs to accept greater responsibility  for the happiness of  Ocean Grove residents. It needs to figure out when enough is enough and to then intervene.  For example end all the “giant” events because they do no good for the folks who are residents in this little town.

And, if they can pay attention, Neptune is in charge of the North End Re-development Project, so cancel it and get us back on the right track.

And then there is the name change where the Giant Fall Craft Show in now (2026) “The Ocean Grove Fall Market.”   This name change is supposed to give the impression that the Grove is becoming more sophisticated and thus the place to go if you are a gentrified Jersey Shore denizen.   But it will still be the same including those $2.00 earrings and $10.00 sausage, pepper and onion sandwiches which are usually served cold.

Do you suppose that the new group:

who used to be the Home Groaners Ass.  would now consider giving up their collections of mens underwear and organizing block parties and get involved with our demographic issues, controversies and  concerns for our town including church vs state matters,  July 4 parade with  no authentic military tributes or a genuine Sousa marching band and finally a true definition of what their organization is about.

PHIL OCHS:   “Changes”

Days Ice Cream. Ocean Grove. Paul Goldfinger photograph

FROM GODSPELL:

Neptune High Marching Band. It  seems that the flute section has emerged from the shadows, so watch out.   Paul Goldfinger photos. 5/30/22.  Video by Jean Bredin.

Neptune High ROTC. They’ve got class. Blogfinger photos by Paul Goldfinger.

We have the most fun photographing the viewers. All on Main Avenue, OG

Watch the parade from your front porch.

Are they New Yorkers or what?

What could be better? 4 year old Kyle on the town with Dad at the parade.

Tammy is a nurse from outatown. She’s here for fun with friends. Will she find it in the Grove? Of course she will !

Speaking of flutes, in my day our high school band flute section had all girls and one boy. Anthony didn’t mind at all.

They sat in front in concert band, at the feet of the conductor.  They had to avoid titillation in how gracefully they held their instruments.

I could never figure out the flute section because no one could hear them as we marched across the field during football season.

But those sweet flautists were eye candy that you would be afraid to touch for fear they would break.  So I asked one of them, Janice, a lovely sophomore, to go to the Junior Prom. She was so delicate, like that flute music she played.

When she sat down in the car, her crinolines went “boing” heading  north. She had little to say that night, but she was beautiful.  After that I went for older women.

Guys, if you are in the NHS band, try to date a flute player, but be careful–don’t be mislead  by those delicate instruments or those red shirts.   As it says on his shirt:   “Fear the Flutes.”

BARRY WHITE:

Paul Goldfinger still from the opening dance scene of Dirty Dancing. This was filmed in black and white unlike the rest of the film.

THE RONETTES:   Fom the motion picture soundtrack:   Dirty Dancing.