Medical Model vs. Nursing Model

[LC8150]

Hey guys,

I am currently applying for PA school and have been talking to someone that was on the PA route but is now doing NP. She brought up to me that one of the main differences between NP and Dr/PA is that NPs learn the nursing model while Drs and PAs tend to learn the medical model. After reading about the two, I am struggling to see how the medical model is better or equal. I know the medical model focuses on diagnostic tests, physical examination, and medical history to diagnose and treat an illness. The nursing model seems to be more varied in its definition but tends to lean towards a holistic approach of care. That is, not only is the biological problem taken into consideration, but it also focuses on how a patient's life is being affected (unable to breathe, unable to walk, cannot communicate with others, depressed, etc) and teaches the patients about health and preventative measures (stop smoking, diet, etc) that can help improve their health and prevent them from becoming ill again in the future.

When reading those definitions, it sounds to me that PAs and Drs do not care about the patients as people and are only there to solve the problem at hand in that exact moment. Am I misunderstanding these models? I know I am a compassionate person and do not need school to teach me to care about my patients but I am wondering what the pros are for the medical model compared to the nursing model. This model is not the reason I chose PA over NP but if you were asked about these models in an interview, how would you answer to make the medical model sound favorable or equally as important as learning the nursing model?

Thank you for the advice! It seems the nursing model definition is a little more varied depending on who you ask so I am just trying to fully understand them and see the pros and cons of each method.

[newton9686]

You made a comment during your post that pretty much hits the nail on the head. You shouldn't need a school to teach you how to be compassionate or even that disease prevention is key. The problem is there is so much to learn in medicine. So that time spent learn holistics is time not spent learning disease processes, pharmacology, anatomy and physiology. So don't get me wrong I respect my NP collegues, they are my teammates and we work well together. But the reason I am at least able to keep up with my NP collegues who have been doing this a lot longer than me as a new grad is because the rigors of PA school plus independently studying medicine gave me the strong medical foundations necessary to succeed. The holistic stuff I pretty much knew or picked up pretty quickly on my own. 

[MT2PA]

You need to shadow some PAs and Drs if you think NPs are the only ones who care about patients, how their lives are affected, and are teaching preventive medicine to patients.

Do you think that primary care  PAs or physicians aren't teaching their patients the value of a healthy diet, exercise, and smoking cessation?  Only NPs do that?

[LC8150]

38 minutes ago, MT2PA said:

You need to shadow some PAs and Drs if you think NPs are the only ones who care about patients, how their lives are affected, and are teaching preventive medicine to patients.

Do you think that primary care  PAs or physicians aren't teaching their patients the value of a healthy diet, exercise, and smoking cessation?  Only NPs do that?

Maybe I didn't express what I meant clearly in my original post! I have shadowed plenty of each type of medical provider and I know they all care about their patients equally. I just meant that the definitions of the two models makes it sound as if Drs and PAs are only focused on the biological problem and not the patients' feelings.

I know that's not true in practice but when the descriptions of each are read, it comes across that way. I was just asking for a way to explain in what ways, based on the above definitions, the medical model is a better/equal/worse model than a nursing model.

[LT_Oneal_PAC]

52 minutes ago, jinglebells0518 said:

Maybe I didn't express what I meant clearly in my original post! I have shadowed plenty of each type of medical provider and I know they all care about their patients equally. I just meant that the definitions of the two models makes it sound as if Drs and PAs are only focused on the biological problem and not the patients' feelings.

I know that's not true in practice but when the descriptions of each are read, it comes across that way. I was just asking for a way to explain in what ways, based on the above definitions, the medical model is a better/equal/worse model than a nursing model.

Inherent in a diagnosis is it’s affect on daily living and inherent in the treatment of disease is improving quality of life (because often there isn’t a cure) such as improving depression, helping them walk better, helping them continue with hobbies, ensuring they live to see their kid graduate high school when they have terminal cancer, and including other activities of daily living. It’s 2 ways of saying the same thing without the new age word “holistic.” 

[True Anomaly]

"Holistic" is the most empty word bandied about in medicine or nursing.  

[StevenBrule]

5 hours ago, jinglebells0518 said:

Maybe I didn't express what I meant clearly in my original post! I have shadowed plenty of each type of medical provider and I know they all care about their patients equally. I just meant that the definitions of the two models makes it sound as if Drs and PAs are only focused on the biological problem and not the patients' feelings.

I know that's not true in practice but when the descriptions of each are read, it comes across that way. I was just asking for a way to explain in what ways, based on the above definitions, the medical model is a better/equal/worse model than a nursing model.

I've thought about this a little bit as I've considered and applied to Med schools and Nursing programs before finally settling on the PA route.  Medicine, regardless of your belief system is, by-and-large, a science.  To practice medicine is to have a comprehensive understanding of this science.  To me, the nursing model addresses only a small--but still very important--aspect of patient care.  Medical based addresses the physical nature of medicine and devotes curriculum to the subject.

[SedRate]

1 hour ago, jinglebells0518 said:

Maybe I didn't express what I meant clearly in my original post! I have shadowed plenty of each type of medical provider and I know they all care about their patients equally. I just meant that the definitions of the two models makes it sound as if Drs and PAs are only focused on the biological problem and not the patients' feelings.

I know that's not true in practice but when the descriptions of each are read, it comes across that way. I was just asking for a way to explain in what ways, based on the above definitions, the medical model is a better/equal/worse model than a nursing model.

Treating a person with a disease requires some level of compassion (regardless of which camp you came from) in addition to an astute understanding of the actual disease you are diagnosing and treating and how it may affect the person afflicted by it. Some providers have a better bedside manner than others, which can be construed as compassion, but treatment and prevention is a goal of all. 

The "nursing model" is a mode of training that stems off a nurse's previous training and experience in nursing, executing doctor's orders, and patient care at the patient's bedside. This is where the "whole person" treatment mentality comes from.

The traditional "medical model" teaches you to understand the disease process and it's manifestation (i.e., how the disease develops and the effect on the patient), thereby allowing you to diagnose and treat a patient's ailment and address any social issues (work, ADLs, family, emotions, etc) that may arise from that diagnosis and treatment. Understanding the intricacies of the disease process also allows those providers to pick up on nuances and variations of the disease that may not follow typical presentations. 

Six is one and half of a dozen of another. It's not necessarily a matter of which is better or worse because we all have our role in healthcare and level of experience and training. I think your question is more of a loaded question that the interview board would use to gauge you. So answer wisely.

For me personally, I wanted to learn, train, and think like a doctor, so I went PA where I would train alongside medical students and then work closely with a physician. NPs arrive via a different route and now in some states without the need to work alongside a physician which has its own benefits and risks. 

[mgriffiths]

8 hours ago, jinglebells0518 said:

After reading about the two, I am struggling to see how the medical model is better or equal...When reading those definitions, it sounds to me that PAs and Drs do not care about the patients as people and are only there to solve the problem at hand in that exact moment. Am I misunderstanding these models? I know I am a compassionate person and do not need school to teach me to care about my patients but I am wondering what the pros are for the medical model compared to the nursing model.

The nursing lobby is massive, and regularly puts forth publications that the medical model lacks compassion, while the nursing model is focused on compassion.  They don't care that they are putting forth a lie, or that they are hurting others.

But, with that said - the medical model teaches objectivity, which allows the provider to remove the patient's feelings from the equation and treat the problem.  Does this mean we ignore the patient's feelings, their "holistic" life, their ability to complete daily tasks?  OF COURSE NOT!!!  But when I am diagnosing, making decisions on tests to order, and/or prescribing medications, in many ways the patient as an individual is ignored - because I have to be objective because science is objective.  I practice evidence based medicine, not "feel-good" medicine.

The nursing model, as you said, is more defined as caring for the patient "holistically." Think about it from a hospital perspective: the provider sees the patient for 5 minutes and decides what tests/medications/etc. need to be executed.  The nurse does the bathing, dressing, feeding, actual giving of meds, etc.  The nurse has a more "holistic" role because he or she does everything that he/she is told to do by the provider and interacts with the patient regularly throughout the day.  That is where the nursing lobby defines the nursing model as "holistic."  Of course, this also leads to NPs ordering more tests, labs, referrals than PA's who are almost on par with MD/DO's.  All of the NPs I work with order TSH as a screening lab because they "were taught to."  It doesn't matter that multiple medical societies recommend against screening thyroids.  None of the NPs I work with are able to read ECGs, perform joint injections (let alone a musculoskeletal exam), etc.  Does this make them bad providers?  Not necessarily, and those skills can be learned - but they had to spend time in school learning what you didn't need to (i.e. how to be a compassionate person).

[karebear12892]

Quick Google search yielded a pretty good explanation of the difference between the two models. Granted, it was written by a PA-C, so it may not be entirely objective. KevinMD also published an article about this, but I tend to interpret their posts with a grain of salt.

https://doseofpa.blogspot.com/2014/02/the-medical-model-vs-nursing-model.html

Edit: Thank you for asking this. I've been wondering how best to explain the difference between the two models when people ask and this was very helpful. 

[AdamPAC]

I agree with Sed that this is unlikely to be a direct question in your interview. More likely, you'll get a question about how you see yourself fitting into a healthcare team, what your role in that team as a PA would be, or your understanding of the relationship between a PA and Doctor. Most anyone interviewing you for school will want to know that you can work well in a team, respect your peers and respect your mentors. They do want to know that you understand the profession. In that situation, I think it is enough to know that while both models differ, as has already been discussed in this post, there are varying levels of experience among both midlevel providers that are fully leveraged in an ideal setting. In the end, PA's and NP's are both trained to practice evidence based medicine, which by its definition includes the empirical evidence both should leverage, the professional experience that both bring to the exam room, and the patient values within which they should attempt to frame their treatment plan.

[EMEDPA]

I don't think you will be asked about the models, but you might be asked "why PA and not MD or RN".

[Marinejiujitsu]

Hey guys,
I am currently applying for PA school and have been talking to someone that was on the PA route but is now doing NP. She brought up to me that one of the main differences between NP and Dr/PA is that NPs learn the nursing model while Drs and PAs tend to learn the medical model. After reading about the two, I am struggling to see how the medical model is better or equal. I know the medical model focuses on diagnostic tests, physical examination, and medical history to diagnose and treat an illness. The nursing model seems to be more varied in its definition but tends to lean towards a holistic approach of care. That is, not only is the biological problem taken into consideration, but it also focuses on how a patient's life is being affected (unable to breathe, unable to walk, cannot communicate with others, depressed, etc) and teaches the patients about health and preventative measures (stop smoking, diet, etc) that can help improve their health and prevent them from becoming ill again in the future.
When reading those definitions, it sounds to me that PAs and Drs do not care about the patients as people and are only there to solve the problem at hand in that exact moment. Am I misunderstanding these models? I know I am a compassionate person and do not need school to teach me to care about my patients but I am wondering what the pros are for the medical model compared to the nursing model. This model is not the reason I chose PA over NP but if you were asked about these models in an interview, how would you answer to make the medical model sound favorable or equally as important as learning the nursing model?
Thank you for the advice! It seems the nursing model definition is a little more varied depending on who you ask so I am just trying to fully understand them and see the pros and cons of each method.

Someone feeding you propaganda saying docs and PAs sent care for the patient. It's all about the individual. Holistic approach is a bullcrap term people throw around to reason with not doing crap. I have seen many NPs give antibiotics for URIs. Doesn't sound holistic to me. Not saying it's the norm. Working in the ER, it's a search for the emergencies, spending too much time with someone that isn't as sick is going to cost some of your patients to not get the care they need fast enough to keep them alive. It's a catch 22. Maybe you should go primary care whatever whether NP,PA,MD. Don't follow the money like alot of us. Unfortunately, my family means more to me than the hole preventive medicine, therefore, I am ER. I need the Benjamin's to take care of my 4 kids in this area with $1million dollar homes in the ghettos.

Sent from my SM-N950U using Tapatalk

[Kaepora]

Honestly, there's really very little difference.  The "nursing model" is just what APRNs say so they can practice medicine while still being licensed by the state boards of nursing rather than the state boards of medicine.  They are trained to practice medicine - they are just nurses before they go back to NP school.  I had physician preceptors for all of my clinical rotations, save one.  So was I trained in the medical model as a NP?  When I'm in the OR assisting on a lap chole, do I look at the screen and "see the whole person" while the surgeon only sees a gall bladder?  Pretty sure he cares about the patient as a whole just as I do, but we both are also interested in diagnosing and treating the acute cholecystitis, because, ya know, medicine.

[CAAdmission]

13 hours ago, Kaepora said:

Honestly, there's really very little difference.  The "nursing model" is just what APRNs say so they can practice medicine while still being licensed by the state boards of nursing rather than the state boards of medicine.  

You hit that nail on the head.

[ventana]

Shouldn't have one with out the other

but medical knowledge with out bedside manor and "nursing skiils" can still be good solid medicine

Nursing skills with out medical knowledge ie bug/drug or drug/drug issues can and IS dangerous...