New Law in Oregon

[Eunuchorn (imported)]

Oregon's House of Representatives voted to allow licensed nurse practitioners to perform vasectomies.

The controversial ruling has some urologists in the state up in arms and they argue the procedure is much more complicated than it may seem.

How easily would a Botched Vasectomy end up here?

What does the community at large think of this?

[TopManFL (imported)]

The last five times I've been put under general anesthesia (over the past 7 years) I've met with a anesthesiologist who was an MD. But, when then in the procedure or operating room, it was a nurse practitioner that actually put me under and monitored me the whole time. Once, it was an emergency at 8pm on a Friday night and I they skipped that part where the actual doctor met with me.

So, we better get used to the idea of getting specialized health care from other than doctors that are trained in every aspect of medicine.

For example. A doctor spends 4 years in medical school learning every bone, tendon, vein, artery, nerve, etc in the human body. Then passes all the tests. One year as an intern basically doing nothing but trying not to kill patients. Then 2 years as a resident still trying not to kill patients while at the same time learning the various specialties.

Finally, after deciding what specialty to go into, they spend the next 30 years of their carrier treating thyroid conditions. Seriously? Couldn't we have saved a great deal of time and money just training them to treat thyroid problems?

So, it sounds like a good idea to me. What urologist are bitching about is loss of income, not medical requirements.

[cutnbulls2ox (imported)]

I agree with TopManFl on this.. Now that current medical knowledge and procedures have expanded so much since the last time the medical training and testing and practices have been changed, its long overdue for a complete overhaul and re design to better serve patients. Its unrealistic to expect drs to be master of all body system knowledge and procedures. They are failing at trying to be jack of all trades and also failing in hyper specializations that deprive rural areas of specialists and adequate drs and care. The current system is outdated, fraudulent, finacially unsustainable, and already broken in poorly treating and serving patients. The wrong students are chosen for medical schools and chosen for the wrong reasons and trained wrong for today s needs.

All of it needs to be re designed and run differently.

[cutnbulls2ox (imported)]

Vasectomies are one of the easiest surgeries to perform without a lot of training. The vas deferens tubes are separate from the other main spermatic cord organs in the scrotum and are easy to locate and identify as the cords to be cut and blocked in a vasectomy. Nature made it very easy to sterilize us men and provided easy, shallow, and fast access to our sperm carrying tubes to be cut and blocked off so easily and simply in a vasectomy. A well trained nurse or military medic can do vasectomies with no difficulty.

The much bigger issues are what harmful effects some men experience from their vasectomies, like chronic pain and their own immune system s long term reaction to all that trapped daily sperm production being digested in their scrotums or inside their testicle s epididymi by their immune systems?

You have to be a real fool to mistakenly cut and block off the big, thick, complex, main spermatic cords instead of the much smaller, single, separate, and easily found vas deferens tubes.

Us men can easily and painlessly locate and tell the difference between those cords in our own scrotums. With your scrotum relaxed and hanging low and thin skinned, like it does after a hot shower or when your body is hot, feel your scrotum.

The vas deferens sperm carrying tubes are a single thinner tube that leaves each testicle and travels alone and free floating and movable by hand as it goes up your scrotum to enter your groin. It feels like a piano wire or single insulated electric wire.

The main spermatic cord to each testicle is the main bundle of numerous tubes, veins, arteries, and muscle that each testicle hangs suspended from in each side of your scrotum. It is thick and muscular, with different organs and tubes all closely bundled together as a group of tubes and cords that are encased and all attached to each other. Feel them in your own scrotum and see how easy it is to locate them and tell them apart.

The long term affects of vasectomies for a small percentage of men, up to 5 to 15 % of all vasectomized men, are more likely to damage men s testicles or castrate them than a nurse trained to do vasectomies.

[nutless1 (imported)]

Since my general physician retired a few years ago, I have been seeing his Physician's Assistant (PA) here in Michigan. He seems as knowledgeable and up-to-date informed as my doctor was, takes more time to explains things and fully answers questions, and can and does prescribe drugs.

Physician assistants and nurse practioners licensed here in Michigan have been doing more of what doctors perform for several years. This was a law change because of a shortage of general practice doctors, as mor doctors are specializing where the money is really earned. Use of PAs and NPs are a way of the future as the number of doctors decline.

[Buster_007 (imported)]

Sweet, its a good move and Nurses are much better trained these days

[cutnbulls2ox (imported)]

Years ago both India and Packistan had large scale public vasectomy programs doing mass vasectomies in train stations, clinics, and mobile trucks to reduce population growth. I m sure those were not all medical drs doing the vasectomies. Most were likely just trained to do vasectomies only with no other medical training beyond first aid courses and quick crash courses and training to learn to do vasectomies only. No one ever reported on the complication rates or outcomes that I ve seen. Likely only in those countries own press and medical journals from those years.

[hd2500ne (imported)]

I personally don't see it as being a big deal. For woman may Nurse Practitioners do IUD/implants on them so why not on men. I am sure it would reduce costs and all of that good stuff. I say bring it on to every state.

[SplitDik (imported)]

I think this is a problem mostly unique to the US. It starts with the stupid amount of student loans that banks here are willing to loan, that creates situation where universities can jack up the tuition, which in turn means that most graduates are in serious debt and people like doctors especially so. So then they need to charge exorbitant rates to try to someday profit. Also the lawsuit-heavy culture requires doctors to carry serious malpractice insurance.

Since becoming a doctor is so expensive there are less of them and those that do graduate specialize to make larger incomes making general practitioners even more rare.

Furthermore, hospitals here are for profit and the insurance companies are for profit.

This creates a perfect storm where hospitals and insurance companies actually lobby to have less qualified people provide the care.

I don't really see any good from allowing this. In most professions having a broad basis of knowledge is useful even if your practice is fairly specific. While a nurse practitioner I'm sure is fine for routine stuff, occasionally what is supposed to be routine is not -- what if a person going in for a vasectomy turns out to have rare allergy, or mental issue, and such. Or what if during the course of the vasectomy there are signs of some other disease like cancer that the nurse practitioner misses?

Within the American health system, this is certainly the way it is going and ultimately necessary. But honestly the real fix (never going to happen here) would be to make education affordable and pump out fully qualified people who don't feel compelled to charge exorbitant rates.

[cutnbulls2ox (imported)]

I agree with you SplitDik. The whole system needs remodeling and is unsustainable and racing toward a cliff as is. It will fail and require replacement no matter what happens.

If poor countries like Pakistan and India can train regular people to do vasectomies in train stations, vans, and similar places by the huge numbers they did in the past, the US can train people to do vasectomies cheaply and know what to look for in men s scrotums and sex organs that is worth further checking by more trained staff that could be on hand in vasectomy clinics to immediately check any unusual men s conditions that vasectomy technitions would see in sterilizing many men every day and quickly learning what is normal in men s bodies and what is abnormal.

Most drs now run to ask computers most answers anyway. Technitions can do the same and refer the fewer complicated cases up to increasingly trained and specialized medical staff as needed.

Our military medics are the most shamefully underutilized and capable medical providers available. They treat battle wounds and routine conditions and refer cases beyond their training to other providers. It works in war conditions far worse than normal civilian conditions.

[cutnbulls2ox (imported)]

It would be great to treat medical care and the jobs in it just like any other jobs. Get rid of all the unhelpful pomp and puffery and train and hire like all other jobs do. All kinds of very complex technical jobs are adequately done by people hired off the street as beginners and progressively trained to become more capable and more knowledgable as they work longer, such as construction, military, transportation, government, food production, and computers. Get rid of 8 year degrees with added residency years and stuffy old titles like dr and nurse, which are not improving patient care or competency in the modern world. Wipe away the old system and replace it with a new system based on real competancy and efficiency to give better and more affordable care. Train people for the duties they actually perform daily. Don t pretend they know it all.

Just like a vasectomy. Its very simple. The vas deferens are a single thin tube detached and movable in the scrotum. It is not bundled in with any other cords, tubes, or organs as it runs through the mid to upper scrotum where its easiest to locate, isolate, cut and block off. The main spermatic cords are complex bundles of many veins, arteries, muscles, lymph nodes, and other organs all wrapped in a muscular tube. Cutting the vas deferens will cause very littlle bleeding and leak out clear sperm filled fluids. Cutting the main spermatic cord would cause intense gushing bleeding and require cutting thru many different layers and organs to completely sever that main bundle. Anyone would quickly realize if they cut the wrong one and started immense bleeding immediately from the cut. Just painlessly feeling your own vas cords verses your main spermatic cords is very easy to do

and tell the difference between th

e two cords right away thru your scrotum skin. A trained person would not make a mistake and cut the wrong one by accident unless they cut close to the testicles or the inguinal canals where these cords are close together and harder to tell apart. Feel those same cords right as they attach to your balls and they crowd together in confused tubes. Feel them a few inches above your testicles in the open part of your scrotum and they are clearly different. Feel them where they enter your groin at the top of your scrotum and they are crowded together again and confusing. Drs cut the vas in the open portion of the scrotum above the testicles. That s why low hanging balls make vasectomies and castrations so much easier to do on a man than if he has high and tight hanging balls with shorter cords and tubes to work with. That extra long scrotum and cord hang space is where his cords separate and are easy to tell apart and access to cut and work on with lots of open space inside his scrotum.

A trained person could hand off doing a vasectomy on a man with short nut cords and high hanging tight balls to more experienced and trained staff member who d open up that tight scrotum to locate his harder to find short vas cords. Opening the scrotum up first to see all his shorter cords more carefully by sight and direct examination. This is an extra wide scrotum opening and extra care that is not needed to find the same vas cords in a man s scrotum with long cords and low hanging balls. Problem solved.

The men with long scrotums with longer cords and low hanging balls should pay less for vasectomies and castrations than men with shorter cords and tight, high hanging balls that are tougher to do surgery on.