L r -) TCDagel iCIEASE "One of my patients, who is paralyzed, needed an ultrasound on her kidney," Diskin said. "I arranged for the ultrasound to come to her home." Adult Primary Care is one of three independent nurse practitioner offices in Michigan. More frequent- ly, nurse practitioners work as part of a physician's office. Because Diskin's practice also works with Dr. Barbara Cingel and Dr. Larry Dell, she and her co- workers can write their own prescriptions under the physicians' licensure. Larger medical insurers, such as Aetna, Blue Cross/Blue Shield and Medicare, cover accepted procedures at the practice just as they would at a physician's office, although the field is still strug- gling to win acceptance from smaller insurers. "We are paid 85 percent of what physicians receive, based on Medicare standards," Diskin said. "So you'd think they'd want the people they insure to go to us." Nurse practitioners are not allowed to do major sur- gery, although the Michigan Council of Nurse Practitioners is working to gain surgery credentials for its members. The collaboration of Drs. Cingel and Dell facilitates hospital admittance, should that become necessary, Diskin said. She refers to the two as her "collabora- tors." Dr. Michael Sandler of West Bloomfield said nurse practitioners require the more direct supervision of a physician. "Many nurses do an outstanding job in doing home health care," said Dr. Sandler, who chairs the board of directors of the Michigan Medical Society. "They are frequently outstanding caregivers. However, we in the medical profession believe nurse practitioners are not sufficiently trained in diagnosis and the efficacy of treatment to work independently of a physician." Dr. Sandler referred to Michigan's Public Health Code, specifically Act 368 of 1978, which calls for "supervision" of medical professionals who are not physicians. Among the definitions of supervision in the code are "continuous availability of direct commu- nication in person or by radio, telephone or telecom- Really Listening Nurse practitioners provide skilled hands and an attentive ear. DIANA LIEBERMAN Special to the Jewish News ickilyn Calvert knew the pain in her neck was- n't psychosomatic. The West Bloomfield resident had been examined by five neurosurgeons and neurologists over a five-year period and, she said, none of them realized her recurring pain was caused by a broken neck. Then she carne to Adult Primary Care Associates, a Southfield-based medical practice run by nurse practi- tioner Cindy Diskin. "Cindy really listened to me," said Calvert, whose daughter attends Hillel Day School of Metropolitan Detroit. "She took a simple X-ray and found that I had a fractured cervical vertebra." Diskin compared Calvert's injury to that suffered by the late actor Christopher Reeve while horseback rid- ing. "If she'd fallen again, she'd be paralyzed from the neck down," said Diskin, a board-certified nurse prac- titioner. When Diskin opened Adult Primary Care in July 2003, she had just this sort of situation in mind. "Nurse practitioners take quite a bit of time listen- ing to each patient, to what they say, how they say it and even what they don't say," she said. "I would hope that all health care professionals would listen. But we specifically take the time to engage the patient and the entire family." Six months after opening, Diskin hired two associ- ates, Kathi Payson and Linda Urso. Today, the trio treats about 400 patients. Nurse practitioner Caroline Broida Trapp of Farmington Hills, who works with people with dia- "Nurse practitioners can do exactly the same thing as physicians would, within their specialty," Diskin explained. "Mine is internal medicine." Diskin received her registered nurse and bachelor of science degrees from Wayne State University in Detroit in 1984. In 1998, she added a master's degree in nursing from Madonna University in Livonia, spe- cializing in chronic health conditions in adults; this was followed by a post-master's specialty certification as a nurse practitioner. At her office, Diskin and her associates do every- thing from medical consultations and tests to sutures, skin biopsies and other minor surgery. In addition, they spend time at West Bloomfield's Danto Health Care Center, the West Bloomfield Nursing and Convalescent Center, Lillian and Samuel Hechtman Jewish Apartments and other retirement and nursing homes, giving lectures and demonstra- tions on such topics as chronic pain, diabetes and nutrition. Residents of these facilities can request private visits, where Diskin or her associates function just as they would in the Adult Primary Care offices. They also make house calls. Joel H. K.aitifitraa_ri COMPUTER CONFUSION? 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