I am also aware that sometimes I need an internist to do more than follow guidelines and recommendations for my healthcare. Sometimes I need him to figure out what is wrong with me.

And there is something else that comes into play here. Sometimes knowing more and having a deeper understanding leads to doing less. (Recall the simple example of the minor head injury.) Very often a smart doctor can figure out what is wrong with you by taking a focused history, asking all the right questions, and doing a careful physical examination for signs of disease. The doctor may be 93% sure about what is wrong with you without doing any tests. Imagine how much money could be saved if you trust his clinical judgment and give him permission to refrain from spending any of your money on tests to raise the diagnostic certainty from 93% to 99%.

I have worked side-by-side with nurse practitioners for nearly three decades, including some I’ve thought were very capable. I am still waiting to meet a nurse practitioner I might judge to be an astute diagnostician.

This is hardly surprising. One can become a nurse practitioner by starting as an RN/BSN and taking an online master’s degree program, while an internist has 4 years of medical school and 3 years of residency after the bachelor’s degree. To expect the two to have similar abilities in the aspects of practice that rely on a foundation of education in the sciences is quite unreasonable.

Let us begin with the assumption that, among bachelor’s-degree RNs, only the best and the brightest decide to go on to earn master’s (or doctoral) degrees and become nurse practitioners. Now I’m going to look at that population of students and ask a simple question. How many of them would do well in the year of organic chemistry required of pre-meds and commonly used as a “weeder” course? My daughter Rose is very bright and hard-working. I know this because I lived with her in the same household for nearly two decades. And I saw how hard she had to work to get grades in organic chemistry last year that would meet with the approval of a medical school admissions committee.

Do you have any children still in school? Think about the smartest kid in your child’s class. Maybe it’s your kid. That kid could go to medical school or law school or choose any other of a number of career paths. Now remember, she’s the smartest kid in the class. When you are older and sick, what do you want her to be? Do you want her to be the consultant other doctors call when they are trying to figure out how to keep a perplexing illness from killing or disabling you? Or do you want her to be the lawyer your family calls when things don’t go well and they want to find out whether your doctors are to blame?