Elite NP has great faith in her new EKG machine's ability to interpret EKGs
💬 comments
"You don’t have to worry about the machine giving you inaccurate results." The EKG machine is never wrong!
Elite NP has great faith in her new EKG machine's ability to interpret EKGs
by u/MidlevelWTF in Noctor
We're ringing in the New Year with this Facebook post by "elite" nurse practitioner Giselle Boigha Wirlen (Texas license #AP141401). Evidently, NP Wirlen thinks she's the hottest fucking shit around because she managed to score a deal on a $2,000 EKG machine and her first 20 patients have already paid off the cost. Ms. Wirlen appears to be the primary owner/provider of Innova Fusion in Aubrey, TX, which advertises itself as a "Family Practice Clinic that is specialized in diagnosing, treating, and managing both acute and chronic diseases for patients aged 2 – 99 years old." As another nurse practitioner who commented on Ms. Wirlen's post sagely foretold, this is indeed the kind of post that will 100% end up on physician-led anti-NP forums! 😂
For those of you needing to know about how easy it is to add EKG services into your practice,
I bought this machine from Mckesson at a $2000 cost.
I charge $100 per testing for all patients who will like to get started on Phentermine( make it condition to get started and they have no option knowing it is for their own good) and patients needing surgical clearance.
My first 20 patients paid off the cost of the machine.
The machine will print out the results and it is pretty specific about any abnormal findings.
In case of an abnormal finding, all you need to let the patient know is they will need to be referred to a Cardiologist for further work up and clearance before you can continue with their treatment plan or clearance.
You don’t have to worry about the machine giving you inaccurate results.
To say the least it is a great addition to my brick and mortar business and I have had more than 250 EKGs performed with this machine since I acquired it last year.
Please do the maths and see if this is something you will like to subcontract to another provider or not.
On another note, needless to say I sent this patient to the ER today because they were symptomatic during their visit.
There's enough questionable or downright false claims in NP Wirlen's Facebook post to give any physician a ST-elevation myocardial infarction!
The machine will print out the results and it is pretty specific about any abnormal findings.
In case of an abnormal finding, all you need to let the patient know is they will need to be referred to a Cardiologist for further work up and clearance before you can continue with their treatment plan or clearance.
You don’t have to worry about the machine giving you inaccurate results.
For starters, NP Wirlen appears to have the utmost confidence in her fancy EKG machine's "ability" to detect abnormalities with high accuracy and specificity.
"You don’t have to worry about the machine giving you inaccurate results"? What the fuck? We have to wonder what exactly Ms. Wirlen learned in her FNP program at the University of Texas at Arlington. Apparently, none of the courses in the 46-credit-hour, 720-clinical-hour curriculum taught the fundamental tenets of EKG interpretation - i.e., you actually need to fucking interpret it yourself and not rely on the results of a primitive computerized algorithm that can be incorrect a significant portion of the time, potentially with fatal or life-threatening consequences. If our emergency physician colleague had a dollar for every EKG that missed a STEMI or every instance a midlevel in the ED missed atypical anginal symptoms in a patient, he would've easily doubled his salary. Similarly, if our primary care colleagues sent a patient to the ED (or cardiologist) every time the computerized EKG interpretation read "abnormal", they would quickly develop a reputation in the local physician community, and not a good one at that.
Seongsoo Kim
Slightly less disturbing is the fact that NP Wirlen's "plan" for every EKG she generates with "abnormal findings" is to refer the patient to a cardiologist. While this approach might be appropriate for certain abnormalities where a primary cardiac etiology is suspected (e.g. a new left bundle branch block), this sort of brainless blanket approach is a surefire way to become the laughingstock of every cardiologist in the region. It certainly wouldn't be the first time an idiotic midlevel sent a patient to the emergency department for completely unnecessary reasons.
Thankfully, some slightly more elite nurse practitioners decided to call Ms. Wirlen out on her utter bullshittery. We've compiled some of the highlights here.
When confronted with the fact that the standards of care regarding the prescribing of phentermine are variable, there is significant variation in clinical practice, her own qualifications (or lack thereof) when it comes to competently reading EKGs, and that cardiologists are often already overwhelmed with unnecessary referrals, Ms. Wirlen decided to double down. By her logic, the science, and sometimes art of EKG interpretation is "just like" "leukocytes, blood, or nitrate in urine maybe indicative of a UTI." We have to question whether Ms. Wirlen actually knows how to interpret urinalyses too, because technically, standard dipstick urinalyses look for nitrites, not nitrates, and leukocyte esterase, not leukocytes themselves.
And when called out by another NP on her woefully misguided belief that the machine is the end-all-be-all when it comes to EKG interpretation, NP Wirlen shot back, stating "that is the job of a Cardiologist to evaluate and treat" and that "I am ACLS certified so no questions about my ability to read EKG readings". Good fucking lord. What kind of special fucking snowflake does NP Wirlen think she is? Virtually every healthcare system requires its inpatient nurses to be ACLS-certified, and no sane healthcare professional we know of would even think of conflating ACLS with competency in EKG interpretation. But who cares about all that when your EKG machine is a money printer and you can "watch your profits increase with adequate marketing"?
It's also hilariously antithetical to read Ms. Wirlen's rants about "understand[ing] our roles as PCPs and the importance of when to collaborate with Specialists", when it's evident through her own words that she herself lacks that very understanding. News flash, Ms. Wirlen: "elite NPs" don't rely on the EKG machine to interpret the EKG, aren't guided by the fallacy you don't have to worry about said machine giving you inaccurate results, don't refer every patient with an abnormal EKG to a cardiologist to "evaluate and treat", and don't think that their ability to interpret EKGs is infallible just because they're ACLS-certified. Hey, guess what - the author of this very article is ACLS-certified, too!
So who is NP Wirlen's supervising physician?
As some of our hawk-eyed readers probably noted, Ms. Wirlen's practice is located in Texas, a restricted-practice state that requires nurse practitioners to practice under the supervision of a physician through a delegation agreement. So who is her supervising physician? The Texas Medical Board makes it easy to find this out:
Darrel Glenn Pierce, MD (Texas license #L9849) is a family medicine physician located 80 miles away in Sulphur Springs, Texas.
We have to wonder whether Dr. Pierce is aware of NP Wirlen's practice patterns and her cavalier approach to EKG ordering/interpretation and making referrals to cardiologists. The better question is, does he care? Interestingly, he started renting his license to supervising four nurse practitioners, including Ms. Wirlen, within the past 6-7 months. We'll let our readers be the judge of that.
JENNIFER FOXWORTH
APN License Number: 1018080
Begin Date: 12/05/2023
Prescriptive Delegation: YES
Hours Delegated: 32
Dangerous Drugs: NO
Controlled Substances: YES
Delegation Location Type: Primary Practice Site
Delegation Address:
7801 South I-35E Suite 301A
Corinth TX 76210
AMY NEWSOM
APN License Number: 1117850
Begin Date: 06/13/2023
Prescriptive Delegation: YES
Hours Delegated: 40
Dangerous Drugs: NO
Controlled Substances: YES
Delegation Location Type: Primary Practice Site
Delegation Address:
1240 Shannon Road E
Sulphur Springs TX 75482
BRANDY PRINCE
APN License Number: AP114862
Begin Date: 09/01/2023
Prescriptive Delegation: YES
Hours Delegated: 20
Dangerous Drugs: NO
Controlled Substances: YES
Delegation Location Type: Primary Practice Site
Delegation Address:
955 Ralph Hall Pkwy
Rockwall TX 75032
GISELLE WIRLEN
APN License Number: AP141401
Begin Date: 09/15/2023
Prescriptive Delegation: YES
Hours Delegated: 20
Dangerous Drugs: NO
Controlled Substances: YES
Delegation Location Type: Primary Practice Site
Delegation Address:
26919 E University Drive Suite 200
Aubrey TX 76227
In what is sure to be a total surprise to everyone, all of the three other NPs - Jennifer Foxworth, Amy Newsom, and Brandy Prince - all appear to operate their own "wellness" practices, or in the process of establishing one.
Jennifer Foxworth, NP operates "Be Whole Wellness Center" in Corinth, Texas, about 100 miles west of Dr. Pierce's listed practice address.
Amy Newsom's LinkedIn profile makes mention of "Newsom Health and Wellness", with a registered practice address identical to that of Dr. Pierce's.
Finally, Brandy Prince appears to operate "Prince Wellness Solutions" in Rockwall, TX, about 60 miles southwest of Dr. Pierce's listed practice address.
Under Texas Board of Nursing requirements as laid out by the Texas Administrative Code, nurse practitioners / "advanced practice registered nurses" must have documented meetings with their supervising physician at least once a month regarding "the sharing of information relating to patient treatment and care, needed changes in patient care plans, and issues relating to referrals; and discussion of patient care improvement", and supervising physicians are supposed to conduct chart review. In the interest of minimizing his medicolegal liability and preserving, the integrity of his medical license, perhaps Dr. Pierce should take a close, hard look at the relationships with the NPs operating under his name, particularly Ms. Wirlen, and decide if the occupational hazard is worth it.