Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors

I am gratified to see such a sound overview on this topic but must point out that "Patient Satisfaction" is a notoriously unreliable assessment of standard of care provided. The Medical profession has long been aware of the importance of a bedside manner but has been driven from bedside manner by scientific observation of outcomes, and the sad fact that a generation of revered Doctors with impeccable bedside manners included several with appalling standards of objective practice, who where likely to practice poorly for extended periods because their patients where very satisfied with them and unlikely to complain.As the profession contemplates clinical governance and professional assessment as a way of improving standards should we not advise our nursing colleagues of the fallacy of assuming care is good if patients like it and bad if they do not like it? I suspect our nursing colleagues are some way behind us in this matter, the ideal is effective care delivered in a manner liked by the patients, and too many published articles on Nurse practitioners display or even attempt to display evidence of clinical outcomes.Let us not suggest "Patient satisfaction" is the prime clinical determinant, nor "outcome measures" alone justifies arrogance and brusque behaviour, but admit that the complex multifaceted assessment of our colleagues we all make asindividuals as to how we regard their standard of care provision has not yet produced an effective universally accepted validated scale with relative quantification of the merits of desirable qualities.