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Posted on 6/21/21 at 10:50 pm to CajunDoc
Good, I have had issues with several nurse practitioners and PA’s. The last issue I had scared the shite out of me. About a year ago, I was in Houston at MD Anderson for my normal 3 month scan and visit with my oncologist. Anyway, I was in the exam room waiting for my doctor to come in and instead a PA that I had never met came in and promptly told me that one of the tumors in my liver(that had been stable) was growing and that they had few options for me. Said that I may qualify for some clinical trials but that was about it. I know the day will come that this will be true but it ain’t yet and I knew that when she told me. I started asking her about next line chemo drugs like Lonsurf and Stivarga were still available to me and that there were other procedures like Y-90 embolization that could still keep my cancer stable. When I started asking the questions she quickly exited the room saying she needed to talk to the Doc. She came back in a few minutes later and said the Doc would be in in a few minutes to discuss my questions. So, a few minutes go by and the doc came in and promptly told me that he had discussed my case with interventional radiology and that thenDoc there felt he could ablate the tumor safely and completely. No mention of changing chemo or no further options. Apparently he had not discussed this route with the PA and she took it upon herself to “give me the bad news)
I was pissed about that turn of events but was grateful the doc was looking for solutions and not content to say oh well we are out of options. With that said, there is a PA I see from time to time that is exceptional. Very good bedside manner and very empathetic to her patients. On my next visit after the above frick up, I told this PA about the incident with the other PA and she was aghast. She told me that even if ablation had not been an option there were several avenues for treating my cancer and that I wasn’t ready for clinical trials yet.
To end this saga, let me say because the Oncologist found another way to treat my growing tumor I was able to stay on the same chemo I had been on for over a year with no further progression. Had that PA been in charge I most likely would be dead by now.
TL:DR
PA fricked up, doctor fixed her frickup and I’m still alive
I was pissed about that turn of events but was grateful the doc was looking for solutions and not content to say oh well we are out of options. With that said, there is a PA I see from time to time that is exceptional. Very good bedside manner and very empathetic to her patients. On my next visit after the above frick up, I told this PA about the incident with the other PA and she was aghast. She told me that even if ablation had not been an option there were several avenues for treating my cancer and that I wasn’t ready for clinical trials yet.
To end this saga, let me say because the Oncologist found another way to treat my growing tumor I was able to stay on the same chemo I had been on for over a year with no further progression. Had that PA been in charge I most likely would be dead by now.
TL:DR
PA fricked up, doctor fixed her frickup and I’m still alive
Posted on 6/21/21 at 11:27 pm to CajunDoc
This makes sense to me. I'm personally only comfortable seeing doctors for primary care
Posted on 6/21/21 at 11:30 pm to CajunDoc
quote:
denies Independent nurse practice
GOOD
Posted on 6/21/21 at 11:36 pm to CajunDoc
My regular medical clinic is owned by an NP. She’s awesome, I can even get my annual papsmear and mammogram at her clinic in Watson.
Posted on 6/21/21 at 11:45 pm to CajunDoc
Mid level isn't an appropriate term for Nurse Practitioners, nothing about being a Nurse Practitioner should be considered mid level. It isn't like nurses are low level and doctors are high level, they are simply doing different roles.
Those who complain about NP's going to the doctor to consult are just stupid, would you rather the NP just wing it or make some shite up instead of consulting a doctor? You better bet doctors consult each other, online resources... even google... when they need some information. I was working with a doctor and they pulled up some info about a drug I had a question about and I asked what resource they used, trying to be good student and all, they used google... I thought she had a good drug book app or something. Lexicomp is what I was given access too but I like some of the other books better.
Anyway, I have no problem seeing a NP, the vast majority of the time I go see a doctor I already know the diagnosis and know what they are going to prescribe I just need a permission slip to get the proper drugs to take care of the problem. I have even seen NP's as my case manager (I have organs that do not work) and the Doctor just reviewed what was going on. Hell, I have never met or spoken to my endocrinologist, I don't even know where he is. He orders tests, he reviews tests, I see a NP to review what he said.
Those who complain about NP's going to the doctor to consult are just stupid, would you rather the NP just wing it or make some shite up instead of consulting a doctor? You better bet doctors consult each other, online resources... even google... when they need some information. I was working with a doctor and they pulled up some info about a drug I had a question about and I asked what resource they used, trying to be good student and all, they used google... I thought she had a good drug book app or something. Lexicomp is what I was given access too but I like some of the other books better.
Anyway, I have no problem seeing a NP, the vast majority of the time I go see a doctor I already know the diagnosis and know what they are going to prescribe I just need a permission slip to get the proper drugs to take care of the problem. I have even seen NP's as my case manager (I have organs that do not work) and the Doctor just reviewed what was going on. Hell, I have never met or spoken to my endocrinologist, I don't even know where he is. He orders tests, he reviews tests, I see a NP to review what he said.
Posted on 6/22/21 at 12:08 am to CajunDoc
You gotta be careful where you get your medical care. Buddy of mine tried to save money by getting one of those "back alley" colonoscopies, and let me tell you, it was not worth it. Not at all.
Posted on 6/22/21 at 1:13 am to CajunDoc
quote:
LA legislature denies Independent nurse practice
A NP/PA is not a doctor bc they either are not smart enough or are an underachiever, neither of which I want diagnosing or caring for me or any of my family.
Posted on 6/22/21 at 3:26 am to CajunDoc
Ex wife is a NP and no they aren’t doctors. They have no where near the training or clinical requirements of doctors. They have the book knowledge but not the practical knowledge.
Posted on 6/22/21 at 4:20 am to CajunDoc
Trained physicians don't like their professions being bastardized by nurses with a superiority complex, bad attitude and a chip on their shoulder. Who'd have thunk it?
Posted on 6/22/21 at 5:42 am to CajunDoc
People say “I’m going to the doctor’s office” instead of “I’m going to the nurse practitioner’s office” for a reason…. Bc they want to see a doctor.
Posted on 6/22/21 at 6:45 am to CajunDoc
What is the current rule on “physician oversight”, if I remember correctly it used to be the md had to be available by phone and review a handful of charts, that is bullshite to begin with and worthless
Either give it some teeth or remove it but just having the word oversight in the practice act does no good
Either give it some teeth or remove it but just having the word oversight in the practice act does no good
This post was edited on 6/22/21 at 6:48 am
Posted on 6/22/21 at 6:58 am to CajunDoc
How will this affect their Tik Tok videos??
Posted on 6/22/21 at 9:00 am to CajunDoc
Everyone wants to complain about healthcare costs, but then they support stupid shite like this.
An NP can handle 80% of what comes up at a doctor's visit. For anything else, they can send you to a specialist.
An NP can handle 80% of what comes up at a doctor's visit. For anything else, they can send you to a specialist.
Posted on 6/22/21 at 1:03 pm to CajunDoc
quote:
Generally interested in people’s overall opinion on this matter. How many of you or your loved ones routinely see mid levels (nurse practitioners or physician assistants) instead of MDs or DOs? Are you happy with or ok entrusting your health and well being to someone with less training even though you pay the same amount for the “care?”
Not everything requires a physician to treat. General family practice and pediatrics are a great example. If an NP can diagnose an ear infection or bronchitis and write a prescription. It is a great way to reduce the cost of delivering health care.
quote:
CajunDoc
I get the sense you spent $200K in med school to become a family practice doctor.
Now if I have cancer or a heart ailment, then absolutely it needs to be an MD or DO.
Posted on 6/23/21 at 5:24 am to CajunDoc
To clarify:
1. No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.
Wife and I are physicians and our oldest child just got done with the MCAT. She studied 300 hours for the test (while keeping a 4.0 GPA in college). I repeat, she studied 300 hours for the test to APPLY to medical school. Her friends did similar levels of preparation.
No other medical discipline studies like that. The number of hours she will study in her 1st year alone of medical school will surpass any mid levels total training for their career.
2. I supervise and lecture mid levels as well as primary care medical residents.
The difference between the two groups (in lecture and clinic) is in stark contrast.
The types of questions I get during a lecture, the way they process information, and the clinical questions I get throughout the day.
We utilize NP’s to see routine complaints in our offices, but we have MD’s in the same clinic with protected time to be available for questions which always arise. We also have several specialists (I am one of those) available by computer message. We can review the patients chart and give advice.
I have never had a medical resident make a “What were you thinking?” type of mistake in diagnosing or dosing a medication. I probably get 1-2 of those mistakes per week with my mid levels.
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
1. No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.
Wife and I are physicians and our oldest child just got done with the MCAT. She studied 300 hours for the test (while keeping a 4.0 GPA in college). I repeat, she studied 300 hours for the test to APPLY to medical school. Her friends did similar levels of preparation.
No other medical discipline studies like that. The number of hours she will study in her 1st year alone of medical school will surpass any mid levels total training for their career.
2. I supervise and lecture mid levels as well as primary care medical residents.
The difference between the two groups (in lecture and clinic) is in stark contrast.
The types of questions I get during a lecture, the way they process information, and the clinical questions I get throughout the day.
We utilize NP’s to see routine complaints in our offices, but we have MD’s in the same clinic with protected time to be available for questions which always arise. We also have several specialists (I am one of those) available by computer message. We can review the patients chart and give advice.
I have never had a medical resident make a “What were you thinking?” type of mistake in diagnosing or dosing a medication. I probably get 1-2 of those mistakes per week with my mid levels.
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
This post was edited on 6/23/21 at 6:29 am
Posted on 6/23/21 at 9:31 am to CajunDoc
I don't think anyone should confuse a NP/PA with a MD.
I believe there are things that are so basic that an NP/PA should be allowed to deal with by themselves with proper regulation.
This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?
I'm often of the opinion that if LA is going against national model, we are probably wrong...
I believe there are things that are so basic that an NP/PA should be allowed to deal with by themselves with proper regulation.
This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?
I'm often of the opinion that if LA is going against national model, we are probably wrong...
Posted on 6/23/21 at 3:22 pm to CajunDoc
Yeah I don't have a problem with this one.
States that have a rural medicine shortage need to lobby for more residency slots and expand their medical school programs. Then have NP's and PA's practice in these clinics under supervision of an MD or DO.
Giving more responsibility to people that may not be prepared for it isn't a solution - although I'm sure there are some NP's out there that are more than capable.
States that have a rural medicine shortage need to lobby for more residency slots and expand their medical school programs. Then have NP's and PA's practice in these clinics under supervision of an MD or DO.
Giving more responsibility to people that may not be prepared for it isn't a solution - although I'm sure there are some NP's out there that are more than capable.
This post was edited on 6/23/21 at 3:25 pm
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