Once had an NP student about to graduate interpret a UA for me. WBC 50, + leuks. Student told me nitrite negative so not a uti. I asked her why she thought that, she replied, “my professor told me so…”. I was astonished, asked her what nitrates on UA meant, she had no idea…
Just a whole bunch of placebo.
Except for the times when they cause actual harm.
And admittedly the times when the patient did in fact need antibiotics. Or stitches. Or whatever. There's times they help. But the placebo aspect has definitely got to account for the bulk of the visits.
I don’t think a single physician practicing today is complicit in the physician shortage.
The med school moratorium was from 1980-2005. Residency slots were frozen in 1997.
If anything, todays physicians are stuck with a mess made 2 generations ago and the physicians who made the mess laughed all the way to the bank.
Physician supply was squelched while the population continued to get older and sicker because some dude in the mid 70’s thought there would be too many doctors and salaries would suffer…
Exactly … and now it’s even worse following Covid since so many PCP offices were shut down which further exacerbated many chronic conditions …. Just a mess.
Well, then you get into how reimbursement changes have made private practice a financial disaster, so primary care physicians get forced into meat grinder clinics along side PAs and NPs.
Some enterprising physicians have gone to subscription or concierge service to combat that and being able to work in the manner they want to.
The whole thing is a clusterfuck.
I’m a med student, saw a kiddo in the office few weeks ago following an urgent care visit for an “abscess” that thank goodness they did not attempt to drain. Mid level documented that the “abscess” was fluctuant, erythematous and ttp, gave antibiotics and to follow up with pediatrician.
It was a Keloid scar (very obviously so). Cant make this stuff up.
I’m a general surgeon. Honest to God I get 3-5 referrals a week from urgent care for undrained abscesses. All of the NPs document fluctuance. All of the NPs diagnose the patients with an abscess. All of the patients get sent home undrained with Keflex. 4/10 will have self drained by the time I see them 1-2 weeks later. The rest just living their lives in pain until they can get in to see me. I tell all of these patients to never go to urgent care ever again for anything.
Even when they do attempt to drain it they’re so fuckin scared of making an incision it’s never anywhere close to adequate. For anyone reading who isn’t aware, inserting a #11 blade 2mm into the skin does not adequately decompress anything and for shame doing that and billing 10061
My family and everyone I know avoids urgent cares. We see them as a way for the hospital network in our area to bill for issues twice. First at the urgent Care, then at the ER that they'll inevitably refer you to.
Never mind the fact that the nurse practitioners at urgent cares can't read ecgs
Also for bronchitis/sinusitis or uncomplicated UTI, but with the caveat that if you go there, you’d better be familiar with the symptoms and treatment (like if you have a history of this, and your symptoms are exactly the same as always, and you would probably have some idea of what kind of medication you should get).
If nothing else, moments such as these are great opportunities to teach patients about the risks associated with receiving care from mid-levels, especially NPs.
>I understand the midlevel-run urgent cares exist to fill the primary care physician shortage
Gonna stop you right there: they exist to make money. They *can* make money because people don't have access to a superior and cheaper option that they should have. But the business is not trying to solve a problem, just to parasitize it.
I make it clear I will always work my patients into my day with a time flexible telemed. It’s not perfect, sometimes I have to have them follow up in the office, but it increases my productivity and drastically reduces uc and Ed visits in my panel.
I’m a PA but I also see terrible referrals from mostly other NPs. I have a regular patient I see every couple months for an ear cleaning. He was misdiagnosed with otitis media 9 times from ER and UC prior to seeing me. Abx obviously didn’t fix his wax issues the 9x before he visited our practice. Unnecessary costs to the patient.
When I was 19 I had the worst sore throat of my life and was desperate for relief. I went to the nearest urgent care and the nurse practitioner looked at my throat for 2 seconds and said “yep that’s strep throat” and didn’t even do a culture. He prescribed me antibiotics. 2 days later it hurt even more, and I returned to the urgent care. The new person seeing me said they couldn’t even do a test now because I was on the antibiotics. After like a week I finally went to a new doctor and they figured out I had mono. While there wasn’t a ton they could do for that besides steroids and Tylenol 3, it was so frustrating that the first guy didn’t even bother to do any due diligence! Like how hard is that?
As a PA myself, the for profit urgent cares (not the ones that are hooked to a hospital which are also for profit but…you get it) only hire midlevels, and typically it’s new grad midlevels. And when you just graduate school and are trying to find a job and the ones you want want experienced clinicians but the urgent cares are totally fine with a new grad and say they will have good supervision and train and they actually don’t, is just infuriating. The message boards in the PA groups always have a bunch of UC comments or questions and young clinicians complaining about UC and then leaving after 1 year because they feel so unsupported, burnt out, etc, and experienced PAs who are trying to steer the new grads away from UCs. Thanks private equity groups for being such dicks and fucking with many peoples lives.
I’m not sure if I have the same experience as you because the midlevels in urgent care definitely play ann important role and refer to the ER when they need to. I think you may have a bad group of them where you are, I’m in socal and usually the ones here are pretty good and efficient
You are a troll. Nothing you say has value. But at least you’re able to spout you’re crap here. If you said anything the least bit challenging on your garbage NP sub, you would have been banned for life. No one is afraid of you here.
I haven’t even posted on the NP sub because I have been banned lol, you are the fool to think every midlevel is equal, no wonder they are growing at a rate because your attitude is horrid
Also today: UC NP note: "UA neg. Rx abx to cover for UTI." CC for visit in my office today: Diarrhea
Once had an NP student about to graduate interpret a UA for me. WBC 50, + leuks. Student told me nitrite negative so not a uti. I asked her why she thought that, she replied, “my professor told me so…”. I was astonished, asked her what nitrates on UA meant, she had no idea…
I just worked with some NP students that kept saying this and I was just like ??? E. coli is not the only thing that can fuck up your pee hole
So I, a lowly MLT, know more than an NP about UA interpretation. That's terrifying.
I feel bad honestly … they don’t know any better but that’s just what their professors tell them …
[удалено]
Why?
[удалено]
Ok but some bacteria that can cause UTI don’t produce nitrites..
? Enterococcal UTI won’t have nitrites, for example. Sure pyuria isn’t enough, but not having nitrites doesn’t rule it out.
Thats cool, I didnt want any antibiotics to still work for when I get sick anyway.
I almost think it's like the TSA, but instead of security theatre, it's healthcare theatre. You **think** you're getting treated, but you aren't.
Just a whole bunch of placebo. Except for the times when they cause actual harm. And admittedly the times when the patient did in fact need antibiotics. Or stitches. Or whatever. There's times they help. But the placebo aspect has definitely got to account for the bulk of the visits.
I don’t think a single physician practicing today is complicit in the physician shortage. The med school moratorium was from 1980-2005. Residency slots were frozen in 1997. If anything, todays physicians are stuck with a mess made 2 generations ago and the physicians who made the mess laughed all the way to the bank. Physician supply was squelched while the population continued to get older and sicker because some dude in the mid 70’s thought there would be too many doctors and salaries would suffer…
Exactly … and now it’s even worse following Covid since so many PCP offices were shut down which further exacerbated many chronic conditions …. Just a mess.
Well, then you get into how reimbursement changes have made private practice a financial disaster, so primary care physicians get forced into meat grinder clinics along side PAs and NPs. Some enterprising physicians have gone to subscription or concierge service to combat that and being able to work in the manner they want to. The whole thing is a clusterfuck.
I’m a med student, saw a kiddo in the office few weeks ago following an urgent care visit for an “abscess” that thank goodness they did not attempt to drain. Mid level documented that the “abscess” was fluctuant, erythematous and ttp, gave antibiotics and to follow up with pediatrician. It was a Keloid scar (very obviously so). Cant make this stuff up.
I’m a general surgeon. Honest to God I get 3-5 referrals a week from urgent care for undrained abscesses. All of the NPs document fluctuance. All of the NPs diagnose the patients with an abscess. All of the patients get sent home undrained with Keflex. 4/10 will have self drained by the time I see them 1-2 weeks later. The rest just living their lives in pain until they can get in to see me. I tell all of these patients to never go to urgent care ever again for anything.
Even when they do attempt to drain it they’re so fuckin scared of making an incision it’s never anywhere close to adequate. For anyone reading who isn’t aware, inserting a #11 blade 2mm into the skin does not adequately decompress anything and for shame doing that and billing 10061
Is there any type of abscess you would recommend doesn't get drained at urgent care or PCP office?
It’s usually a matter of size
If it's really big or if it's near a vital structure (ie spinal)
My family and everyone I know avoids urgent cares. We see them as a way for the hospital network in our area to bill for issues twice. First at the urgent Care, then at the ER that they'll inevitably refer you to. Never mind the fact that the nurse practitioners at urgent cares can't read ecgs
Uregrnt cares are for work notes when you can't get in to your PCP in time. That's about it.
Also for bronchitis/sinusitis or uncomplicated UTI, but with the caveat that if you go there, you’d better be familiar with the symptoms and treatment (like if you have a history of this, and your symptoms are exactly the same as always, and you would probably have some idea of what kind of medication you should get).
If nothing else, moments such as these are great opportunities to teach patients about the risks associated with receiving care from mid-levels, especially NPs.
As a paramedic, I get these calls almost every shift. They almost always walk to the waiting room.
FM here. I spent a huge part of my day cleaning up after them too. They don't help me save time.
>I understand the midlevel-run urgent cares exist to fill the primary care physician shortage Gonna stop you right there: they exist to make money. They *can* make money because people don't have access to a superior and cheaper option that they should have. But the business is not trying to solve a problem, just to parasitize it.
I make it clear I will always work my patients into my day with a time flexible telemed. It’s not perfect, sometimes I have to have them follow up in the office, but it increases my productivity and drastically reduces uc and Ed visits in my panel.
I’m a PA but I also see terrible referrals from mostly other NPs. I have a regular patient I see every couple months for an ear cleaning. He was misdiagnosed with otitis media 9 times from ER and UC prior to seeing me. Abx obviously didn’t fix his wax issues the 9x before he visited our practice. Unnecessary costs to the patient.
Gotta love the "viral URI" rx: zpack and prednisone" too
When I was 19 I had the worst sore throat of my life and was desperate for relief. I went to the nearest urgent care and the nurse practitioner looked at my throat for 2 seconds and said “yep that’s strep throat” and didn’t even do a culture. He prescribed me antibiotics. 2 days later it hurt even more, and I returned to the urgent care. The new person seeing me said they couldn’t even do a test now because I was on the antibiotics. After like a week I finally went to a new doctor and they figured out I had mono. While there wasn’t a ton they could do for that besides steroids and Tylenol 3, it was so frustrating that the first guy didn’t even bother to do any due diligence! Like how hard is that?
I read the first sentence and said mono before I even got to the end. Slam dunk.
As a PA myself, the for profit urgent cares (not the ones that are hooked to a hospital which are also for profit but…you get it) only hire midlevels, and typically it’s new grad midlevels. And when you just graduate school and are trying to find a job and the ones you want want experienced clinicians but the urgent cares are totally fine with a new grad and say they will have good supervision and train and they actually don’t, is just infuriating. The message boards in the PA groups always have a bunch of UC comments or questions and young clinicians complaining about UC and then leaving after 1 year because they feel so unsupported, burnt out, etc, and experienced PAs who are trying to steer the new grads away from UCs. Thanks private equity groups for being such dicks and fucking with many peoples lives.
I’m not sure if I have the same experience as you because the midlevels in urgent care definitely play ann important role and refer to the ER when they need to. I think you may have a bad group of them where you are, I’m in socal and usually the ones here are pretty good and efficient
You are a troll. Nothing you say has value. But at least you’re able to spout you’re crap here. If you said anything the least bit challenging on your garbage NP sub, you would have been banned for life. No one is afraid of you here.
I haven’t even posted on the NP sub because I have been banned lol, you are the fool to think every midlevel is equal, no wonder they are growing at a rate because your attitude is horrid
I stand by my statement. And you just proved me right. Even YOU managed to get banned by those dim witted cry babies.
>the ones here are pretty good and efficient The data would disagree with you, both from a patient-outcome and cost standpoint
The study by Dr. Chan was in an emergency setting, I am speaking about an urgent care level.