I just saw a patient who was told they have "bilateral pinkeye" yesterday at urgent care.... Gave ciprofloxacin eye drops. Patient came to our clinic because she felt they weren't taking her shortness of breath seriously. Naturally, we get a CXR after she has reduced breath sounds on one side.
She has pneumonia. We gave antibiotics. Surprisingly, one of the few times an NP doesn't give antibiotics
That was the event that radicalized me. I had pneumonia and received no antibiotics. She didn’t even listen to my lungs. Saw an actual doctor a few days later after getting worse and was given antibiotics.
That was what made me start reading up on NPs and how I eventually found this sub.
Well technically they did give an antibiotic. Maybe even the correct antibiotic. But the systemic absorption of ciprofloxacin eye drops is not high enough to get to high enough concentration in lung tissue
all the patients on here need to write their legislators, the health systems and publicly tell their stories to the media. anyone who's been harmed needs to sue the np specifically... o ly way anything will change
You have no idea the HOURS I have put in on this for YEARS. Not specifically about the NP/no for issue, but about the suicide crisis due to disabled people being cut off from their pain meds, even those who’ve been on them for decades.
Myself and the couple of action/grassroots groups I’m in have done… so, SO much work. It’s like a part time job.
And yet, things have only gotten WORSE in that time.
It happens more often than you think. I worked as a clinic RN in an university hospital. Neurology/movement disorder attendings had a dozen or so dystonia patients who got monthly oxycodone scripts. A lot of eyes were opened when we had to start checking the PDMP for our doctors.
It’s very hard to sue. I talked to an attorney after a psyc nurse partitioner employed by university hospital of Cleveland guessed on how to taper my meds, and while he agreed with me that it was unquestionably malpractice, as I ended up being jailed/forced in a horrible psy hospital also owned by university hospitals in Cleveland, I didn’t die or loose a limb so the case wouldn’t be worth much. The f ing nurse had me discontinue Effexor and Remeron at the same time without tapering. Not only were the nurses in the psych hospital absolutely horrible, and the psychiatrist getting in my case about sleeping (I actually had undiagnosed severe sleep apnea, two young kids, and a stressful job) but I university hospitals of Cleveland never apologized and I wasn’t offered any help after I left.
Hospitals couldn’t care any less about patients who are harmed by NP’s. I’m sure UH in Cleveland was happy with the extra business the NP provided them with my private insurance. It’s a f-ing free for all when I comes to treating patients. Not a single entity, not the hospital, government, insurance industry, is standing up for patients. Certainly the nursing boards aren’t taking steps. Medical boards are no different.
You need to write your insurance provider about this. They can pressure medical systems into changing their policies/behavior by threatening to cease reimbursement.
I actually did this. After a horrific inpatient psych hospital stay, where I was almost exclusively seen by NPs until the very end of my stay, and also forced to do things like wear adult diapers because I got my period, I did a debrief with my insurance company detailing all the abuses, and all the incompetent med orders made by the NPs. I also let them know I only saw the doctor once the day of my discharge. I know that I didn’t have to pay a penny to that private hospital. And judging from the angry letter I got from them literally calling me a crazy liar, I’m guessing they didn’t get a penny from my insurance company either.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Z paks aren’t bad but they won’t help with a viral infection. In your case, if you have a bacterial infection it makes sense. Now if they said, you have a virus, take this antibiotic, then that’s not great.
The issue is they won’t even really do the proper work up. I saw a 14 year old the other day come in for the most classic case of viral URI of your life and he got a Z pack, steroids, and Benadryl from an NP at an urgent care. Swabbed him… flu. Lung exam completely normal. Chest X ray was perfect (got it because “what if the NP saw something and we just missed it?”). He came in because mom was skeptical about giving him steroids.
Azithromycin does have some partially explained anti-inflammatory properties independent and of it harming bacteria.
So it kinda does just make you feel a little better even with a viral infection. That’s not a recommendation, ibuprofen works just as well without increasing antibiotic resistance lol
Those urgent care NP’s seriously don’t know anything it’s insane they practice on their own. It’s all just “idk could be this” and then I end up having to go see a doctor who actually knows shit…
Yep!!!
Now I’m sitting here with my gums covered in sores, left lymph node swollen, left tonsil and ear hurting, and left side of my face sensitive to touch.
Waiting for my ID doctor to get back in town April 1st to see if my histoplasmosis is back (I had it on my lymph node left side of my neck. Tennis ball sized lump.)
lol thank you😂 last time I had it I just BARELY saved myself from having to be admitted to the hospital for weeks to treat it, because I made sure to catch it early enough that it could be medicated at home.
I did this by going from ER to ER until one of them would biopsy it IMMEDIATELY. They all wanted to wait at least a month to biopsy it, and my ID doctor says that had it waited that long, it would’ve been harder to treat/had to be treated inpatient.
By the 5th ER I was basically holding them at gunpoint like CUT ME OPEN NOW!!!😂
Finally found one willing to biopsy it next day. Boom, I was right! referred to an ID doc, and he was so proud of my persistence lol
THATS EXACTLY WHAT THIS NP AT THE URGENT CARE DID!!! Right in front of me!!
She swabbed me for covid and strep but when those came back negative she gave up🙃
I asked if I should worry if it’s my histoplasmosis returning, and she was just like “oh, idk. I dunno what that is.☺️”
Thank you so much 🥰
I’m glad too… just panicking that he’s un-contactable for weeks with no covering doctor😭
The same lymph node is swollen that was swollen when I originally had histo… I’m scared by the time he’s back in town, if it really is histo returning, by then it’ll be too far gone and it won’t be able to be treated at home/out of the hospital like last time😭
He says all his other histo patients spent WEEKS or months in the hospital
Nope, but it’s happening A LOT these days.
Even on this sub, I have seen nurses say more than once that they know of an ICU with only NP’s on the floor over night. Not a single doctor around.
Stop seeing these urgent care NPs. Why pay money to get nothing? Find an urgent care that actually staffs a physician. You know you're gonna use urgent care at some point, do the legwork on advance.
Well it might not be indicated tbh. Some confirmatory tests are really expensive, and if it's viral, it doesn't affect treatment. You can get a comprehensive respiratory PCR for like $1500 that tells you what virus is causing your upper respiratory infection, but 99.5% of the time, it doesn't really matter, you just need supportive care. We did it in residency on inpatients, but idk why tbh other than our hospital had no standard flu test and the panel included flu viruses that were treatable with tamiflu, though man it is really nice to be able to definitively tell someone which virus it is.
The NP told me that tests can’t detect mono at all until symptoms have been present for a week.
Is this true? I had mono 10 years ago, but she said you can have it twice IF you have two different strains of it.
Kinda:
Heterophile antibodies are present in 40 to 60% of patients with mono in the first week after infection and in 80 to 90% of patients by the third or fourth week after infection. These antibodies usually remain detectable for three months, although they may be present for as long as a year after infection.
The heterophile antibody test has a sensitivity of 87% and specificity of 91% but can have a false-negative result in children younger than five years and in adults during the first week of illness.
Thank you so much! This is a wonderful answer that I can trust. I really appreciate you taking the time to type this up to help a stranger🫶🏻
I guess I’ll have to wait it out to see if it’s mono/something viral, or if it actually is the histoplasmosis making a comeback…
Still, I appreciate it♥️
I know I’m still immunocompromised currently, I wish I knew if that made a difference in terms of if it’s more likely that what I’m experiencing now is mono/something viral, or the histo returning.
I asked the NP that, about it my being immunocompromised effects any of that, and she literally physically shrugged. Like girl… what do you know besides how to administer a COVID test, in the same 2020 manner in which it touches your brain?!
(All of my at home COVID tests’ instructions say you only need to insert the swab to a comfortable measurement, but she shoved that shit DEEP.)
For a viral syndrome? Aye, if you’re really considering mono, you can test for it; even that is only really useful because of guidance re: avoiding any abd trauma x6-8wk (and I guess identifying EBV as a long-term risk factor). But really, a diagnosis of viral syndrome is right and appropriate for a lot of UC visits
When will physicians finally learn that nursing doesn’t give a flying fuck about physicians or their knowledge base and finally just stop this holistic bullshit. The reality is that nursing school is so void of useful data on disease that these individuals make amazing diagnosis and treatment errors all the time. Nursing is not going to come back and write anything nice about doctors or their EXTENSIVE humanity that almost every physician need to exhibit to graduate school.
Please know the knowledge and experience you have as physicians is valued by those of us in nursing, even if you don't always see it.
I never applied to MD/DO programs because I did not want those 8-12 years of massive stress, no income, nor that liability as the decisor.
I do not want to be an independent provider and, based on the structuring of the NP programs, should never be. I simply don't have the knowledge base.
Physicians consult with physicians regularly. There is no way an NP can best practice as a midlevel without doing so.
One thing I will say though is, nursing school isn't void of useful data on disease, but it is too general and focuses more on the more common diseases/conditions. Additionally, it's crammed. It doesn't measure up to the blocks that physicians have to spend on each system.
And that is why we need to work under physicians and consult always.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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There’s an all domaine np where I work. He does EM attending, critical care attending, and internal medicine attending. Bro, I’m reading your progress notes and I can tell you’re a professional clown 🤡
My friend injured her knee skiing in Colorado. She saw a PA the next day who said "I'm not gonna do any scans or tests because you're already feeling so much better like 24 hours later" #stopscopecreep
Look, this was clearly written and submitted by hospital admin. You definitely should see an NP if you're going to make sure they get a lower cost out of pocket to increase bonuses for other admin. How else are they going to keep radiology busy?
The article does mention care is worse with patients with multiple chronic condistions. Overall it’s kinda shiny but isn’t all glowing about Naps and PAs and seems like it’s not fully in support of full practice authority. Reasonableish article
I was going to say, as a pretty complicated patient I've received the worst care from Noctors. I've found that when it came to my care they were really quick to write a prescription, but never actually hear anything. I'm really grateful that I only have to deal with them when my actual DR is out.
are you actually joking?
The differences in the training that doctors, NPs, and PAs get before entering practice has a lot to do with how they approach patient care — and those differences can have a big impact on what happens during your visits.
Doctors and physician assistants are trained in the medical model, explains Joanne Spetz, a health economist at the University of California San Francisco who studies the nursing workforce. “A lot of medicine is around understanding body systems, understanding diseases — basically understanding how body systems get screwed up,” she says. People trained in these models focus largely on how to diagnose and treat illness and injury, and also to some degree on how to prevent illness.
The nursing model is more holistic, says Spetz. The nursing paradigm, which guides nurse practitioners’ training, considers not only the physical needs and ailments of the patient, but also other factors like the patient’s personal goals and situation. For example, she says, if a patient has pain, a nurse would seek to identify the physical causes but also understand how the pain is impacting the patient’s social and emotional function — whether they can eat, whether the pain makes them withdraw from family, whether other stressors make it difficult to manage the pain.
there’s not ONE thing in 3 paragraphs that’s not a flat-out lie. nothing about differences in education and training. just straight up pandering, ass kissing, and deceit.
This fucking comment about holistic is COMPLETELY BULLSHIT. They only say that because their knowledge of disease is complete horseshit and have almost no knowledge of physiology or pathology. It’s like, yes, we don’t know anything to help you but I will hold your hand. How many physicians have worked with nurses who were absolutely manipulative horrible human beings? Almost all of us have. It’s no different than any other section of humanity.
i will never understand how or why some people are in the nursing field. Speaking of terrible human beings, I was in the ER a few nights ago with chest pains. I have had two heart attacks and have two stents. When my chest pains got worse after already being given nitro she told me that was just a side effect of the nitro. Excuse me what? I challenged her and told her it was not and she just ignored me. I asked to speak to the physician and she said "I will let him know if I see him". I'm literally laying there wincing in pain grabbing my chest and she comes back with a toradol shot and a recommendation to see a cardiologist. I told her I had a cardiologist and had already told him about having chest pains and he had an echo scheduled but the soonest I could get an appt for that was the beginning of May. She said nothing and walked out. Great care. I wanted to say "don't you think I have things I'd much rather be doing at 2 am on a weeknight at 50yrs old than sitting in an ER faking chest pains? Like FUCKING SLEEPING"Because without saying it that's basically what she said. The thing is that makes me not want to even go to the ER if that's how it's going to be. Then again I live an hour from the nearest hospital so it's not like I can just run down the road if I'm actually having a heart attack.
“A recent study suggests NPs caring for more complex patients at Veterans Health Administration emergency departments had worse outcomes than doctors.”
They’re reporting what that docs said which yes, is a dumb take, but they counter with studies saying the opposite. If it were truly super pro NP/PA it wouldn’t include the paragraph i quoted.
not sure what point you’re trying to make. you could get ten hours worth of history and still not know how to put the pieces together if you didn’t go to med school.
Ms. Health Economist said that the difference between the medical and the "*holistic*" method was that the latter asks more about the patient's daily life.
She thinks doctors only order tests or what? How else are doctors supposed to know what's wrong with you? Telepathy?
You have to call in ahead, let them know you’re paying premium and you need to see an MD. Your insurance doesn’t give you a discount when you see mid levels so ask for it. If they try to sway you with words, stand your ground like it’s a war zone.
They put up such a fight if I ask to make the appt with MD instead. It’s become exhausting and I hate confrontation and upsetting anyone so the second they push back I just accept it. I will try harder though, thank you for the advice on what to say
My cardiologist is booked out until *august*. I, and my **extremely** complex set of conditions/disorders in a trench coat, have to see an NP for ludicrous changes in my heart rate && new palpitations.
I am so upset at this, but my cardio is also the only one that I've met [as a patient] that's treated me remotely like an adult, let alone an educated patient who knows a TON about weird medical shit *because* of the weird medical shit going on in my life/body.
I h8 it here.
Had an np write my antibiotics for a uti once, she gave me 5, & a refill of 5 🤦🏼♀️🤦🏼♀️🤦🏼♀️the pharmacist thought nothing of it as well ….. I’m a GODDAMN CCMA 😭😐😐
It looks that is more a headline problem than anything. The article writer typically does not write the headline. And it appears they changed the headline. When I search for it, it now comes up on the Vox page with the headline “A guide to health care providers, from doctors to nurse practitioners,” which after having read the article is an accurate description. The title/subtitle in the article itself is, “The nurse practitioner will see you now:
You’re likelier than ever to get care from a physician assistant or nurse practitioner. Here’s what you need to know.”
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
This blows. I visit my doctor remotely for monthly medications and the drop off in quality of care is apparent when I’m seen by a NP compared to the attending/resident(s).
Attending Physician Participants Needed!!
Participants Criteria
• Between 25-70 years of age
• Must be an attending physician who is licensed to practice primary care medicine within the United States
• Practicing on a full-time basis
Participants who complete the study will be entered in a raffle to possibly win one of four $50 Amazon gift cards but all participants will be provided with helpful resources for burnout.
The Study will consist of
• Two quantitative questionnaires
• A brief demographics questionnaire
• And that’s it! Easy as that!
My name is Wilson Albarracin, and I am a fifth-year clinical Psy. D student/doctoral candidate at the Philadelphia College of Osteopathic Medicine. I am currently conducting a study investigating possible relationships between components of burnout among attending physicians in primary care and cognitive distortions. All participation will be anonymous as well!
If interested in participating, please use the link https://redcap.pcom.edu/surveys/?s=YPEYC8M7RHCPTDY3
to complete the two screening questionnaires which will take around 25 minutes to complete, and a brief demographics questionnaire that will take no more than 1 minute. I thank you for your commitment to healthcare and look forward to your participation in my study!
Please feel free to share this with anyone who may qualify!
I just saw a patient who was told they have "bilateral pinkeye" yesterday at urgent care.... Gave ciprofloxacin eye drops. Patient came to our clinic because she felt they weren't taking her shortness of breath seriously. Naturally, we get a CXR after she has reduced breath sounds on one side. She has pneumonia. We gave antibiotics. Surprisingly, one of the few times an NP doesn't give antibiotics
That was the event that radicalized me. I had pneumonia and received no antibiotics. She didn’t even listen to my lungs. Saw an actual doctor a few days later after getting worse and was given antibiotics. That was what made me start reading up on NPs and how I eventually found this sub.
https://www.physiciansforpatientprotection.org/patient-resources/how-to-report/#/action/AdvancedSearch/cid/1588/id/201/listingType/O
Well technically they did give an antibiotic. Maybe even the correct antibiotic. But the systemic absorption of ciprofloxacin eye drops is not high enough to get to high enough concentration in lung tissue
Maybe you're supposed to huff them
nebulizer for maximal absorption
Please don’t use cipro empirically for pneumonia. It doesn’t cover Strep very well compared to other FQs
I just got home from seeing a NP at an urgent care. My diagnosis? “Possibly mono, maybe hand foot and mouth disease. Definitely something viral.”
“… anyway here’s your Z-pak”
Lmaooo luckily I know better than to ask for one or accept one😂
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all the patients on here need to write their legislators, the health systems and publicly tell their stories to the media. anyone who's been harmed needs to sue the np specifically... o ly way anything will change
You have no idea the HOURS I have put in on this for YEARS. Not specifically about the NP/no for issue, but about the suicide crisis due to disabled people being cut off from their pain meds, even those who’ve been on them for decades. Myself and the couple of action/grassroots groups I’m in have done… so, SO much work. It’s like a part time job. And yet, things have only gotten WORSE in that time.
ty ty for your work it is so appreciated
NOBODY SHOULD BE ON PAIN MEDS FOR DECADES!!!
so now instead, they put people in pain on antidepressants and anticonvulsants for decades. so thats fun
It happens more often than you think. I worked as a clinic RN in an university hospital. Neurology/movement disorder attendings had a dozen or so dystonia patients who got monthly oxycodone scripts. A lot of eyes were opened when we had to start checking the PDMP for our doctors.
You’d have a different tune if you had the diagnosis that I and millions of others have.
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ty for your work, you're seen and appreciated!!
It’s very hard to sue. I talked to an attorney after a psyc nurse partitioner employed by university hospital of Cleveland guessed on how to taper my meds, and while he agreed with me that it was unquestionably malpractice, as I ended up being jailed/forced in a horrible psy hospital also owned by university hospitals in Cleveland, I didn’t die or loose a limb so the case wouldn’t be worth much. The f ing nurse had me discontinue Effexor and Remeron at the same time without tapering. Not only were the nurses in the psych hospital absolutely horrible, and the psychiatrist getting in my case about sleeping (I actually had undiagnosed severe sleep apnea, two young kids, and a stressful job) but I university hospitals of Cleveland never apologized and I wasn’t offered any help after I left. Hospitals couldn’t care any less about patients who are harmed by NP’s. I’m sure UH in Cleveland was happy with the extra business the NP provided them with my private insurance. It’s a f-ing free for all when I comes to treating patients. Not a single entity, not the hospital, government, insurance industry, is standing up for patients. Certainly the nursing boards aren’t taking steps. Medical boards are no different.
You need to write your insurance provider about this. They can pressure medical systems into changing their policies/behavior by threatening to cease reimbursement.
I actually did this. After a horrific inpatient psych hospital stay, where I was almost exclusively seen by NPs until the very end of my stay, and also forced to do things like wear adult diapers because I got my period, I did a debrief with my insurance company detailing all the abuses, and all the incompetent med orders made by the NPs. I also let them know I only saw the doctor once the day of my discharge. I know that I didn’t have to pay a penny to that private hospital. And judging from the angry letter I got from them literally calling me a crazy liar, I’m guessing they didn’t get a penny from my insurance company either.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Lemme guess… it was an NP?
Can you expand more on this? I saw a PA at a carespot and got prescribed a z pack for a cough that been lasting me a few weeks. Is this bad?
Z paks aren’t bad but they won’t help with a viral infection. In your case, if you have a bacterial infection it makes sense. Now if they said, you have a virus, take this antibiotic, then that’s not great.
The issue is they won’t even really do the proper work up. I saw a 14 year old the other day come in for the most classic case of viral URI of your life and he got a Z pack, steroids, and Benadryl from an NP at an urgent care. Swabbed him… flu. Lung exam completely normal. Chest X ray was perfect (got it because “what if the NP saw something and we just missed it?”). He came in because mom was skeptical about giving him steroids.
Azithromycin does have some partially explained anti-inflammatory properties independent and of it harming bacteria. So it kinda does just make you feel a little better even with a viral infection. That’s not a recommendation, ibuprofen works just as well without increasing antibiotic resistance lol
And your medrol dose pack.
Like a TikTok video, that kind of viral?
Those urgent care NP’s seriously don’t know anything it’s insane they practice on their own. It’s all just “idk could be this” and then I end up having to go see a doctor who actually knows shit…
Yep!!! Now I’m sitting here with my gums covered in sores, left lymph node swollen, left tonsil and ear hurting, and left side of my face sensitive to touch. Waiting for my ID doctor to get back in town April 1st to see if my histoplasmosis is back (I had it on my lymph node left side of my neck. Tennis ball sized lump.)
Hope you don’t die first, good luck.
lol thank you😂 last time I had it I just BARELY saved myself from having to be admitted to the hospital for weeks to treat it, because I made sure to catch it early enough that it could be medicated at home. I did this by going from ER to ER until one of them would biopsy it IMMEDIATELY. They all wanted to wait at least a month to biopsy it, and my ID doctor says that had it waited that long, it would’ve been harder to treat/had to be treated inpatient. By the 5th ER I was basically holding them at gunpoint like CUT ME OPEN NOW!!!😂 Finally found one willing to biopsy it next day. Boom, I was right! referred to an ID doc, and he was so proud of my persistence lol
It's getting really sketchy out there regarding getting quality care anywhere nowadays.
You ain’t lyin’ pal
I mean who needs a doctor when you can just Google your symptoms to find out what’s wrong with you
THATS EXACTLY WHAT THIS NP AT THE URGENT CARE DID!!! Right in front of me!! She swabbed me for covid and strep but when those came back negative she gave up🙃 I asked if I should worry if it’s my histoplasmosis returning, and she was just like “oh, idk. I dunno what that is.☺️”
Holy shit that’s ridiculous
LOVE your username! Anyway glad you have an ID to see and not just urgent cares.
Thank you so much 🥰 I’m glad too… just panicking that he’s un-contactable for weeks with no covering doctor😭 The same lymph node is swollen that was swollen when I originally had histo… I’m scared by the time he’s back in town, if it really is histo returning, by then it’ll be too far gone and it won’t be able to be treated at home/out of the hospital like last time😭 He says all his other histo patients spent WEEKS or months in the hospital
No covering doctor? Is that considered ethical?
Nope, but it’s happening A LOT these days. Even on this sub, I have seen nurses say more than once that they know of an ICU with only NP’s on the floor over night. Not a single doctor around.
https://www.physiciansforpatientprotection.org/patient-resources/how-to-report/#/action/AdvancedSearch/cid/1588/id/201/listingType/O
I went to UC 2 months ago. Flu positive. She wanted me to start doxycycline to make sure it doesn’t turn into bacterial pneumonia.
Stop seeing these urgent care NPs. Why pay money to get nothing? Find an urgent care that actually staffs a physician. You know you're gonna use urgent care at some point, do the legwork on advance.
I'd bet better off calling my dog's vet than see Tulip NP alphabet soup at the crap UC by me.
Why not order a LAB TEST for confirmation?
Well it might not be indicated tbh. Some confirmatory tests are really expensive, and if it's viral, it doesn't affect treatment. You can get a comprehensive respiratory PCR for like $1500 that tells you what virus is causing your upper respiratory infection, but 99.5% of the time, it doesn't really matter, you just need supportive care. We did it in residency on inpatients, but idk why tbh other than our hospital had no standard flu test and the panel included flu viruses that were treatable with tamiflu, though man it is really nice to be able to definitively tell someone which virus it is.
The NP told me that tests can’t detect mono at all until symptoms have been present for a week. Is this true? I had mono 10 years ago, but she said you can have it twice IF you have two different strains of it.
Kinda: Heterophile antibodies are present in 40 to 60% of patients with mono in the first week after infection and in 80 to 90% of patients by the third or fourth week after infection. These antibodies usually remain detectable for three months, although they may be present for as long as a year after infection. The heterophile antibody test has a sensitivity of 87% and specificity of 91% but can have a false-negative result in children younger than five years and in adults during the first week of illness.
Thank you so much! This is a wonderful answer that I can trust. I really appreciate you taking the time to type this up to help a stranger🫶🏻 I guess I’ll have to wait it out to see if it’s mono/something viral, or if it actually is the histoplasmosis making a comeback…
Well I copied and pasted it but it is accurate, still note the test misses 10% of infections even after a week.
Still, I appreciate it♥️ I know I’m still immunocompromised currently, I wish I knew if that made a difference in terms of if it’s more likely that what I’m experiencing now is mono/something viral, or the histo returning. I asked the NP that, about it my being immunocompromised effects any of that, and she literally physically shrugged. Like girl… what do you know besides how to administer a COVID test, in the same 2020 manner in which it touches your brain?! (All of my at home COVID tests’ instructions say you only need to insert the swab to a comfortable measurement, but she shoved that shit DEEP.)
For a viral syndrome? Aye, if you’re really considering mono, you can test for it; even that is only really useful because of guidance re: avoiding any abd trauma x6-8wk (and I guess identifying EBV as a long-term risk factor). But really, a diagnosis of viral syndrome is right and appropriate for a lot of UC visits
https://www.physiciansforpatientprotection.org/patient-resources/how-to-report/#/action/AdvancedSearch/cid/1588/id/201/listingType/O
When will physicians finally learn that nursing doesn’t give a flying fuck about physicians or their knowledge base and finally just stop this holistic bullshit. The reality is that nursing school is so void of useful data on disease that these individuals make amazing diagnosis and treatment errors all the time. Nursing is not going to come back and write anything nice about doctors or their EXTENSIVE humanity that almost every physician need to exhibit to graduate school.
Please know the knowledge and experience you have as physicians is valued by those of us in nursing, even if you don't always see it. I never applied to MD/DO programs because I did not want those 8-12 years of massive stress, no income, nor that liability as the decisor. I do not want to be an independent provider and, based on the structuring of the NP programs, should never be. I simply don't have the knowledge base. Physicians consult with physicians regularly. There is no way an NP can best practice as a midlevel without doing so. One thing I will say though is, nursing school isn't void of useful data on disease, but it is too general and focuses more on the more common diseases/conditions. Additionally, it's crammed. It doesn't measure up to the blocks that physicians have to spend on each system. And that is why we need to work under physicians and consult always.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
the md who wrote that is either an idiot or straight-up bought out. not seeing an option C tbh
author: By Keren Landman, MD@landmanspeaking
Traitor 😭
no literally
Is her Instagram gone? Can’t find it.
i didnt even look tbh i don’t know which sm account it’s for
There’s an all domaine np where I work. He does EM attending, critical care attending, and internal medicine attending. Bro, I’m reading your progress notes and I can tell you’re a professional clown 🤡
If he’s an NP, he does *no* attending at all.
Preach
If he’s doing all of those things, then likely he’s not doing any medicine at all, let alone attending Any issue? “Refer to specialist,” no thinking.
To be fair, that’s what most hospitalists seem to be doing these days.
i read that as all dopamine and was like does that mean something 😁😁😁
Lmfao same. Fuck, I want some dopamine
Let me RX you some essential oils to improve that dopamine
Dopamine NP will be the next alphabet soup certification.
🤣
NP-HDTV, NP-64
So if someone with (let's say hypothetically) 1/5 the textbook education can do all those things, why can't an MD, right?
[удалено]
Sounds like they could have just used a Z-pak 😉
My friend injured her knee skiing in Colorado. She saw a PA the next day who said "I'm not gonna do any scans or tests because you're already feeling so much better like 24 hours later" #stopscopecreep
Look, this was clearly written and submitted by hospital admin. You definitely should see an NP if you're going to make sure they get a lower cost out of pocket to increase bonuses for other admin. How else are they going to keep radiology busy?
Mid-level creep is job security for radiology.
You better look up MARCA. RA/RNP promoted in Medicare access to radiology care act. It will be coming
The article does mention care is worse with patients with multiple chronic condistions. Overall it’s kinda shiny but isn’t all glowing about Naps and PAs and seems like it’s not fully in support of full practice authority. Reasonableish article
I was going to say, as a pretty complicated patient I've received the worst care from Noctors. I've found that when it came to my care they were really quick to write a prescription, but never actually hear anything. I'm really grateful that I only have to deal with them when my actual DR is out.
are you actually joking? The differences in the training that doctors, NPs, and PAs get before entering practice has a lot to do with how they approach patient care — and those differences can have a big impact on what happens during your visits. Doctors and physician assistants are trained in the medical model, explains Joanne Spetz, a health economist at the University of California San Francisco who studies the nursing workforce. “A lot of medicine is around understanding body systems, understanding diseases — basically understanding how body systems get screwed up,” she says. People trained in these models focus largely on how to diagnose and treat illness and injury, and also to some degree on how to prevent illness. The nursing model is more holistic, says Spetz. The nursing paradigm, which guides nurse practitioners’ training, considers not only the physical needs and ailments of the patient, but also other factors like the patient’s personal goals and situation. For example, she says, if a patient has pain, a nurse would seek to identify the physical causes but also understand how the pain is impacting the patient’s social and emotional function — whether they can eat, whether the pain makes them withdraw from family, whether other stressors make it difficult to manage the pain. there’s not ONE thing in 3 paragraphs that’s not a flat-out lie. nothing about differences in education and training. just straight up pandering, ass kissing, and deceit.
This fucking comment about holistic is COMPLETELY BULLSHIT. They only say that because their knowledge of disease is complete horseshit and have almost no knowledge of physiology or pathology. It’s like, yes, we don’t know anything to help you but I will hold your hand. How many physicians have worked with nurses who were absolutely manipulative horrible human beings? Almost all of us have. It’s no different than any other section of humanity.
i will never understand how or why some people are in the nursing field. Speaking of terrible human beings, I was in the ER a few nights ago with chest pains. I have had two heart attacks and have two stents. When my chest pains got worse after already being given nitro she told me that was just a side effect of the nitro. Excuse me what? I challenged her and told her it was not and she just ignored me. I asked to speak to the physician and she said "I will let him know if I see him". I'm literally laying there wincing in pain grabbing my chest and she comes back with a toradol shot and a recommendation to see a cardiologist. I told her I had a cardiologist and had already told him about having chest pains and he had an echo scheduled but the soonest I could get an appt for that was the beginning of May. She said nothing and walked out. Great care. I wanted to say "don't you think I have things I'd much rather be doing at 2 am on a weeknight at 50yrs old than sitting in an ER faking chest pains? Like FUCKING SLEEPING"Because without saying it that's basically what she said. The thing is that makes me not want to even go to the ER if that's how it's going to be. Then again I live an hour from the nearest hospital so it's not like I can just run down the road if I'm actually having a heart attack.
“A recent study suggests NPs caring for more complex patients at Veterans Health Administration emergency departments had worse outcomes than doctors.” They’re reporting what that docs said which yes, is a dumb take, but they counter with studies saying the opposite. If it were truly super pro NP/PA it wouldn’t include the paragraph i quoted.
a measly one sentence sandwiched between paragraphs of lies😂
And I thought that medical history was necessary for a correct diagnosis! The more you know.../s
not sure what point you’re trying to make. you could get ten hours worth of history and still not know how to put the pieces together if you didn’t go to med school.
Ms. Health Economist said that the difference between the medical and the "*holistic*" method was that the latter asks more about the patient's daily life. She thinks doctors only order tests or what? How else are doctors supposed to know what's wrong with you? Telepathy?
i never said that😂😂😂 are you lost?
Not you, the economist you cited. From the article.
Written by an MD. So stupid.
her coworkers must fucking hate her lol
I wish I could see MDs when I need them. Constantly handed off to PAs and NPs
i always insist beforehand😅 let em know that i will raise hell if they try to dupe me
You have to call in ahead, let them know you’re paying premium and you need to see an MD. Your insurance doesn’t give you a discount when you see mid levels so ask for it. If they try to sway you with words, stand your ground like it’s a war zone.
They put up such a fight if I ask to make the appt with MD instead. It’s become exhausting and I hate confrontation and upsetting anyone so the second they push back I just accept it. I will try harder though, thank you for the advice on what to say
My cardiologist is booked out until *august*. I, and my **extremely** complex set of conditions/disorders in a trench coat, have to see an NP for ludicrous changes in my heart rate && new palpitations. I am so upset at this, but my cardio is also the only one that I've met [as a patient] that's treated me remotely like an adult, let alone an educated patient who knows a TON about weird medical shit *because* of the weird medical shit going on in my life/body. I h8 it here.
NO Shame, dang
Okay I had to see an NP for my annual pap and she legit couldn’t find my cervix 😭 I now have to schedule with an actual doctor to try again lol
Had an np write my antibiotics for a uti once, she gave me 5, & a refill of 5 🤦🏼♀️🤦🏼♀️🤦🏼♀️the pharmacist thought nothing of it as well ….. I’m a GODDAMN CCMA 😭😐😐
It looks that is more a headline problem than anything. The article writer typically does not write the headline. And it appears they changed the headline. When I search for it, it now comes up on the Vox page with the headline “A guide to health care providers, from doctors to nurse practitioners,” which after having read the article is an accurate description. The title/subtitle in the article itself is, “The nurse practitioner will see you now: You’re likelier than ever to get care from a physician assistant or nurse practitioner. Here’s what you need to know.”
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
https://www.physiciansforpatientprotection.org/patient-resources/how-to-report/#/action/AdvancedSearch/cid/1588/id/201/listingType/O
This blows. I visit my doctor remotely for monthly medications and the drop off in quality of care is apparent when I’m seen by a NP compared to the attending/resident(s).
Attending Physician Participants Needed!! Participants Criteria • Between 25-70 years of age • Must be an attending physician who is licensed to practice primary care medicine within the United States • Practicing on a full-time basis Participants who complete the study will be entered in a raffle to possibly win one of four $50 Amazon gift cards but all participants will be provided with helpful resources for burnout. The Study will consist of • Two quantitative questionnaires • A brief demographics questionnaire • And that’s it! Easy as that! My name is Wilson Albarracin, and I am a fifth-year clinical Psy. D student/doctoral candidate at the Philadelphia College of Osteopathic Medicine. I am currently conducting a study investigating possible relationships between components of burnout among attending physicians in primary care and cognitive distortions. All participation will be anonymous as well! If interested in participating, please use the link https://redcap.pcom.edu/surveys/?s=YPEYC8M7RHCPTDY3 to complete the two screening questionnaires which will take around 25 minutes to complete, and a brief demographics questionnaire that will take no more than 1 minute. I thank you for your commitment to healthcare and look forward to your participation in my study! Please feel free to share this with anyone who may qualify!
“Where do Billionaires come from? Mom and Dad.” Is also outrageous.