Reply to I do not want to see an NP!

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.”  The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing.[b] I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.[/b] [/quote]

I caught my husband’s melanoma, so pretty sure an NP could as well.[/quote]

The people who don't like "anyone except a full MD" seem to not realize that [b]you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.  [/b]

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam.  If they see any issues, they will always get me in to see the Gyn for follow up.  But there is typically no need to see a Gyn if you don't have issues.  Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.  
I have never dealt with a PA/NP that isn't highly qualified.  OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent[/quote]

(new poster) No. [b]I am a specialist MD and routinely get patients who have received poor/inappropriate care from mid levels - way more than those who have gotten poor care from MDs. [/b][i][u]In my professional discussion groups, we routinely trade horror stories about mid level overmedication, dangerous medication interactions that were overlooked, grossly inappropriate dosing, missed diagnoses that were obvious, and overall quite a lot of intervention that led to more harm than if they had done nothing at all. It's not like these things never happen with an MD, but it's orders of magnitude less frequent. The scope creep is scary to me not just as a provider, but as a patient like everyone else. [/quote]

[b]Could that possibly be because NPs actually DO refer out to an MD when they need the assistance, unlike MDs, who will be convinced of their own knowledge and competence even when they really should be referring to someone else?[/b]
So you just never know about your fellow MDs who are also providing poor care.

I will never forget my PCP when I first moved to the area.  She was an MD and was convinced she could handle everything herself.  She never would give me a referral to a dermatologist, and required two visits before I could get her to write the referral to a cardiologist for a life long congenital defect.
Fortunately I was able to change both PCP and insurance at the next open enrollment.  I now see an NP who is wonderful and happy to work with MD specialists.[/quote]

What? No. These are patients who were not referred out by the mid levels. The ones I've gotten (outpatient) have come to me because they moved, their provider moved, or they realized that the care they were getting was not good, or (inpatient) because they were hospitalized. I do also get plenty of patients that were previously managed by MDs, for all the same reasons. So no, these were not complicated patients sent to me because the mid level needed more help. I do in fact think that the overmedication/mismedication that I've seen is a reflection of the very hubris that you are attributing to doctors, and of NOT asking for MD help when they should. Because MDs have had many many more training hours, we've had more chances to see when things go wrong, and I think that because mid levels don't get that opportunity, it's not altogether surprising that they can be more cavalier.  [/quote]

Fine, you've seen that. And in my family I have one member facing a terminal condition because his doctor blew off symptoms and told him his cancer was a "sinus infection" and my entire family of 4 was minutes away from a catastrophic scenario when my dh had a seizure just before getting the car due to medical mismanagement.  Both MDs.  Both experienced. Does this mean I don't trust doctors?  Of course not. So spare me the "horror stories" about NPs/PAs, doctors make bad and dangerous decisions all the time and you know this is true.[/quote]

I'm so sorry about your experiences, both terrible. But your n is 2, and mine is in the hundreds if not thousands. I see many, many patients coming from both mid levels and MDs, and have had many, many opportunities to compare the care they provided. [/quote]

I’m a nurse who works in quality assurance type work and I agree with the doctor. My experience is also in the hundreds  or thousands of record review. The inappropriate treatment plans are BY FAR coming from mid-levels. [/quote]

Just curious, in how many cases of mismanagement by mid-level did either the mid-level or the managing physician/clinic suffer consequences for the malpractice?[/quote]

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