Anonymous wrote:I feel bad for these posters. I have never made an apt with a physician and seen a nurse. Are you in HMO’s or what?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Pretty shocking that you refer to your wife’s deceased patient as, “an idiot.” Such compassion.

Since I assume you heard the tale from her, that is even more appalling.

Another take on this might be that it was highly irresponsible (malpractice?) for the office to put off a patient with a life-threatening condition for six weeks, when all he wanted was to see his doctor. But still they found no way to move up his appointment.

Some practices might have felt awful about this turn of events. The incident might have caused them to investigate how the case was handled…but your wife and her colleagues just wrote this poor caller off as “an idiot. “

Please do share the name of the practice , if you think they operate to such a high standard.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

Not sure what you think “ standard of care” means. Patient refused appointment. Had a deadly outcome. The practice had no obligation to let him pick his provider, they gave him an inroad to care and he declined. As unfortunate as this situation is, nobody who knows the first thing about healthcare would call this “malpractice.”

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Pretty shocking that you refer to your wife’s deceased patient as, “an idiot.” Such compassion.

Since I assume you heard the tale from her, that is even more appalling.

Another take on this might be that it was highly irresponsible (malpractice?) for the office to put off a patient with a life-threatening condition for six weeks, when all he wanted was to see his doctor. But still they found no way to move up his appointment.

Some practices might have felt awful about this turn of events. The incident might have caused them to investigate how the case was handled…but your wife and her colleagues just wrote this poor caller off as “an idiot. “

Please do share the name of the practice , if you think they operate to such a high standard.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

Not sure what you think “ standard of care” means. Patient refused appointment. Had a deadly outcome. The practice had no obligation to let him pick his provider, they gave him an inroad to care and he declined. As unfortunate as this situation is, nobody who knows the first thing about healthcare would call this “malpractice.”

Says who?

Says anyone who knows anything about practice management. Says anyone who had read the "patient bill of rights." It's not Wal-Mart, you're entering a practice as a patient and should be made aware of how they triage visits and to whom so you can go elsewhere if it doesn't suit you. That's totally legit. But you have no "right" to any particular doctor. I mean try it, tell the risk and quality management director that you have the right to a certain doctor and see what they tell you.

Tell the jury that “the practice” didn’t abandon a patient when they sought to see a physician with whom they had an established relationship, were refused, and were not warned of the dangers of delaying attention. Go ahead. Tell them that.

The midlevels don’t care. They disappear when the servers come knocking. It’s the doctors who are ultimately liable.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. 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.

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

+1

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

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

(new poster) No. 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. [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.

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?
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.

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.

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.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. 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.

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

+1

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

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

(new poster) No. 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. [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.

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?
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.

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.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Pretty shocking that you refer to your wife’s deceased patient as, “an idiot.” Such compassion.

Since I assume you heard the tale from her, that is even more appalling.

Another take on this might be that it was highly irresponsible (malpractice?) for the office to put off a patient with a life-threatening condition for six weeks, when all he wanted was to see his doctor. But still they found no way to move up his appointment.

Some practices might have felt awful about this turn of events. The incident might have caused them to investigate how the case was handled…but your wife and her colleagues just wrote this poor caller off as “an idiot. “

Please do share the name of the practice , if you think they operate to such a high standard.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

Not sure what you think “ standard of care” means. Patient refused appointment. Had a deadly outcome. The practice had no obligation to let him pick his provider, they gave him an inroad to care and he declined. As unfortunate as this situation is, nobody who knows the first thing about healthcare would call this “malpractice.”

Says who?

Says anyone who knows anything about practice management. Says anyone who had read the "patient bill of rights." It's not Wal-Mart, you're entering a practice as a patient and should be made aware of how they triage visits and to whom so you can go elsewhere if it doesn't suit you. That's totally legit. But you have no "right" to any particular doctor. I mean try it, tell the risk and quality management director that you have the right to a certain doctor and see what they tell you.

Tell the jury that “the practice” didn’t abandon a patient when they sought to see a physician with whom they had an established relationship, were refused, and were not warned of the dangers of delaying attention. Go ahead. Tell them that.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. 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.

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

Of course you did. Of course you did.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. 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.

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

+1

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

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

(new poster) No. 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. [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.

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?
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.

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.

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.

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.

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.

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?

Anonymous wrote:

Anonymous wrote:Why aren't there more medical schools in the US?
Acceptance to medical school is so ridiculously competitive - if people feel so strongly that we need to be seen by an MD, the only answer is to train more MDs.
So what's the hold up with more medical schools?

The issue isn't a lack of MDs, the bottleneck is a lack of residency spots. That's up to Congress. In other words, we're screwed.
https://www.openhealthpolicy.com/p/medical-residency-slots-congress