Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP or PA is fine if you have an uncomplicated, easily diagnosable problem like strep throat that requires amoxicillin. Anything even slightly out of routine and they just aren't intelligent enough to deal with it. I've been misdiagnosed or received improper treatment from PAs/NPs many times, as have my family members.

Most of the time they will just throw a z-pack at a likely virus even after testing negative for strep just bc they get thrills from the feeling of doing something…I mean if they actually told you you have a virus they’d have to suffer the same haters as responsible physicians do.

I am an NP. I was a bedside nurse for a long time before I was an NP. I know what I don’t know. I have worked in Primary Care and specialities. In my experience, MDs give antibiotics much quicker than I do, esp in primary care. The time it takes to talk to a patient for symptom management for an upper respiratory infection and explain why he/she doesn’t need an antibiotic takes much longer than getting a Z-pack- which is what patients are used to. Some of that, I think, is just time saving for busy MDs.

Most of my NP colleagues are the same.

I don’t think intelligence has anything to do with it. Lots of super smart nurses out there. Education and training are different.

Interesting. It is not typical for NPs and PAs in general.

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/

This was national data over decades from sites across the country, sampling 1.3 million visits out of about 1.13 billion.

All ambulatory visits from 1998 to 2011 in the United States were divided into 2 groups: visits that involved a NP or PA, and visits that involved physicians only. Both the frequency of NP/PA visit involvement and trends in antibiotic prescribing for all conditions over this time period were assessed to determine whether significant differences exist in the proportion of visits that result in an antibiotic prescription. ...
Between 1998 and 2011, there were an average of 1.13 billion (95% confidence interval [CI], 1.04–1.21 billion) ambulatory visits per year in the United States based on estimates from 1,301,474 sampled visits in the NAMCS/NHAMCS.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:NP or PA is fine if you have an uncomplicated, easily diagnosable problem like strep throat that requires amoxicillin. Anything even slightly out of routine and they just aren't intelligent enough to deal with it. I've been misdiagnosed or received improper treatment from PAs/NPs many times, as have my family members.

Most of the time they will just throw a z-pack at a likely virus even after testing negative for strep just bc they get thrills from the feeling of doing something…I mean if they actually told you you have a virus they’d have to suffer the same haters as responsible physicians do.

I am an NP. I was a bedside nurse for a long time before I was an NP. I know what I don’t know. I have worked in Primary Care and specialities. In my experience, MDs give antibiotics much quicker than I do, esp in primary care. The time it takes to talk to a patient for symptom management for an upper respiratory infection and explain why he/she doesn’t need an antibiotic takes much longer than getting a Z-pack- which is what patients are used to. Some of that, I think, is just time saving for busy MDs.

Most of my NP colleagues are the same.

I don’t think intelligence has anything to do with it. Lots of super smart nurses out there. Education and training are different.

As a physician working with both NPs and MDs in general its more the MDs that know what they dont know.

Anonymous wrote:

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

+1. I think Dr Google has encouraged patients to diagnose themselves. When the doctor (who went to medical school) doesn’t agree, he deemed incompetent. Another concern of mine: Med Express is not a PCP. It is imperative to find a doctor that YOU trust. If you only have annual appointments, this process will take awhile.

I've generally had positive experiences and respected the doctors who have treated me. But I've been burned too: One doctor ordered a test that was not recommended for a patient with my characteristics. When I asked, he said he was following standard recommendations. It took multiple emails, with me citing the recommendations of every major medical organization, before he changed his mind. He even referred me to a publication that explicitly contradicted him.

This was a minor issue, but it completely destroyed my trust.

The wide availability of medical advice has definitely allowed incompetent patients to get bad ideas, but it's also allowed some of us to know when our doctors are wrong.

Anonymous wrote:

Anonymous wrote:Yup.

I'm guessing you are a woman just now entering middle age? Welcome.

Yes. 38/f
This sucks.

You are lucky. It happened for me in my mid 20s.

Anonymous wrote:

Anonymous wrote:NP or PA is fine if you have an uncomplicated, easily diagnosable problem like strep throat that requires amoxicillin. Anything even slightly out of routine and they just aren't intelligent enough to deal with it. I've been misdiagnosed or received improper treatment from PAs/NPs many times, as have my family members.

Most of the time they will just throw a z-pack at a likely virus even after testing negative for strep just bc they get thrills from the feeling of doing something…I mean if they actually told you you have a virus they’d have to suffer the same haters as responsible physicians do.

I am an NP. I was a bedside nurse for a long time before I was an NP. I know what I don’t know. I have worked in Primary Care and specialities. In my experience, MDs give antibiotics much quicker than I do, esp in primary care. The time it takes to talk to a patient for symptom management for an upper respiratory infection and explain why he/she doesn’t need an antibiotic takes much longer than getting a Z-pack- which is what patients are used to. Some of that, I think, is just time saving for busy MDs.

Most of my NP colleagues are the same.

I don’t think intelligence has anything to do with it. Lots of super smart nurses out there. Education and training are different.

I have many doctors in my family and a few NPs. Be skeptical of all of them, but the good ones do exist. The doctors in my family are beyond arrogant. One NP in my family I would trust with my life. The other NP failed several courses, but was allowed to retake. She's really flaky and I would not trust her to diagnose a common cold.

I had one common and painful medical condition that sent me to urgent care. PA's hunch was right, doctor sent me in the wrong direction. I ended up in ER and ER doctor had no idea what it could be. A cat-scan confirmed PA's hunch.

I have dealt with some really poor doctors but because i have them in my family and i know how their egos can get the best of them I am polite, but skeptical. As a result I gently ask questions while stroking fragile ego so as not to poke hornet's nest. I get second opinions and I pick up and move on if needed. I now have a dream team for my kids, my husband and me. There absolutely are top notch doctors who are both brilliant and have a good bedside manner.

The point of my long winded post is do your research, get second opinions if needed and move on if needed. There are top notch doctors, NPs and PAs, but sometimes it takes trial and error and waitlists to get them.

Anonymous wrote:Has anyone had a better experience going to a concierge practice like One Medical? I really need a new PCP and the one I like is with OM, but I’m hesitant to join a concierge practice - but will if it means more attention and less of a rat race.

It does mean more attention and less of a rat race.

I had the worst experience with NPs..never dealt with a PA

Anonymous wrote:I never cease to be amazed by the doctor hatred on this board. You’d rather entrust your health to someone who never went to medical school or trained in a residency. Just astonishing.

Agree, I wouldn't go to a bike mechanic to fix my car, why in the world would anybody think a PA or NP would be better than a physician for primary care is farcical.

My mom is a Dr. and she always said she loved everything about her job except working with a lot of the other doctors because so many of them were jerks.

I have had good luck with doctors myself so far. I had one smug dermatologist but my primary care providers and my OBGYNs have been excellent. I think if you don't like your doctor you need to keep looking til you find someone you do like. There are lots of good doctors out there.

Doctors are plain humans like all of us. Figure out what you want out of a doctor - symptom management, wellness, root cause discovery, integrative lifestyle approach, specific skill set and expertise, conventional versus holistic or both etc… figure it out and then research research research and ask around.

It’s not just personalities but a conventional MD will differ from a DO or an FM. All doctors that have gone through med school. The vast majority of conventional doctors are symptom management focused, which is how our health and insurance system is structured. DO’s and FM’s will be more about root cause discovery. Also these various doctors will be more or less open to incorporating integrative modalities into long term care such as acupuncture, food as medicine etc…

Until I got sick sick in my 30s I didn’t take the time to really delve and understand how to get myself quality care. It is combination of research and trial and error. Once you get to know one doctor you really appreciate you will realize their network of practitioners they would refer you too are similar in care and approach so it gets easier to build a network of doctors that are a good fit with you.

Women doctors seem to be the worst in terms of smug and condescending. And I say this as a woman.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm an RN and prefer NPs for my PCP. Dh and DS also see NPs. I really do think part of the MD burnout is because of how PCP is set up. Med school is long and expensive and in the grand scheme of the MD world, they don't make much. The system is set up to see as many patients as they can a day in order to make money. And dealing with the general public burns you out as it is.

Nps who go into a PCP do it because they want to. And while the schooling is hard, its not as expensive and time consuming as MD

Yeah and just wait until they miss something important or you get really sick or they screw up your medications. I’m an MD and spend about 1/3 of my time correcting and undoing the mistakes of NPs and PAs who practice without supervision. It’s crazy that this is even allowed. I’ve worked with absolutely wonderful NPs and RNs as part of a team, inpatient. But allowing them to practice independently unsupervised on the theory that 85% of medicine is “routine” is insane. 15% of the time it’s not. And even in that 85%, only the best ones know when they don’t know and are wise enough to say so. So much invested in proving that medical school and residency are somehow superfluous to the practice of being a doctor.

When “MDs” stop prescribing based on incentives they receive then maybe we can start trusting doctors a little more. The way I see it, these doctors don’t have the time for much other than straightforward routine cases. When a case is more complex, some doctors try pushing meds and some doctors seem to assume that people are hypochondriacs. I’m guessing very few people are hypochondriacs. Most people would just like to feel better.

Not sure why you use MD in quotes, but you lose cred there.
This just isn't happening. The reverse is also true. Patients want meds that are a quick fix. Please see the example above about the Zpacks. It's absolutely true. Parents want antibiotics for ear infections and when they are offered nothing and told it's "viral" patients get mad.

I don't know that I find them smug, but I do feel like they throw around terminology and expect people to understand. I have a health related background, so I can decipher most of it, but I think it's wild that they would talk to the general public using medical jargon without further explanation.

Yes, I am, too. I suspect that it’s because the generation raised by the some of the parents on the MCPS and College and Universities forums here are entering the profession - kidding not kidding.