coast2coast, MSN, NP 7,589 Views
Joined Jul 9, '10.
Posts: 404 (42% Liked)
The socioeconomic and educational level of my patients is pertinent. Less sophisticated people, with poor adaptive skills, are easily swayed by a healthcare system that doled out opiates the past 30 years like candy.
The healthcare system set these people up for this. Now there is a gnashing of teeth about addiction.
Enshrining the pain scale as sacred contributed, in my opinion. The most vulnerable members of society were like sheep to the slaughter, lacking coping skills.
That is a very sad situation. Why not go back to the NP that was understanding of your mom's need for pain meds and anxiety meds? This is exactly what I feared would happen with the pressure for Dr's not to prescribe narcotics, that people will be left with uncontrolled pain. I see this already with nurse friends who are treated as drug seekers if they need narcotics for an injury or chronic back problem.
Is there any way you can go back to the NP with her? Otherwise seek out pain management for sure. Sometimes non narcotics can help such as lido patches or a steroid shot, but narcotics should not be withheld from her. Plus she is dealing with anxieity and dementia. The dementia may be increasing the anxiety as she realizes she is forgetting things. I imagine that would be very unsettling.
while I totally understand your frustration, I must say that your former doctor was very much correct in his tactic, although not in his actions.
As I get it, your mother is in her early to mid 50th. She has chronic pain and tremor, both of unknown origins, some dementia-like symptoms, personality changes and now new pelvic symptoms. It is a description of a complex patient who was, as far as I get it, never was worked up and has no working diagnosis. It is up to your mother to refuse testing, but it doesn't mean that she should be given meds with high addiction potential for this and that symptom just because she likes how they work on her. Your doc was absolutely right in attempting to transfer care, get specialists on board, etc., Sudden changing meds was not appropriate, but he was correct in refusing to escalate dose without proper diagnosis.
Regarding pelvic exam, it is up to provider to determine who is more qualified to do which type of assessment in practice setting. Pelvic exam #1 on difficult diagnostic case needs to be done by whoever knows better, not by whom the patient likes more. Unless the NP was specializing in women's health, she might have very limited experience with abnormal pelvic exams.
Regarding passing info, I can assure you that it is what happens in 100% of cases. No provider in his or her right mind would transfer care without communicating every single detail to accepting care office. Transferring a patient with even traits of "risky behavior" which might affect one's licensing status (even non-compliance, refusing to test, missing appointments, etc) and not telling about it is seen as extremely unprofessional behavior and can kill physician's career.
I do not say that your mother is addicted, but there were several things in your post pointing on developing of at least tolerance. She absolutely should not be treated in primary care setting, it is not safe for her on the long run and you need to understand it. She should be referred to specialists and get diagnosed before making any changes in her meds. As the very least safe step, she should take the same meds in the same doses, but there should be no increasing doses before we know what is really going on.
I have to work on regular basis with highly dependent and escalating patients suffering from chronic neurologic diseases from MS to Alzheimer, and it is incredibly painful, in all senses of the word, for everyone involved. I hope you would be able to convince your mother to get diagnosed and find a capable physician for her.
Be careful with going into a direct entry program. You may have a difficult time finding a job afterwards with no bedside experience. I'm not sure who hires Nurse Practioners with no actual nursing experience.
As a new graduate NP you need to be in the supportive environment.
There's no data to support the idea that "bioidentical hormones" are any safer than synthetic ones- nor are they actually more "identical" than synthetically produced hormones.
I don't see a problem in specializing in hormone replacement therapy, per se. I do a lot of it in my practice, and as long as you are adequately trained it is well within NP scope, barring local regulatory silliness. I do, however, feel a little bit alarmed whenever I hear NPs espouse pseudoscientific health beliefs, especially ones that actually have potential for harm. Bioidentical hormones are largely produced by an industry that is just as profit driven and susceptible to corruption as Big Pharma, and who also benefit from a lack of outside oversight. Actual amounts of hormone in a pill can vary widely from company to company, and even batch to batch.
Bioidentical Hormones << Science-Based Medicine
Meh, if you can't beat 'em, join 'em.
"Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."
Since when is it "news" that opioids cause constipation?
This is new?
Not trying to be sarcastic. This has always been a recognized issue.
Is this perhaps a "sponsored" article?
"I have had a similar situation. I had a bad virus infection (as I thought) for more than a week. Progressively, it became worst and I went to see my PCP. Paid $20 co-pay by a check. My PCP was on vacation and the covering bit$& (a female) refused to prescribe any antibiotics. She did not even suggest that I do any lab tests! Frustrated, I stormed out, and went to the walk-in clinic affiliated with CVS, and walked out with my meds. Two days later my infection went away. But, I stopped the payment on my check to my PCP's office. They sent me a bill plus $25 for the stopped payment they had to pay. I responded with a copy of my bill from the walk-in clinic and a copy of prescription bottle, with two questions next to the balance due of $45 - for medical mal-practice? Failure to diagnose? Never heard again from my PCP again."
To me this displays something that is all too common these days, a very low distress tolerance, and this attitude of entitlement, that if they pay to be EVALUATED and assessed by a professional, that it entitles them to be prescribed whatever they want. I actually had a patient who wanted her money back after an 1.5 hour Psych Eval because I wouldn't recommend a stimulant. "But why won't you give me Adderall, I paid for this appointment". Ugh....
I think canceling a check for service provided is wrong. Just because you don't like the diagnosis you got doesn't mean you shouldn't pay for the work that was done. And no, no lawyer is going to call such an episode "malpractice."
Lab test is not necessary for a URI unless strep throat is suspected. Obviously this is all theoretical since I didn't see you personally, but in general if the cold went away within 2 weeks (with or without antibiotics) it is safe to say it was a viral infection. That's what evidences show. So you can't attribute the fact that you got better when you took the antibiotics to the good work of antibiotics. You were on your way to getting better and you happened to take an antibiotic so you think that's what made it better. Again, that's if the whole thing lasted 2 weeks or less and all in theory.
Genetic testing is offered when considering having a child, as well as during pregnancy; one can test for Fragile X syndrome, which is a leading gene in ASD.
My GYN offers genetic testing for fertility, as well as genetic testing for most genetic carrier disorders; albeit my GYN is a part of health system that has been researching genetic testing for most carrier disorders for some time, and now offer pts the ability to undergo testing.
I work for Big Pharma (commence terrified screaming!!!!!!!) and just want to let you know that yep, we are actively trying to kill every single person on this planet. Oh, and Big Foot exists, aliens crash landed at Roswell, and 9/11 was an inside job.
NOW YOU KNOW THE TRUTH
*rolls eyes and heads off to get popcorn. gonna sit back and watch the flamessssssssss*
What happened in 1976 with GBS and the swine flu vaccine?In 1976 there was a small increased risk of GBS following vaccination with an influenza vaccine made to protect against a swine flu virus. The increased risk was approximately 1 additional case of GBS per 100,000 people who got the swine flu vaccine. The Institute of Medicine (IOM) conducted a thorough scientific review of this issue in 2003 and concluded that people who received the 1976 swine influenza vaccine had an increased risk for developing GBS. Scientists have multiple theories on why this increased risk may have occurred, but the exact reason for this association remains unknown.
The link between GBS and flu vaccination in other years is unclear, and if there is any risk for GBS after seasonal flu vaccines it is very small, about one in a million. Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination. It is important to keep in mind that severe illness and death are associated with influenza, and vaccination is the best way to prevent influenza infection and its complications
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