Doctors vs NP's?

Nurses General Nursing

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I hate to say this but I no longer like to see the NP when I go in for a doctors visit. I have noticed that doctors are much more secure with decisions and aren't so scared to prescribe something. I have been on testosterone for several years through my family practice doctors. However, as I recently moved, I was set up to see a NP. Well instead of handling the low T issue herself she had to refer me to an endocrinologist? WTH? Over time I have noticed NP's like to pawn you off to anyone else for your matters if they can. She wanted to write a script for a psyche med though. Doesn't this require a psychiatrist if she wants to be technical? If NP's are expected to be a growing profession then this is gonna suck. GROW SOME!

What was the urgency here besides your desire for a testosterone refill? Am I missing something?

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What was the urgency here besides your desire for a testosterone refill? Am I missing something?

Unexpected Relocation with expiring insurance.

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Specializes in ICU, LTACH, Internal Medicine.
Unexpected Relocation with expiring insurance.

Yet another common red banner for Schedule II and III scripts. Like being on a trip, on a vacation, on business conference, air company lost my bag, my car was broken into, that plumber guy stole my pills from my bathroom, I kept my pills in the basement so that kids wouldn't find them but it got flooded, etc., etc.

We all know that these things and more of them happen in live but nowadays nobody would risk years of hard work, income and career just because it once happened with you. You, or any other such dude, can be the one triggering random audit of your prescribing practices.

Next time, before you leave your prescribing provider, do staff-witnessed UDS for three months, then ask for a personal note about you being a good and entirely compliant guy with the doc's cell phone number on it, copies of those UDSs (all of them clean, of course) and a copy of your state prescription monitoring system run of your name. I cannot give you a guarantee, but it seriously can help. At least that's what providers want to see in Florida and other places where people who just lost their airbags and now have three hours before boarding their cruise ships tend to suddenly appear in primary care offices.

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Yet another common red banner for Schedule II and III scripts. Like being on a trip, on a vacation, on business conference, air company lost my bag, my car was broken into, that plumber guy stole my pills from my bathroom, I kept my pills in the basement so that kids wouldn't find them but it got flooded, etc., etc.

We all know that these things and more of them happen in live but nowadays nobody would risk years of hard work, income and career just because it once happened with you. You, or any other such dude, can be the one triggering random audit of your prescribing practices.

Next time, before you leave your prescribing provider, do staff-witnessed UDS for three months, then ask for a personal note about you being a good and entirely compliant guy with the doc's cell phone number on it, copies of those UDSs (all of them clean, of course) and a copy of your state prescription monitoring system run of your name. I cannot give you a guarantee, but it seriously can help. At least that's what providers want to see in Florida and other places where people who just lost their airbags and now have three hours before boarding their cruise ships tend to suddenly appear in primary care offices.

Any schedule medication can be misused by anyone. Should all schedule meds be outlawed since now a days no one wants to trust the patient?

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Yeah, I'm back to the whole urgency issue. I don't think you weren't denied a med that was going to have imminently and negatively affected your life. In short if you had to wait to see a specialist you weren't going to have negative consequences from what I can tell. If you were out of insulin, psych meds, heart / bp meds or even (for a short term) narcs I would have filled it. However, I think specialists have their place and if you are on some meds its appropriate for them to follow you. Long term opioid / chronic pain patients should have probably been followed by a lot more pain centers than PCPs and perhaps there would be less drug addicts today as more PT and less Percocet would have got handed out. Ditto benzo's and anxiety perhaps if more mental health specialists got referrals there would be a lot less Xanax in the world. The fact that you moved, switched docs or whatever doesn't create any medical urgency. Not giving you what you want when you want is not a sign of a bad provider. This isn't about growing a set. The providers that simply write scripts to satisfy patient demands have no balls. The ones that say no do because they have to listen to the patient moan and then defend their action to the patient satisfaction super-geniuses. Yep from what I can tell in this limited fact scenario this provider did the right thing & I wholly endorse their actions weather they have NP or MD behind their name

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Yeah, I'm back to the whole urgency issue. I don't think you weren't denied a med that was going to have imminently and negatively affected your life. In short if you had to wait to see a specialist you weren't going to have negative consequences from what I can tell. If you were out of insulin, psych meds, heart / bp meds or even (for a short term) narcs I would have filled it. However, I think specialists have their place and if you are on some meds its appropriate for them to follow you. Long term opioid / chronic pain patients should have probably been followed by a lot more pain centers than PCPs and perhaps there would be less drug addicts today as more PT and less Percocet would have got handed out. Ditto benzo's and anxiety perhaps if more mental health specialists got referrals there would be a lot less Xanax in the world. The fact that you moved, switched docs or whatever doesn't create any medical urgency. Not giving you what you want when you want is not a sign of a bad provider. This isn't about growing a set. The providers that simply write scripts to satisfy patient demands have no balls. The ones that say no do because they have to listen to the patient moan and then defend their action to the patient satisfaction super-geniuses. Yep from what I can tell in this limited fact scenario this provider did the right thing & I wholly endorse their actions weather they have NP or MD behind their name

Testosterone is not what I "want" when I want it. It is what my body has relied on consistently for years and the testosterone crash effects are not nice at all. So if that's how you see it I hope your never my practitioner. Thanks for the opinion í ½í¸Š.

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You are more then welcome for my input and somehow I think I'd survive professionally not being your PCP. I think building a successful practice is about finding a good fit with the patients you serve. The best care providers I know only work under that circumstance & will "fire" patients they whose expectations don't match what the provider thinks is the best course of action.

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... Ditto benzo's and anxiety perhaps if more mental health specialists got referrals there would be a lot less Xanax in the world.

Totally agree but the real world gets in the way sometimes. I work as an RN care manager in a large internal medicine practice, our cohort is predominantly lower income medicare/caid. My providers would love to refer some of our folks to mental health specialists (or pain mgt clinics for that matter) but lack of insurance coverage is a real issue. So my primary docs, NPs and PAs oftentimes have to manage mental illness and pain issues that ideally should be handled by specialists.

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Yep, I with you on that CharlieFoxtrot. Fortunately I work for the VA and face no such issues but I've seen them in my clinical hours. Many providers simply purge Medicaid patients from their practice even on the Primary Care level due to low reimbursement levels and in some cases patient expectations. I live in Pittsburgh so Medicare is fairly universally accepted because of our graying population but as always the poor among us get the short end of the stick. So what's to be done? The simple answer followed by many providers is to just whip out the script pad and get these patients out of the office. This is unfortunate but a reality I've witnessed. As a result of this you have chronic pain patients with spiraling levels of prescribed opioids to combat acquired tolerance & the same holds true for patients with anxiety issues and benzos. So I guess the provider does the best he / she can given the realities of the resources available but we see the result of this mismanagement constantly in the form of wrecked lives, ODs and benzoed out zombies everyday. Sad truth

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Any schedule medication can be misused by anyone. Should all schedule meds be outlawed since now a days no one wants to trust the patient?

No, of course not. Neither should they be handed out like M&Ms. That's kinda the point of them being schedule drugs.

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Specializes in Adult MICU/SICU.
Just FYI: I've been on Paxil for 14 years, and not once has anybody, MD or otherwise, suggested I get "counseling or any type of therapy."

Someone isn't doing their job.

I have cat on paxil for "normal male aggression" - maybe he needs therapy too! Maybe that's why he is still surly?

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Certified Cat Counselor. I like it

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