Doctors vs NP's?

[FrankRN2017]

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!

[Susie2310]

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.

Assuming you are referring to physicians when you mention "the best care providers", in my state it is not easy for a physician to legally "fire" a patient. Physicians can be charged with patient abandonment by the state Medical Board for discharging a patient from their services without very good cause. I would be surprised if the law in your state is very different.

A patient has the right to express a difference of opinion regarding treatment as long as they do not make threats or attempt to intimidate staff, or engage in other criminal behavior towards the physician or his/her staff.

A patient also has the right to be informed of all treatment options and their likely outcomes, along with the risks and benefits for these treatment options, including the option of no treatment. The patient makes the decision about what, if any, treatment they wish to undergo.

[caliotter3]

Certified Cat Counselor. I like it

Doggie Depression Doctor, DDD.

[KatieMI, BSN, MSN, RN]

Assuming you are referring to physicians when you mention "the best care providers", in my state it is not easy for a physician to legally "fire" a patient. Physicians can be charged with patient abandonment by the state Medical Board for discharging a patient from their services without very good cause. I would be surprised if the law in your state is very different.

A patient has the right to express a difference of opinion regarding treatment as long as they do not make threats or attempt to intimidate staff, or engage in other criminal behavior towards the physician or his/her staff.

A patient also has the right to be informed of all treatment options and their likely outcomes, along with the risks and benefits for these treatment options, including the option of no treatment. The patient makes the decision about what, if any, treatment they wish to undergo.

1). Everything it takes to "fire" a patient is to have him or her to sign appropriately-worded Schedule II and I II contract and then just sit back and wait for designated number of breaks. An attempt to obtain a drug from another provider without informing the first one before doing so is counted as a "break" pretty much 100%. As I wrote above, nobody cares about one's life circumstances in such cases. And some contracts about Substance II allow only one break.

The immediate result to wheedle a script from, say, me will depend on my interpretation of "intimidation". Most providers I know count as one any attempt to request some particular drug by name unless the talk is about well-established case with complete "transition of care".

2). Providers can be reported to Boards all the one wants. If the patient had repeatedly broken the contract and the breaks were documented, everything to be done is sending the copies of documents there.

It really takes more efforts to get rid of an extreme "frequent flier" or someone who regularly harasses the office staff or doesn't pay bills out of life principles than from someone who thinks that he can play with "good drugs" scripts and screens.

3). In case of "firing the patient", the office just Googles list of same specialty providers 50 miles around, prints it and sends to the patient together with end-of-service letter. Unless the patient needs some highly specialized care to sustain life or continue, say, curative chemo, any pre-arrangements are highly unlikely to happen at that point, as well as a long discussion about risks, benefits and the rest.

As I wrote, providers, whether M. D. or not, nowadays care very little about particular FrankRN2017 feelings, comforts and outcomes if they feel even lukewarm against their butts. Nowadays, patients who can go to withdrawal from benzos, which is life-threatening condition, are sent to ERs all over the country instead of being prescribed Valium. It would be better medically for them, and everyone knows it, but it is just the case when policies and current climate prevail over our best intentions.

And, if you do not know it, any pharmacy can refuse to dispense controlled substances to anyone with no explanations and no arrangements required. It happens pretty often with patients who are moving or travelling, and there is nothing to be done in such cases.

[SpankedInPittsburgh, DNP, RN]

Oh I didn't notice the response about firing patients. Patient's get fired all the time. Google Patient Termination letter & I imagine you will get a zillion stock letters doc's use to fire patients they don't believe they can work with. Patient's should be given treatment options but only those the provider agrees with if he / she is to follow the case and be responsible for a course of treatment. Patients should never be forced into any particular course of treatment as they have every right to call the shots. What they do not have a right to do is instruct a provider how to apply medical judgment and treat patients. They also don't have a right to be disruptive to a practice. For example, they can't show up or call everyday with the same complaint in the hopes of battering a provider into giving them what they want. They gotta pay their bills & if your insurance company has low reimbursement rates then that plan may be dropped from the practice effectively firing the patient. There are many, many ways providers fire patients in fact. Some of it is sad and driven by simple dollars using the logic of why have a Medicaid patient in an appointment slot when I can have a private insurance patient in that same slot and make twice as much money. Some of it is personality driven and some over a simple disagreement over how to treat a condition. There are many care providers and patients are free to choose conversely the provider (within legal limits) has the right to choose his patients based upon certain criterion.

[Julius Seizure]

Because everyone else doing it makes it ok? I was taught this as a child. For instance, someone in high school offers you drugs and says everyone else is doing it would you do it? geese!

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[Rb72390]

Unnecessary consults and repeat testing wastes money. Cost effective healthcare is today's current focus right? All men experience a decrease in testosterone as they age and a general practitioner should be well past capable of handling this just as my past 2 general physicians have. Not only is this a waste of money but also an inconvenience for patients and ultimately affects patient satisfaction negatively. Furthermore, the NP was about to refill my lexapro without assuring that I was in counseling or any type of therapy but she did not. In my opinion, just refilling a psyche medication without any further supervision or therapy is much more dangerous than testosterone as lexapro in certain circumstances can cause someone to commit suicide if not properly followed or managed correctly. Also, if you do not want to be spoken to then don't post on my thread. That's the better way of deciding you don't want to be involved. Thanks! 😊

My husband has been taking lexapro for a while now prescribed by his M.D. and he has never been required to do counseling. I've never heard of that being a requirement for anxiety medication.

[chiromed0]

Hmm...been on several sides of this discussion as patient and provider. Whether you choose a physician or not for PCP is up to you and probably fewer insurance or prescription issues with the M.D. However, don't be surprised if you won't be seeing a PA or NP at their office eventually, too. There is no way you will know someone's competence from their degree, I can assure you of that. As far as an NP wanting to continue the testosterone script and prescribing anxiety med, that would really depend on what happened in your exam and how one feels about research/EBM concerning HRT. Some say it's complete BS so I'm not surprised they didn't want to manage it. Many who prescribe TRT do NOT manage it properly and hardly ever f/u with labs, levels, DHT conversion, etc. and hematocrit...it's a pain to do it right. So not letting them off the hook but seeing and Endo is probably the best for YOU as a patient not a place where it's just side income to the practice to "juice" everybody. As far as mood meds, I say CBT first before meds ALWAYS but that's your choice. I do agree with the direct entry "problem" and now NP's practicing w/o ANY RN experience is an issue simply b/c they have no background in treating patients or the strong basic and medical science knowledge to do it safely w/o real world experience like new PA's (yeah I know, PA's did rotations in their programs but that ain't real world...it wasn't their license!)

[FolksBtrippin, BSN, RN]

Your problem is not that your provider is an NP but that she is referring you to an endocrinologist.

This has nothing to do with NP vs. MD.

[LucyLou88, MSN, RN, NP]

Low T treatment is not something generally done in general practice where I live. It's handled at hormone specialty clinics. If she didn't feel comfortable writing the script, then she did exactly what should be done, refer on. Even endocrinologists often shy away from it. My personal physician and the NP's in her office do not do hormone replacement. On the psych meds, no. You do not have to be psychiatrist to write for psych meds. We prescribe them in general practice, and in other specialties. As a nurse, I'm surprised you don't know this. If you seemed as angry in the office visit as you do in this post, I can see why she was concerned about your taking testosterone, and why she suggested a psych med.

[SpankedInPittsburgh, DNP, RN]

HAHA!!!! Priceless

[LucyLou88, MSN, RN, NP]

Yes. Patients believe that there is a pill for everything. Are they wrong? No. There really is a pill for everything because it's big business. Huge profits for the drug industry, and the rest of it are little minions serving big pharma. I've been in NP school for a couple of years now, and will graduate this summer. We learn so many things, but at the end of the day, we practice medicine based on government and medical organization guidelines. The guideline is almost always as drug as first line treatment. Even obesity gets a drug now. Sad? Here some generic prozac. Wait, that's only a buck sixty, take this Lexapro instead! Constipated? Take this. Tired? Take this. So, we have trained patients to expect that the answer lies in a drug. Now they are furious when we tell them that their URI is viral, and there is no reason for an antibiotic. It's a quagmire. Somebody should probably tell the patients what all of their meds are doing to their bodies and minds. I was a an RN and holistic nutritionist before going to NP school. Can ya tell?

[SpankedInPittsburgh, DNP, RN]

I totally agree!!! The proof is in the pudding so to speak. We take way, way more drugs than any other country and yet our results as far as any measurable outcome are not better. In fact they are often worse. We have been sold a bill of goods by big pharma and the legislatures that work for them