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!

[BostonFNP, APRN]

PCPs all over the country are prescribing antidepressants, and other, more serious psychiatric medications, every day without encouraging people to go to therapy (although psych people think that's a horrible idea), but that doesn't fit the OP's narrative, so ...

I am not sure this is a good thing though, though at least in my locale, it is (unfortunately) necessary due to a dearth of psychatric specialists. Most PCPs (MD/DO/PA/NP) are not adequately prepared to treat complex mental illness; I do feel like it is important to be acutely aware of what we know and what we don't know.

Going back to testosterone, I do prescribe it in simple cases after an appropriate workup, but I will not prescribe it in complicated cases. So if the OP is a male under 40 I likely would have referred too. I wonder if the OP would change his tune on the NP in question if the endo discovered a prolactinoma?

[elkpark]

I am not sure this is a good thing though, though at least in my locale, it is (unfortunately) necessary due to a dearth of psychatric specialists. Most PCPs (MD/DO/PA/NP) are not adequately prepared to treat complex mental illness; I do feel like it is important to be acutely aware of what we know and what we don't know.

I didn't mean to suggest that it was a good thing -- I'm a psych CNS and think it's a horrible idea -- but my point was that the fact that the OP's NP was prepared to renew a Lexapro rx without insisting he be in therapy is not at all uncommon in the primary care world, and certainly not evidence of sub-par practice by the NP vs. common MD practice.

[BostonFNP, APRN]

I largely agree with you and won't see NPs for my or my family's healthcare unless I have 0 other options. They are great NPs out there, yes, but there are far too many direct entry ones or ones that spent too few years at the bedside that I wouldn't trust with my dog..

First, I wouldn't recommend having any medical professional (MD/DO/PA/NP/etc) take care of veterinary health issues. It is outside their education and training. Your dog would thank you for sticking to veterinary professionals.

Second, how exactly do you know the extent of an NPs relevant RN experience? Do you interview them as to their Rn experience in both hours and practice settings? DO you account for years as a provider as well? Enlighten us so we can all avoid those "dangerous" DE grads. Also, I trust you interview all your RNs as well to make sure they have years of CNA experience prior to being an RN: too many dangerous inexperienced RNs out there. And physicians, they really should be interviewed to make sure they had years of direct patient care experience before medical school.

[BostonFNP, APRN]

I didn't mean to suggest that it was a good thing -- I'm a psych CNS and think it's a horrible idea -- but my point was that the fact that the OP's NP was prepared to renew a Lexapro rx without insisting he be in therapy is not at all uncommon in the primary care world, and certainly not evidence of sub-par practice by the NP vs. common MD practice.

Refill lexapro....seems complicated....refer back. :)

[Farawyn]

First, I wouldn't recommend having any medical professional (MD/DO/PA/NP/etc) take care of veterinary health issues. It is outside their education and training. Your dog would thank you for sticking to veterinary professionals.

Second, how exactly do you know the extent of an NPs relevant RN experience? Do you interview them as to their Rn experience in both hours and practice settings? DO you account for years as a provider as well? Enlighten us so we can all avoid those "dangerous" DE grads. Also, I trust you interview all your RNs as well to make sure they have years of CNA experience prior to being an RN: too many dangerous inexperienced RNs out there. And physicians, they really should be interviewed to make sure they had years of direct patient care experience before medical school.

Especially in July.

[SpankedInPittsburgh, DNP, RN]

I must say that, overall, parrots are awfully smart creatures. At least, they generally get it pretty quickly that if the word was "no", then it was what it was and there would be no bargaining about it in the foreseeable future. (that can last 5 min., but that's another story).

Yep Parrots world wide are mad at me. They are suing me in a class action case because they do not believe that any creature no matter how mentally deficient can keep repeating that they are a nurse over and over again to some poor provider who is trying to take care of them

[Workitinurfava, BSN, RN]

I don't the comparison of the two are fair considering all things. Lions, tigers, parrots, and bears O my! What is this the wizard of Oz? What happened in this thread?

[FrankRN2017]

Dear OP,

One of the best and most reliable ways to put ANY provider, either physician or mid-level, on high alert and NOT get what you want is to start teaching him how to do his job. It is especially so if the talks are about controlled substances. Such behavior is the hallmark #1 for potential abuse and usually leads to refusing prescription in some creative way, of which we know plenty and then some. Worse still, the specialist you have been referred to gets detailed handout and free to make his own conclusions about you before you even call for your appointment. Nowadays, nobody wants risk his or her license just because someone whom you see first time in your life sits here and demands something Schedule II just because he was popping it for years when he was feeling like it and felt great after that.

Just letting you know it for your future reference.

And, BTW, testosterone is not always indicated for so-called "low t syndrome" and has no evidence of effect for most notable of its components such as erectile dysfunction.

Treatment of Men for "Low Testosterone": A Systematic Review

I didn't demand anything. I presented the regimen my physicians have had me on for years. My insurance was running out and had no time to reschedule to see an endocrinologist. But thanks for your attempt to shine above 😊

[FrankRN2017]

That's true!!! I worked a long, long time in an ER and the fastest way to "no pills for you" was self-diagnosis, an attitude of entitlement and a belligerent attitude. Patients like that typically got to wait for hours in a crowded waiting room for little more than a referral slip, a cold bagged lunch and maybe some Tylenol for the road. I have no doubt that after doing their due diligence they found a Dr. Feel-Good of their choosing but that's both the patient's and the Pez-Dispenser's problem as it is a match made in heaven and they so richly deserve one another. The only exception to this was usually if the patient showed up with all the attitudes above and constantly reminded you that they were a nurse like a mentally deficient Parrot. They also usually didn't get pills, a bagged lunch or any other darn thing just told to go see their doc.

Who said I had any of those behaviors in front of this NP? I was polite the entire interaction. Excuse you!

[FrankRN2017]

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.

[FrankRN2017]

I am not sure this is a good thing though, though at least in my locale, it is (unfortunately) necessary due to a dearth of psychatric specialists. Most PCPs (MD/DO/PA/NP) are not adequately prepared to treat complex mental illness; I do feel like it is important to be acutely aware of what we know and what we don't know.

Going back to testosterone, I do prescribe it in simple cases after an appropriate workup, but I will not prescribe it in complicated cases. So if the OP is a male under 40 I likely would have referred too. I wonder if the OP would change his tune on the NP in question if the endo discovered a prolactinoma?

My PCP initially prescribed me lexapro many years ago. He never encouraged me to do anything else but take this pill daily. Well, after years went by of taking this medication, I cannot get off this pill because of the withdrawal effects. Not good in my opinion.

My testosterone replacement is very simple and I am above 40.

[FrankRN2017]

I didn't mean to suggest that it was a good thing -- I'm a psych CNS and think it's a horrible idea -- but my point was that the fact that the OP's NP was prepared to renew a Lexapro rx without insisting he be in therapy is not at all uncommon in the primary care world, and certainly not evidence of sub-par practice by the NP vs. common MD practice.

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!