It's time to vent!!!

[MegRyanGirl]

I was looking for a place to release some work tension but didn't find the right topic. So here is a place for every NP out there to vent your frustrations that you come across as an NP :-) Advice, encouragement and support is what we are looking for! Share and sympathize

Here goes mine.

I've had a typical week at a primary care office. Saw about 40 patients with some form of URI. I'm very diligent about not prescribing antibiotics when it's clearly a viral case. With the new CDC recommendations and the antibiotic resistance epidemic, every one has to take a part. But I'm getting really frustrated with providers out there that have no problem prescribing abts to pts that had some cold for a few days. It really undermines providers like myself that diligently educate the patients on viral v.s. bacterial infections, not to mention bad medicine that goes against the most up to date evidence based practice. Patients can be quite frustrating as well. They all fall into one of 3 categories. 1) Those that I educate about the viral infection, understand it and follow instructions, 2) Those that seemed to have understood it but then second guess and start calling and asking for antibiotics when it's not necessary, 3) those that get annoyed that I didn't give them an antibiotic and just go to another place or urgent care and get what they want. ARRRRRRRRRRGGGGGGHHHHH

What am I to do???

Another issue. I don't know how many people on this forum are from the U.S. or another country, but I was raised outside of the U.S. and the mind set is very different for that of the U.S. where I practice. I don't want to be judgmental or anything but American born patients seem to have a very low tolerance for anything that's a little uncomfortable. They can't deal with a little sore throat or a little cough here and there. I mean I have pts that come running to see me for some medicine after some sniffles or some sore throat or a little cough for even less than a day! Most common is someone with cold symptoms for 3-4 days. Where I come from, you just suck it up for a week or so. Back when I was younger I didn't know much about viral versus bacterial infections but now I understand that most of those sniffles were just viral anyway and went away on it's own. Here in the U.S., people take and demand so much antibiotics that they get sick much faster! It's really frustrating. Sometimes I just want to tell them to stop their whining!!!! Or have some cheese with it

[cayenne06, MSN, CNM]

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.

I guess there is two sides to the request and denial of antibiotics!

Curious what labs you thought might have been indicated? To me, this sounds more like you had a provider with a bad bedside manner. If a patient feels heard, and the rationale for treatment is explained, usually a bad experience like yours can be avoided. I am sorry you had such a negative experience.

On a similar note, I have become aware that some patients know the symptoms they need to describe in order to get the treatment they want. Worried about that one night stand last weekend and want to be sure you don't give your girlfriend an infection? Come in and say your partner tested positive for gonorrhea and chlamydia and you can get meds right then and there. That's not a good strategy, people!

I have also noticed that both patients and many support staff often really don't have a clear idea of what resistance actually means (usually they think the person themselves becomes resistant to the antibiotic). Even many clinicians don't understand the specifics, like lateral gene transfer and how that relates to resistance, most especially (in my field) with that ingenious little bastard, N. gonorrhoeae.

[Pachinko]

No, you can't judge all Americans based on your selection bias. For every patient I see who overreacts to a minor cold, I have one (or more) with serious symptoms who has been avoiding an office visit. That includes people with cellulitis, ongoing chest pain, intractable vomiting, etc.

Also, I work with the underserved and underinsured, including a lot of migrants. I see my fair sure of nervous nellies who panic over a mild sore throat with cough in this population.