When I first started at Wrongway Regional Medical Center (WRMC) back in '03 the psych division utilized the patients' PCP for any areas of medical concern. They were difficult to reach and to get to intervene. Then, sometime later, WRMC hired a couple of medical Docs as hospitalists, and the situation improved somewhat.
Some years ago, a chief MD was contracted to oversee a group of NPs for the entire hospital for routine medical assessments and to be on call 24/7. THAT improved things significantly! We now have immediate access to medical professionals that are, generally speaking, great with which to work. One of the NPs, Bob, who regularly works MN weekends, is extraordinary. Bob will work with us, take suggestions, and explain the rationale for his decisions. The others are very good, also.
Just last night, I was working on the men's psych unit when a patient, with no prior complaints of discomfort, began to experience a little GI distress. I gave him some Mylanta, then some Vistaril, when the patient began experiencing some nausea. The patient then had an emesis, so I did a complete assessment on him checking VS, bowels sounds, rebound tenderness. He had had a splenectomy/cholecystectomy circa '02 but wasn't sure if an incidental appy was done at the time. I contacted Janie, the NP on call, and got an order for Zofran, an abdominal series, CBC, CMP, amylase, and lipase.
VS were good, his abdomen was somewhat distended but the abdominal series was unremarkable. The enzymes were okay, but the WBC was a whopping 30.1! His WBC, three days prior, had been 10.7!
Eventually, the patient was transferred to ER where plans were to transport him to a St. Louis facility with a diagnosis of "acute abdomen".
To make a short answer long, I trust the NPs I work with who answer to the Doctor.
And I apologize for the long post, but I really wanted to sing the praises of the NPs. As has been said, and I quote, "Once I start, I get too lazy to stop".