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Pts want to see a doctor

Posted

Has 3 years experience.

I just graduated in December 2013 and now work full time in a clinic. It really bugs me when a patient insists on seeing a doctor when I walk into the exam room. Have you guys experience this? What do you do? How do you respond?

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

It will happen less and less the longer you practice. Don't let it bother you. If they want to see the doctor let them see the doctor.

I respond: "sure, let the front desk know you want to see Dr, he's booking about 4 months out, if I can help you sooner, feel free to return"

I will just let them see MD without trying to persuade or misrepresent anything. It is their choice. It happened to me several times before and I was tempted to use ambiguous term to represent myself to next patients and I fear of directly mentioning my credential... but then on reflection... I will try my best not to misrepresent myself or make my credential ambiguous (like so many NPs do). I made it clear in the beginning that I am an NP in a specialty, not a PA, assistant, or MD and perform some similar tasks as MD. I am not going to give credits from my hard-work to MD or PA, which will contribute to the lack of visibility of our profession.

Many times the office staff misrepresented us to patient and made them think that they would see a physician.. then a few of them get upset and surpised to see an NP instead. I would rather have a patient refusing me as an NP rather than disguising myself for one patient's acceptance.... At least, I am doing something good for our specialty and profession. ...

Edited by harmonizer

phillycpnp-pc, MSN, RN, NP

Specializes in Peds Med/Surg; Peds Skilled Nursing. Has 8 years experience.

As a new NP only 6 months out, i use take this personally. I'm starting to have my own little following and some patients are only requesting me, so it doesn't bother me as much and i don't take personally anymore. Similar to Boston, i tell patients that you were scheduled with me but if want to see the DR. you have to go up to the front desk and ask the scheduler to put in with the MD, but it may be a wait.

When i was on call over the weekend, i actually had a parent argue with me as to why she wasn't speaking with a dr. I told her the NPs and MDs share call and simply said, it 12 am on Saturday night and I'm the only one on call, but if you want to still speak with a dr, you have the option of go to any of the local ERs. lol She didn't like that option and proceeded to tell me her concerns.

On the contrary, I had patients who liked to see only NP instead of MD providers.

Let me admit though that these patients had well searched on google, and were very well informed that NPs were better than MDs in listening and caring for their patients.

orangepink, NP

Has 3 years experience.

How about when fellow MDs dont recognize you as a colleague? How do you deal with that?

For example, I do all follow ups for my collaborating physician, Dr Xyz. Whenever I see a pt, my name is on the notes instead of dr Xyz since it's already a follow up. So when I was on vacation, one pt called the on call practitioner which was another MD let's say dr abc. When she would log in her notes, she'd refer that "after reading dr Xyz notes". But dr Xyz only saw that pt once on the initial visit. The rest were my notes.

Most of the time this MD, dr abc, doesn't even acknowledge my existence. The only time we talk is during the monthly doctors meeting and only if necessary. I try not to let it bother me when she doesn't say hi. I just got irked when I saw her on call notes. But oh well.

Honestly, in my daily interactions with patients & other providers, It seems like there is an uphill battle to climb...that I have to prove my capabilities every minute of the day.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

How about when fellow MDs dont recognize you as a colleague? How do you deal with that?

For example, I do all follow ups for my collaborating physician, Dr Xyz. Whenever I see a pt, my name is on the notes instead of dr Xyz since it's already a follow up. So when I was on vacation, one pt called the on call practitioner which was another MD let's say dr abc. When she would log in her notes, she'd refer that "after reading dr Xyz notes". But dr Xyz only saw that pt once on the initial visit. The rest were my notes.

Most of the time this MD, dr abc, doesn't even acknowledge my existence. The only time we talk is during the monthly doctors meeting and only if necessary. I try not to let it bother me when she doesn't say hi. I just got irked when I saw her on call notes. But oh well.

Honestly, in my daily interactions with patients & other providers, It seems like there is an uphill battle to climb...that I have to prove my capabilities every minute of the day.

You are worrying way too much about this.

I agree with BostonFNP, bleep 'em. Some MDs just have bad habits, or maybe that is how they deal with their own NPs. I really am completely unbothered by that type of stuff. I try to take the opportunity to educate people (patients, the public, MDs) when it makes itself available, otherwise I work on doing my job well. I consider that my part in raising the profile of the profession.

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

I agree with BostonFNP, bleep 'em. Some MDs just have bad habits, or maybe that is how they deal with their own NPs. I really am completely unbothered by that type of stuff. I try to take the opportunity to educate people (patients, the public, MDs) when it makes itself available, otherwise I work on doing my job well. I consider that my part in raising the profile of the profession.

Absolutely agree with this.

In one ED I worked in we had morning trauma meetings with the orthopaedic doctors. We found that whatever we were doing was wrong and after comments such as "Well, you would expect them to have gone to medical school" about a set of notes - written by a doctor in this case. The Nurse Practitioner team stopped attending. Our medical staff are happy with what we do and that is what counts.

As for patients, if they want a doctor they can have one - no biggie.

Biggest problems tend to be Americans - no disrespect intended or meant - who ask "Who is going to read my X-Rays". Yeah, that will be me, it's part of what I get paid for.

Referring to other speciality doctors - plastic surgeons, orthopaedics etc. should not be a problem in this day as NP's have been around for a long time.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

GrumpyRN - may I ask if you practice in the US? Or another country? Or are you from another country?

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

I'm an Emergency Nurse Practitioner in Scotland.

BritFNP

Specializes in Family Practice, Urgent Care. Has 6 years experience.

I tell them they scheduled with me, today they would be seeing me. Next time though, as to not waste anyones time, they can schedule with the MD.

orangepink, NP

Has 3 years experience.

I'm an Emergency Nurse Practitioner in Scotland.

Now that's awesome!

GrumpyRN, NP

Specializes in Emergency Department. Has 39 years experience.

Now there you go, just as I said it is no biggie up pops a patient I saw who asked why no-one gets to see a doctor nowadays. :)

Actually felt a bit aggrieved for a minute then thought, sod it, and got them a senior doctor to confirm exactly what I had diagnosed and what my follow up plan was.

BlueDevil, DNP

Specializes in FNP, ONP.

I haven't had anyone express ideas of this nature aloud to me since I was a new grad, but I've been told people mumble things akin to this to the staff from time to time. It isn't surprising, given the physician centric culture we still support in the US. I'm too busy to fuss with grumpy patients. If they don't want to see me, I really am OK with that, and I say that amicably without a trace of bitterness. There are a few of them I'd rather not have to see as well, lol. But I have a professional responsibility to them and I behave professionally; presumably whatever prompted them to make the appointment 2-3 months ago was bothering them enough they don't want to forfeit their co-pay just to reschedule and wait another 2-3 months so see someone else, so we both suck it up and learn to deal with our frustrations. They live (because I'm good at my job) and I live, (because even the worst of them are just people, and most people are basically good) and we all move on. I suggest you adopt a similar attitude or you're going to be constantly upset by failing to meet the narcissistic expectations of strangers.

It reminds me of a situation with my neighbor. He choose his neurologist because she went to UPenn (great school, I'm an alum) even though he'd been referred to someone those of us on the inside well know to be a far superior physician, but apparently had the misfortune to go to medical school at the Universidade Federal do Parana, Brazil. My neighbor could not accept that someone who went to any Ivy League medical school would not be a much smarter, kinder, probably more attractive ;) physician in every way, than someone who went to school in Brazil. I mean, do they even have aspirin in Brazil yet? How could anyone educated outside of the US, much less outside of the Ivy League, possibly know anything? :roflmao: So no matter what his own PCP advised him, what his oncologist advised him, what I advised him, he looked up the CVs of all the providers on his ins plan and chose the one with the credentials he liked best. I don't think Dr. Brazil (who is internationally known, published in his field and hugely respected) is going to lose a moments sleep over it, and neither should we.

My neighbor is still waiting to see his Penn neurologist. I hope he is happy with her, I am confident he will get competent care. His confidence in her is a very important part of their therapeutic relationship, and for that reason alone, I think he is better off with her than her more talented colleague from Brazil. My neighbor has to feel safe, comfortable, assured. Our patients must also feel so under our care. Speaking for myself, if they do not, I'd rather they saw someone with whom they did. Their trust is integral to their health promotion, as well as implementing any treatment plans we have to adopt. Without it we are going to get nowhere, and neither of us is going to be better off for that.

I don't have anything to prove anymore at work. I know I'm good at my job. My colleagues know it. Most of my patient panel feels like they know it, lol. When you are a new grad, and still do have to build that reputation, let it be about the work and not about the personalities. Excellence in practice and quiet dignity, along with tincture of time seem to earn most NPs and PAs I know the complete respect of physician colleagues. Rising to the bait from the jerks among them gets you nowhere. Believe me, you won't be the only one who notices some people have attitude problems, but you don't want to be the first one or the only one to say it. I wouldn't ever put up with abuse, and I've had a 'quiet word' with a few people here and there. I think that's par for the course in most adult work places. But again, that is always about personalities, not usually performance. For now, focus on performance and the rest will sort itself out.

Riburn3

Specializes in Internal Medicine. Has 10 years experience.

If they want to see a physician let them. Articulate that you can provide the same service and address their problem, but ultimately they are free to choose if they don't mind waiting longer.

I hate when NP's or PA's try to mask the fact that they are NP's or PA's. The best thing we can do for our profession is clearly state what we are, and then do a great job. This will allow you patients to not only appreciate you and your skills, but also respect the profession.

orangepink, NP

Has 3 years experience.

I appreciate all the responses! I had an episode last week where I saw a pt and gave my treatment plan, he still insisted he only wants to see the doctor. So I said ok let me call him in. The doctor came inside the room and repeated the same recommendations for treatment. When the doctor left, the pt was surprised and said oh it's just the same thing. I just chuckled and said yeah I know hehehe