Shocked by MD care of my patients

[grammynp]

I have been off one week so far recovering from surgery. I have a new grad MD, covering my patients. I work in a rural community. Today I was reviewing charts from home per EMR. She has told several of my type 2 DM pts that they do not need to check home glucose, because they are type 2. She also refilled their prescription for a year and told them to come back in a "couple" months to have their labs drawn. Is this the new standard of care? Ps I am brand new to this site. Thank you for your input.

[Barnstormin' PMHNP]

No it is not. I am still in grad school but I know that is NOT the standard.

www.diabetes.org/diabetescare

The above is the website that has the "Standards of medical care in diabetes for 2015," (the title of the publication, you can probably google it) I tried attaching the pdf but it won't let me. If you go there you can find the standards and maybe give her a copy.

Hope you feel better soon!

You must be going nuts after seeing something like that!

[BostonFNP, APRN]

Depends on the patient, but that seems pretty lax if the patient was not stable and at goal.

I have many stable T2s with A1Cs at goal that don't check their sugars at home unless symptomatic.

Sent from my iPhone.

[grammynp]

Part of what upsets me is these are my patients, not hers. I have worked hard to establish trust and motivate healthy habits.

[Tesses]

Like you said, she is a new MD grad.....still a lot to learn in clinical practice. MD title does not make her any better than a new grad NP. You can call your patients and have them make sooner appointments without mentioning to them that the MD did something wrong/not recommended......just for the sake of professionalism.

[Jules A, MSN]

MD title does not make her any better than a new grad NP.

So while it is somewhat dependent on the individual in most cases I would say a having completed medical school would make her more equipped to practice as compared to the average NP new grad.

[Tesses]

I guess that's been our 'fight' that they are not any better than us......I dont think I will give in to the fact that she is 'better equipped/prepared' than us. There are many horrible providers across the board

[morte, LPN, LVN]

So while it is somewhat dependent on the individual in most cases I would say a having completed medical school would make her more equipped to practice as compared to the average NP new grad.

depends on training after med school. a large portion of NPs have experience before going back for their NP, that new grad MDs don't have.

[BostonFNP, APRN]

So while it is somewhat dependent on the individual in most cases I would say a having completed medical school would make her more equipped to practice as compared to the average NP new grad.

I would agree but not because she completed medical school but because she completed three years of residency; most of the clinical learning develops over those three years of supported practice.

Sent from my iPhone.

[Tesses]

I would agree but not because she completed medical school but because she completed three years of residency; most of the clinical learning develops over those three years of supported practice.

Based on years of residency....then yes.

[greygooseuria]

Uhh, I would not say the average new grad MD is better equipped to practice than the new grad NP. I was running circles around new grad MDs as a new grad RN in terms of doing things clinically (OH HEY LET'S GIVE 4 YEAR OLD 80MEQ OF K AT ONCE AND NOT CHECK A BEFORE AND AFTER POTASSIUM LEVEL AYUK AYUK......this actually happened to me and I was like *** are you even thinking?).

The new grad MD clearly didn't pay attention during his/her IM/family practice rotations. Educate them and get your patients back in. For patients with type 2 DM that I have only on metformin, I only do fastings 3x a week, if their fastings are good but their A1C isn't at goal, I have them do a few pre-prandial and post-prandials during the week too to see if/when they are spiking sharply. I don't use glipizide/glyburide because I prefer to go straight to insulin rather than wear out their beta cells, but if I inherit a patient on these or they are extremely resistant to insulin I have them check their blood sugars 2 times a day or so.

[Jules A, MSN]

a large portion of NPs have experience before going back for their NP, that new grad MDs don't have.

Although others say this isn't an established advantage I would agree with you in most cases however the experienced RNs becoming NPs seem fewer and farther between. Now there are so many new grads who have decided their quest to get away from the bedside will begin before they ever work at the bedside and schools are happy to admit anyone with a fist full of tuition cash into a NP program.