Still Angry at MAs playing nurse or PA

[CaLLaCoDe]

My wife called her Doctor's clinic today in order to discuss her Provera prescription. She was told that the Physician was out of the office and would not be back by friday, so "we'll have our MA return your call." And so the MA calls back and says that its ok for my wife to reduce her dose from 10mg to 5mg daily and she can check back with the physician on Friday. I thought MAs were supposed to work under direct supervision of a doctor. Sure this MA may have heard the doctor say the give the same advice to another patient, but it doesn't make this practice right (not conferring directly with the MD). Even I as a nurse would never consider prescribing a dose without consulting a physician...because we're trained to do so. So how can we stop this common practice from happening?

My wife loves her clinic and wouldn't think of complaining. Since her physician had stated that the Provera could be stopped by her at any time without side effects, she thought of it as no big deal. So, it's not my place to complain. Or is it? She's not my doctor and I did not speak directly to the MA. My wife specifically asked if she were a Physician's Assistant and was told MA. (So no confusion there!) Should I as a nurse write a heads up letter or speak directly to the physician that this is putting her practice in jeopardy? How would you handle this?

[mama.RN]

I would find out if when your wife left the message if it included the exact info about her wanting to know if she could reduce dose from 10 to 5mg. If so, the MA may have seen that and contacted the doc before returning her call. In any case, I don't see a problem with her calling the physician about this, just in case it did happen as you think it did. If this was occurring in my office we would certainly want to know.

[Been there,done that, ASN, RN]

You need to find out the routine and see if this is the way the doctor runs his practice.

If he/she is doing this , ESPECIALLY to save on staffing costs... it's time to find a safe doctor.

I would not allow an MA to make that decision regarding my care.

I have seen serious errors when an MA gives advice in a doctor's office.

[Sam J.]

In some states MAs aren't regulated by the state and they can do almost 'anything' a physician allows them (and supervies them) to do- start and give IVs, call in Rxs, wound care, etc. It's perfectly legal, even though it makes no sense- even LPNs need to take and pass IV certification courses in most states. If an MA is doing something you find questionable, it's probable the physician is well aware of it and condones it, and is willing to accept the liability. Why pay a nurse when you can pay an MA to act as your nurse?

[BlueDevil,DNP, DNP, RN]

Most practices have a provider on call 24/7. That person is authorized to make decisions, relay them to the MA, who then returns the call to deliver the message to patients. This is how we do it in my practice. I do not typically speak directly to patients on the phone, but I get electronic messages about their issues. I answer them electronically, and the MAs call the patient back with my response. When I am on call, I also address issues for patients of other providers from whom I am covering.

I suspect this practice has a similar arrangement and I think it is highly unlikely a medical assistant just made an independent decision such as this. Don't assume the worst without all the facts. Why not just ask before going off the rails and lodging unfounded complaints?

[TheGooch]

I would find out if when your wife left the message if it included the exact info about her wanting to know if she could reduce dose from 10 to 5mg. If so, the MA may have seen that and contacted the doc before returning her call. In any case, I don't see a problem with her calling the physician about this, just in case it did happen as you think it did. If this was occurring in my office we would certainly want to know.

This is a 4 year old thread you're commenting on. I would imagine this specific problem has been resolved.

[BostonFNP, APRN]

If a non-MD gave permission to alter the dose of a prescribed medication that is practicing medicine without a license. "[/quote']

Hey, let's not limit that to just MDs!

Quite frequently patient a will call my office about med changes and talk to the MA. The MA talks with me between patients, I make a change, the MA calls back and tells the patient. Twice people have called to report the MA, both times she has discussed it with me prior, she just didn't make that clear. We have discussed it and she does a better job letting people know who made the decision now.

[BostonFNP, APRN]

This is a 4 year old thread you're commenting on. I would imagine this specific problem has been resolved.

Wow. Absolutely right!

[schnookimz]

I used to work at a clinic where something like this happened frequently BUT there's a whole behind the scenes that you aren't seeing.

For example: your wife would call about her prescription. A note would be entered into the computer that she called. Doctor can see these notes at home and write a reply. Then the note goes back to the MA who calls you and reads out what the note says. Thus you might think it's advice from her when really it's an order from the doc.

[nursel56]

In all the years I worked in ambulatory care there never was an instance when the common "I"ll talk to the doctor and get back to you" followed up (hopefully :-)) with "I talked to the doctor and..." led to any confusion.

Probably too late to find out more details now, though.

[BlueDevil,DNP, DNP, RN]

Oh for Pete's sake, you're right. I never check the dates. doh. I hate when that happens!