Uneducated provider.

[ventana]

Recently had a discussion with a local DNP that blew my mind.  
 

11yr old 

dx with pna and admitted x 1 night for iv abx.  (Was an very honest admission not soft)

 

on d/c put on augmentin and zithro.  
 

d/w peds office and caller identified as DNP ___________ I am the assistant medical director. 
 

they went on to state 

1) they didn’t know why they treated with zithro and augmentin instead of amox

2) tried to tell me to decrease the amox dose to 50/mg/kg/day as they had not heard of 90

3) said they are seeing a lot of atypical pna right now.   

4) I asked for etiology and they said strep they were and treating with amoxicillin at 1000mg bid (50mg/kg//day)

 

needless to say I was floored    
 

I will be talking to the medical director of this clinic and questioning the status as assistant medical director with such a total lack of knowledge    
 

this is what we are up against   

 

[ventana]

The er doc was a boarded er doc.  The hospitalist is boarded med/peds.  And she was trying to over rule both.  

[CAAdmission]

I've met a fair bit of dumb healthcare providers. They usually do ok, as long as they are not overconfident. 

The confidently dumb ones will get you every time. 

[sas5814]

28 minutes ago, CAAdmission said:

I've met a fair bit of dumb healthcare providers. They usually do ok, as long as they are not overconfident. 

The confidently dumb ones will get you every time. 

THIS^. Arrogance combined with ignorance is a fatal combination.

[Reality Check 2]

Once upon a time, I took over for a retiring NP on a panel of patients.

In 10 months I took over 40 people off ezetimibe as the PRIMARY AND ONLY cholesterol medication.

90% of the patients had never been on a statin. A few said they had and experienced issues on OLD statins. Some refused statins believing unsubstantiated side effects from TV, books, social media. The NP perpetuated these myths.

A few had cardiovascular events during their time NOT on a statin. Super............

Multiple patients on beta blocker ONLY for "blood pressure control". Metoprolol does squat doodle for HTN.

One guy with claudication. "Serial ABIs" but nothing more - FOR FOUR YEARS. He got a CT runoff from me and vascular surgery within 3 months of that study. No flow to one leg. Past Medical Hx - CABG, stents, CEA - ya think he might be a vasculopath?

I dealt with this day in and day out. BAD MEDICINE. BOLDLY BAD MEDICINE. And zero oversight. Because NP was "Licensed Independent Practitioner". 

Even a google search would have helped this person.

Makes me irate. 

And PA profession is still dying. 

[SedRate]

59 minutes ago, Reality Check 2 said:

Once upon a time, I took over for a retiring NP on a panel of patients.

In 10 months I took over 40 people off ezetimibe as the PRIMARY AND ONLY cholesterol medication.

90% of the patients had never been on a statin. A few said they had and experienced issues on OLD statins. Some refused statins believing unsubstantiated side effects from TV, books, social media. The NP perpetuated these myths.

A few had cardiovascular events during their time NOT on a statin. Super............

Multiple patients on beta blocker ONLY for "blood pressure control". Metoprolol does squat doodle for HTN.

One guy with claudication. "Serial ABIs" but nothing more - FOR FOUR YEARS. He got a CT runoff from me and vascular surgery within 3 months of that study. No flow to one leg. Past Medical Hx - CABG, stents, CEA - ya think he might be a vasculopath?

I dealt with this day in and day out. BAD MEDICINE. BOLDLY BAD MEDICINE. And zero oversight. Because NP was "Licensed Independent Practitioner". 

Even a google search would have helped this person.

Makes me irate. 

And PA profession is still dying. 

Wow, even as a surgical PA I know not to do any of that... Yikes

[ventana]

I used to believe there were good and bad providers but no generalizations could be made. 
 

I am starting to wonder with the flood of NPs rather <5 or <10 yrs out are in general substandard?   I know a few great newer NP’s but most are functioning at the level of a LPN.  
we need to seriously distance ourselves from NP’s

[EMEDPA]

2 minutes ago, ventana said:

I used to believe there were good and bad providers but no generalizations could be made. 
 

   I know a few great newer NP’s but most are functioning at the level of a LPN.  
we need to seriously distance ourselves from NP’s

Agree. I just saw a pt who will now get a $1400 ER bill because their NP sent them to the ER for "compartment syndrome" in their leg. It was a bruise. They fell off their bike a week earlier, had a normal xray, minimal discomfort, walking on it, etc. The 3cm x 3 cm bruise hurt when you pushed on it, so they thought it was compartment syndrome. WTF. Discharged from triage by me.

[CAAdmission]

1 hour ago, EMEDPA said:

I just saw a pt who will now get a $1400 ER bill because their NP sent them to the ER for "compartment syndrome" in their leg. It was a bruise.

Sadly I don't feel bad for the patient. Why seek treatment at all? Stay home, ice and Motrin. Everyone is such a wuss these days. 

[SedRate]

2 hours ago, CAAdmission said:

Sadly I don't feel bad for the patient. Why seek treatment at all? Stay home, ice and Motrin. Everyone is such a wuss these days. 

I had a physician schedule an urgent appt with me for a calf sprain sustained over the weekend to make sure he was ok to go on his ski trip. 

[Reality Check 2]

18 hours ago, ventana said:

I used to believe there were good and bad providers but no generalizations could be made. 
 

I am starting to wonder with the flood of NPs rather <5 or <10 yrs out are in general substandard?   I know a few great newer NP’s but most are functioning at the level of a LPN.  
we need to seriously distance ourselves from NP’s

The NP in my story was older - chronologically and training wise. Don't think she ever actually "got it". 

I have run into more complacent or just blissfully ignorant older NPs who have pigeonholed themselves into whatever they do and they are just stuck in this mode of "I know all I need to know" (one actually said that in a meeting) or they are "too busy" to look stuff up. Travesty for patients either way. NPs have a specialty from the get go - peds, women's health, geriatrics, yada yada. 

Goes back to PA training - medical model. Broad medical knowledge and then we can specialize. But overall, more PAs than not have broad knowledge and put the pieces of medicine together. And I see a lot of learning and investigation in my PA colleagues - dig, learn, adapt. 

Newer grad NPs have been fairly brazen with me. "I have a doctorate"............... great, whatever. But they can't figure out a differential or use critical thinking skills to deal with multiple medical issues.

That said, I work with some stellar NPs who are great colleagues and teach me a great deal or we collaborate well. They are treasured colleagues and friends. But they are too few to say the profession as a whole is qualified.

NP degrees are still willy nilly, online, no or little clinical and seriously lacking in hours and critical thinking. 

We should distance ourselves - we are not the same animal. We are also more than a decade behind in advocating for ourselves in any effort to survive.

[thinkertdm]

On 9/18/2024 at 7:23 AM, Reality Check 2 said:

The NP in my story was older - chronologically and training wise. Don't think she ever actually "got it". 

I have run into more complacent or just blissfully ignorant older NPs who have pigeonholed themselves into whatever they do and they are just stuck in this mode of "I know all I need to know" (one actually said that in a meeting) or they are "too busy" to look stuff up. Travesty for patients either way. NPs have a specialty from the get go - peds, women's health, geriatrics, yada yada. 

Goes back to PA training - medical model. Broad medical knowledge and then we can specialize. But overall, more PAs than not have broad knowledge and put the pieces of medicine together. And I see a lot of learning and investigation in my PA colleagues - dig, learn, adapt. 

Newer grad NPs have been fairly brazen with me. "I have a doctorate"............... great, whatever. But they can't figure out a differential or use critical thinking skills to deal with multiple medical issues.

That said, I work with some stellar NPs who are great colleagues and teach me a great deal or we collaborate well. They are treasured colleagues and friends. But they are too few to say the profession as a whole is qualified.

NP degrees are still willy nilly, online, no or little clinical and seriously lacking in hours and critical thinking. 

We should distance ourselves - we are not the same animal. We are also more than a decade behind in advocating for ourselves in any effort to survive.

I can’t agree with this more.  Furthermore , Nps have positioned themselves as leaders in the healthcare field while we are left in the dust because of confusion over “supervision” and/or “collaboration”.  

[ventana]

Had a patient yesterday refuse to follow my orders due to me being a “doctors assistant”.  Ugh. 

[rev ronin]

6 hours ago, ventana said:

Had a patient yesterday refuse to follow my orders due to me being a “doctors assistant”.  Ugh. 

Some people will never learn. An increasing number of us have the option of saying "Well, I am a doctor, so..." and confusing them even further, just like NPs. I haven't ever done that, because I am backlogged with desperate people who need me on their care team and could care less what title I have.

[EMEDPA]

2 minutes ago, rev ronin said:

 An increasing number of us have the option of saying "Well, I am a doctor, so..." and confusing them even further, just like NPs. I haven't ever done that, because I am backlogged with desperate people who need me on their care team and could care less what title I have.

Yup, this is my practice as well. 

[sk732]

Just had an odd experience today with an NP...with me as the patient.  Long story short, the things they claim to be so much better at than MD's and us, failed.  Didn't introduce themselves when they wandered in, didn't even say hi.  Dubious physical exam, couldn't adequately explain findings, didn't take VS beyond my temp.  Didn't explain the management to me beyond "I think this is a lingering sinus infection, so will be Rx'ing a steroid spray"...and I think an antibiotic.  I say think because they consulted something in their antimicrobial handbook.  Asked what she was Rx'ing but brushed me off.  Can't wait to get to my pharmacy tomorrow (stat holiday today) to find out what my gift bag has and who the secret Santa is...luckily, they're colocated with my doc's office, so will be trying to book a follow up shortly.  Didn't want to go to the ED because, while I thought I was sick, I didn't think I was ED, min 6 hour wait, sick.  Lesson learned.  Also it was the ED I used to work at.

Saw a chart note a few weeks ago from the same clinic on a patient of ours that was visiting the city...Diabetic, rash in their axillae and groin.  Dx as "Intertriginous Seborrheic Dermatitis"...when the description at best was erythrasma, at worst, a nasty yeast or fungal infection...which they were managing with steroid creams.  Showed the note to a couple docs I work with and got  "Just saw a 4 headed alien" looks.  I have seborrhea...yeah, not in any of those areas.  Qu'est-ce que phuque??!!  But they have an independent licence...

[SedRate]

I had an interesting encounter with a furniture salesman who told my spouse and I about the time he thought he broke his back after falling down some stairs. He said he went to see "the little lady" (NP) he sees at Mayo because "you can't even see a PA anymore let alone a doctor, you have to see the next step down." He said she looked surprised when she saw the results of his scan which confirmed a couple of fx and told him she needed to confer with her physician colleagues. When my spouse shared I worked in medicine, he asked if I was a physician and I answered PA, he said, "well they're basically the same thing."

[sk732]

 I remember chatting with a patient in Emerg one day, dude in the next bay heard what I was saying through the curtain and said "Hey Doc, I really liked how you explained that", replied "Well, I'm not a doc, I'm a PA but thanks."  Dude was from the US - his face lit up and he started talking me up to his neighbour for a bit, who was still trying to come to grips with what a PA was, since we were a little new then.