FNP: opinions anyone?

[rose13]

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Ordinarily, I do not share this much about myself with anyone, but I am fuming now and would really like to know what others think.

Today I had a doctor's appointment. In addition to a physical needed for med school, I have a sour taste in my mouth, abdominal distrubances and a "knot" (abdominal mass, about 1 in. in diameter, and 2 in. long) in my epigastric region, exactly centered along the midsagittal plane. The "knot" is a bit uncomfortable, but not really painful. (I was told to go to the FP for a referral to GI.) I had been told seveal years ago that I had IBS, but I never had anything other than occasional abdominal disturbances.)

The doctor became sick today, so I was seen by a FNP. He examined my throat and told me that I was allergic to something (and said nothing else). Then he pressed my abdomen in various places (except where I showed he the "knot" was) and told me that I have IBS. When I inquired about the "knot," he pressed the area in question and said that he "felt it, and?" I asked him for his professional opinion. He said that he did not know what it was and asked me what I thought it was. I told him that I did not know because I an not a physician. He asked me what I wanted him to do. I told him that I want a consult for GI and possibly the barium, if they deemed it necessary. He then had the nerve to ask me why would I want to put myself through all of that. He said that I probably pulled a muscle (I'm highly annoyed by now). He then told me to take Zantac; I told him that I tried it and it makes me very nauseated; he responded that he found that hard to believe. I told him that I would not take it. He gave me a Rx for Hyoscyamine (refills included) and told me to take Galviscon.
I have an appointment next week with a physician, so I have written this off.

I was wondering if anyone cared to share their thoughts on this, specifically whether or not physicians should reconsider the authority they have allowed mid-level providers to assume. Do you all think my incident is an isolated one, or are physicians (myself included eventually) doing patients a disservice (i.e., growing the practice, refusing to practice in "undesirable" locations, etc.) by allowing mid-levels (NP's, PA's) to diagnose and treat? (No offense intended to any mid-levels reading this, but this is my experience as a patient.)

Constructive commentary is greatly appreciated.

 

[DrMom]

I used to go to a physician who has 2 FNPs. One of them is excellent, the other scares me with her incompetence. (One example is that she prescribed my husband a drug he was highly likely to be allergic to after he had mentioned his drug allergy list to her 3 times...she never looked the drug up to verify that his allergy to a related drug was significant.) I ended up changing Drs because whenever anyone in my family needed to get in the scary NP was the only one available.

Like any other profession, you're going to find a mix of good and bad NPs. I wouldn't write them off completely, but I certainly want to see them in action before deciding their competence.

 

[dr.smurf]

your situation is an unfortunate one and the NP was way out of line and incompetent. i agree with the above post that there are bad people in every profession. i know some very good NP's. you should definitely let the attending physician know about this. the NP is doing a grave disservice to the practice and putting peoples health in harms way, and not to mention is essentially working under this doctors license. i think its your duty to politely, but firmly let the doc know that his NP is an idiot!

get yourself back to an M.D. or D.O. and get things going for your workup. you need an EGD or at the least a barium swallow!

 

[sdude]

That story is really disturbing. You agree that you should discuss this with the supervising doctor. In fairness, though, every field has its idiots, and there are definitely incompetent doctors out there who might have treated you the same way.

In general, I think most NP's and PA's understand that they are well trained only for the "normal" 95% percent of stuff that comes into a general practice, and are more than eager to pass anything weird to the physician. I think most people in those mid-level professions generally love to care for people, and are glad to be able to do so without taking on final responsibility for difficult and serious cases.

The ones who want more responsibility generally wind up in med school.

I think there are some mid-levels who aren't med school material, don't understand their limitations, yet want to "play" doctor--sometimes with disasterous results. Fortunately I think this is a small minority, but it sounds like you may have seen one of these.

 

[skypilot]

I think midlevels are great. My sister is a midlevel (CNM). One of the most important talents they must have is immediately to recognize when they are beyond their abilities.

Without that talent they become dangerous like any doctor who doesn't recognize when a consult or diagnostic test is necessary.