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Ep. 107 Independent NPs: Public Health Threat or Libertarian Step Forward?

Hordes of independent nurse practitioners are on the horizon. Many physicians are raising the alarm bell, but our guest views things differently.

GUEST:

John Mandrola, MD: Twitter and Website

LINKS:

Independent Nurse Practitioners and Physician Assistants: A Doc’s View (Medscape)

RELATED EPISODES:

Ep. 69 MD vs. NP: Patient Protection or Turf War? (with guest Rebekah Bernard)

Ep. 72 Taking the USMLE to Task (with guest Bryan Carmody)

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3 Comments

  1. Rafael Cruz on 02/13/2020 at 12:51 PM

    I am a veteran and was treated very poorly by residents who ran the dermatology clinic at the Corporal Michael J. Crescent Va Hospital in Philadelphia. I was mismanaged for 2 years, saw a different resident every visit who did not know me nor seem to understand my case, my opinion was invalidated repeatedly even to the point of ridicule. All they did was provide the same treatment the others had, despite my complaints of my condition worsening, expanding and resulting in alopecia from scarring. Plus, it was very painful.

    I have acne keloidalis nuchae which began at the VA while hospitalized for PTSD secondary to a scalp abscess that developed from a painful papule on my occiput. I was seen by an NP in-house who did not believe it was infected and refused to treat it as such. Even as it grew (quickly) I had to go and complain one of the Psychologists who demanded she treat me. She did not have the skill to drain it, I soaked it and drained it myself in my room (very, very painful)!

    As an outpatient, I was initially seen by a very nice, thoughtful and thorough attending. After, I was seen exclusively by residents for two years. I was very patient and did my research into my condition and remained very compliant. On multiple occasions I requested to be seen by an attending. After insisting, a physician presented behaving like an attending, explaining her credentials and experience- and telling me there was nothing else she could do for me. I requested to have steroid injections but was dismissed with the excuse that they would be too painful. I became very (quietly) upset, left and reported the dermatology clinic to the (new) White House advocacy hotline.

    After that, a Nurse Practitioner took over the case. She asked me to give her a chance, that she was willing to inject steroids. I agreed, she proceeded with injections and added antibiotic (doxycycline ) for inflammation. That helped, but I still experienced frequent flare ups (which are very painful). After 3 visits with that NP she consulted an attending who worked at Walter Reed- he took over my case. He changed my antibiotic to bactrim ds bid , long term. That helped more. I discussed Walter Reed protocols which I obtained online concerning step wise management of acne keloidalis nuchae. We agreed that I would continue treatment and discuss whether I wanted to proceed with plastic surgery consult- which he agreed he would submit after informing me about the risks and potential benefits. It was my ideal to wait, and research outcomes. I have an appointment soon and will go ahead with consult.

    The difference between the residents, the first NP at the VA hospital and the attending is tremendous. The second NP, that took over my case (eventually sending me to an attending) was better; but, she recognized her limitations and was not driven by ego. She was kinder too- in fact, because of her I did not proceed with further action against the dermatology clinic.

    The attending behaved as one would expect a physician would. Detail oriented, spoke to me on equal level, acknowledged my concerns and opinions.

    I actually have several instances that I can discuss- such as misdiagnosis of a rotator cuff tear by an NP who prescribed Ibuprofen- even though I told her that my symptoms were suggestive of a rotator cuff tear. I have many more stories like these as a patient. I am a physician, and have many more examples during my years in practice, but I will leave it here.

  2. Fouradoulas, Marc on 02/19/2020 at 1:38 PM

    What does it mean to “consider the entire patient” ?

    • Michel Accad on 02/19/2020 at 4:23 PM

      There might be an upcoming episode to answer that question 🙂

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