[NPInfo] 3 moments in an NP life

[Rose Moran-Kelly]

Very nice moments Jeff....but PMR?   I am not familiar with those
letters..(and am sure I will be embarrassed when you tell
me....but...that is what this list if for)   Thanks  Rose


On 1/19/07, Jeffrey Hazzard <jeffnp27 at yahoo.com> wrote:
>
>
> Jeffrey Hazzard <jeffnp27 at yahoo.com> wrote:  Date: Fri, 19 Jan 2007 00:50:01 -0800 (PST)
> From: Jeffrey Hazzard <jeffnp27 at yahoo.com>
> Subject: 3 moments in an NP life
> To: pat1 at rconnect.com
>
>   Pat,
>     Congrats on your studies and welcome to the profession!
>
>     Here are three moments that defined my practice.
>
>      1.  I began using a new medication for acne which was new to the market and which was effective in a new method of action, reducing the risk of a similar medication already on the market.  I weighed the cost of the new medicine against the increase in efficacy and pt. tol and decided trying it was warranted.  After several weeks and 4 or 5 uses, the use of the new medicine must have filtered through several computer audits because the drug rep of the medication came to give our office lunch.  I sat quietly as the effusive, bubbly, and beautiful young drug rep thanked my "supervising" physician next to me for using her new medicine.  Imagine the surprise on her face when he told her he never used her new medicine and had never heard of the med before.  I sat there quietly the whole time, knowing that my prescriptions, which I never discussed with the doctor, were the reason for her sales call.  I figured if we NPs are invisible people we might as well be mute, too.
>
>     2.  I was seeing a hypertensive patient who had also seen a nephrologist because of renal insufficiency.  I was seeing the patient again and is renal indices had worsened in the interim.  I decided to call the nephrologist and ask if a treatment change or earlier specialty follow-up was indicated.  I waited for the nephrologist to come to the phone, identified myself, and was presenting my bullet to him when he interrupted to say, "I don't talk to nurse practitioners.  Patients sick enough to see me deserve medical care."  I was stunned, then hushed, then incensed in sequence of emotions that came about as fast as you read this.  I handed the phone to my "supervising" physician next to me and said, "Here, this call is for you," also giving the chart to my doctor.  I stood by and watched as the two fumbled awkwardly on the phone to each other for a few minutes, my doc not able to answer several questions in seccession, missing the whole point of the call completely,
>  frantically paging through the chart in order to get caught up and not sound inadequate.  Finally, my doc said, "Actually, Mr. Hazzard, our NP was the last in our practice to see this case, he's standing right next to me, let me have him speak to you."  I took the phone and gave the same bullet I would have several minutes before.  The nephrologist impatiently said, "have him get a priority appointment to see me" and hung up.  I had to smile for the "gotcha" moment.
>
>      3.  I saw a 63 year old woman with persisting malaise, muscle aches about the shoulders and thighs, and subjective fevers.  She was not getting better, and some days she had headache, but no other focal symptoms.  This malady had come and gone for several years, and seemed to be sapping her virve for life.  She had told two other doctors in our practice who ran some blood tests (CBC, CMP, TSH) and told her she likely had latent symptoms of menopause.
>        I listened to everything she complained of, and wrote it all down carefully, as all NPs do.  I asked about psychosocial concerns, but there didn't seem to be any.  She went through menopause at age 48, had not menstruated for 13 years, and was no longer having vasomotor symptoms.  Finally I reviewed all the symptoms and PMR came to mind.  I told her that her constellation of symptoms might be from PMR and the best way to test the theory would be to start oral steroids as a new batch of labs cooked (which were all normal).  I gave her the prescription and sent her for labs.  About 8 days later the patient called me and told me, "I didn't want to take steroids but 2 nights ago I was feeling at my worst and decided to try the medicine.  I'm like a new woman.  You are so great.  Thank you.  You should be a doctor."  I told her she was welcome, but that if I was a doctor she might not have been properly diagnosed!  About 4 months after that a new journal article (in 2002)
>  came out suggesting that while PMR shows no increae in standard inflammatory markers, serum prolactin is frequently higher when its victims are symptomatic.  Now I would run add that to the tests.
>
>     Good luck at school and in your practice.  Pay attention, forget nursing theory, remember the psychosocial being, and learn as many medical facts as you can....you'll need them all when you are done.
>
>             Jeff Hazzard, Tampa
>
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