[NPInfo] rough week

[David or Diane Dito]

AnnMarie,

Don't sweat it. Whenever things like this happen, it's not about you but
rather the patient. It's too bad the patient didn't feel confident enough in
his own opinions or feelings to calmly tell you that he was uncomfortable
being evaluated and counseled by an NP or whatever if was that was bothering
him at this visit. I mean, why did he allow the visit to continue if he
wasn't willing to follow through with your recommendations? Who knows in
these situations? I don't know how your practice is set up, but maybe he was
unaware his appointment wasn't with an MD, or maybe he made or in the past
has made an appointment with an MD but was seen by an NP or PA instead
(comes off as bait-and-switch to the pt, even if the NP or PA is equally
competent), maybe he or another family member had a bad experience with an
NP or PA in the past, maybe his father or another relative is an MD and is
anti-NP or -PA or whatever.

As you said, it sounds as if the visit went well. There's little you can do
to change a person's perception other than to continue doing what you're
doing and doing it well. As you pointed out, he may come around. He may not.
It's his choice.

Your story brings to mind a phenomenal little book by don Miguel Ruiz called
"The Four Agreements." It's powerful stuff packed into four rules for
everyday life: 1. Never take anything personally; 2. Always do your best; 3.
Don't make assumptions; and 4. Be impeccable with your word. You did your
best, and you didn't belittle the patient to your staff but rather asked
staff to comply with his requests to meet his needs and not yours. The other
two are harder but if you remember it's not about you, it's easier to let
things like this go and to continue to focus on the patients who DO value
you and the wonderful care you provide them.

As the saying goes, keep on keepin' on. You're doing a great job.

Diane Dito, NP


-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of AnnMarie Roetzer
Sent: Tuesday, March 11, 2008 9:25 PM
To: NP Info
Subject: Re: [NPInfo] Physician blogs maligning NP s and PAs another issue

Hey group, 
   
  Had a rough week last week regarding patients. I spend all day taking care
of the sickest heart failure patients, complex and all, and I notice that my
last appt is a one year follow up. I am sooo excited, young guy with CAD.
And better yet he has an NP for a PCP. I thought this would be a great
patient. 
   
  So i went through the visit, as usual, providing my usual education and
thoroughness, noting that he hadnt had a stress test in a year (with
multivessel CAD and multiple risk factors) so I discuss the importance of
stress testing with him, talked about importance of HL and HTN control as
well. As seemed well, shook his hand and he left. 
   
  My nurse called him Monday morning and he refused to schedule the stress
test. Demanded to see the "real doctor" before he made any more decisions
and was very rude about it I guess. My nurses were very upset -- and
internally so was I -- but externally I calmly told my nursing staff to just
get him an appt with the MD (who will just repeat my plan of care, I know)
because it is simpler.
   
  Outside no one would ever know I am upset, but internally its just rough.
I know people say it... and I know I did nothing wrong.... and in the end
the patient may even come back ... and I know I have a practice of wonderful
patients who appreciate my care and education, but still. 
   
  So just tell me super experienced people, is there a point where you dont
get stung by those comments..... or should I just get over it. 
   
  Thanks for your help, 
  AnnMarie :)