[NPInfo] Physician blogs maligning NP s and PAs another issue

Wed Mar 12 06:24:47 PDT 2008

Maybe he was in denial and when you mentioned "multivessel disease and risk factors" he didn' t want to hear it (from anyone- but you were the one there in the room). My thoughts would be that he's not happy (with himself and the situation) hoping for a better opinion. You can't please everyone, do your best and realize it's usually not about you personally.

________________________________

From: npinfo-bounces at nurse.net on behalf of David Mittman
Sent: Tue 3/11/2008 10:53 PM
To: NP Info
Subject: Re: [NPInfo] Physician blogs maligning NP s and PAs another issue

I can't tell you how to feel, only a foolish person would.
I can tell you how I would react. I would care. BUT I would ask him 
why he felt that way? Did he feel I did not care for him, or know 
enough medicine? Or that a PARTICULAR doc knew more? (Maybe that doc 
does?).
I think people should be allowed to see a doc whenever they feel the 
need. That's what will prove us right/good/high quality clinicians. 
If I did not know better, I might want to see a doc also-OK, I 
understand. I would think of it as a second opinion, nothing more 
unless a doc put that question into someone's head. Then that's a 
different story. So short answer-don't take it personally; it's part 
of the professions we are in.
dave
\
On Mar 11, 2008, at 10:25 PM, AnnMarie Roetzer wrote:

> 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 :)
>
> Carla Anderson <carla_rayne at yahoo.com> wrote:
>   Thanks Dave, yes I agree, it is the pioneer issue, and politics.. 
> and I do think that there are things being said to the patient when 
> they walk in the door to the specialist, it could be one work, but 
> the tone says all. For example, they could just say "who referred 
> you? with a raised eyebrow, and then "hmmmm"... or, you really 
> should be seeing a doctor with these issues... But many patients 
> have said to me breaking into tears "you have taught me more in one 
> visit, than in all the years I have been seeing doctors.." and so 
> on.. so I will just keep on with the educating, and being positive, 
> and go to the groups in person, because even if they dont want me 
> out there in the community solo, I know they want the referrals. Carla
>
> David Mittman wrote: Carla: You are a pioneer. Most physicians 
> don't want you to have,
> see, refer, or be the medical home for any of "their" patients. Some
> will have you do that all if you work for them, some wish you (and
> PAs also) never happened.
> Talk to an old D.O. The same exact thing happened to them. Their
> patients were taken at every turn. MDs told the patients DOs were
> quacks. A few still do.
> So, what do we do? Do we turn the other cheek? Sometimes, but let
> them know you are watching with both eyes. I would lunch with the
> "opinion leaders" in the community and ask them to help. They might
> say no, but I bet most will think it over or say you are right. Also
> a letter to the medical board asking what to do would be of interest.
> Not giving names, etc; just the situation and if they feel it's 
> ethical.
> As for joining the ACC, please do. We are still a struggling group of
> committed people. We will be doing much over the next year. Clinician
> Reviews will be working with us and has agreed to help us with
> getting some advertising going.
> There are a number of ACC BOD members now on NPInfo.
> Dave
>
> On Mar 9, 2008, at 5:32 PM, Carla Anderson wrote:
>
>> I also wish to join the ACC. I mentioned it before, and am working
>> at my second job today, but will get back to it right away. I have
>> a question for the list. I did not see the original blog, of
>> malignment, but along those lines..I have my own practice. I do
>> not know if it has anything to do with me being an NP PCP rather
>> than an MD but here is what is happening.
>>
>>
>> I have noticed over and over again, that I refer to Ortho, or
>> General Surgery, or wherever, and rather than them writing me a
>> nice letter of Consult and sending the paient back to me, they
>> either continue seeing the patient for weeks or months (if they
>> have good insurance) and they are doing primary care visits, not
>> needed for their specialty services, (billing the patients
>> insurance at their specialty rates) , or they are referring
>> patients to another specialist. They are breaking the rules. They
>> upset the patient and confuse them. I do not know if they tell the
>> patient negative things about NPs, and they do not really know me
>> personally, this is not a personal thing. But one patient had
>> severe swelling, pain, feeling cold, and numbness to her left
>> wrist with positve phalens and tinels, and does a lot of repetitive
>> computer work...so I sent her for an u/s to r/o dvt, then emg/nct,
>> to eval for Carpal tunnel synrome. Initial labs including ana, rf
>> were negative,
>> but sed rate was slightly elevated. I put her on a steroid taper,
>> ice (after dvt was ruled out), splinting, off work, and sent her to
>> ortho. After I referred her to one ortho, the patient called me,
>> and said she called another one on her own, and got in sooner, so
>> now could I send all thepaper work there. So I had to send another
>> letter to the first ortho doc, apologizing, and cancelling the
>> referral, and then sent another referral letter to the ortho doc
>> that the patient wished to see now.
>>
>> Anyway, this ortho doc did not write me any type of letter
>> thanking me for the consult, or did not write me any letter
>> regarding his exam or findings. He just referred the patient on
>> his own to rheumatologist to r/o lupus... and then tells the
>> patient to come back to him.. I had to find this out, by calling
>> the patient. This has happened several times, and then the
>> specialist gets a letter from the next specialist, as they were the
>> referring doc, and I get pushed out of the loop.
>>
>> UNLESS OF COURSE, INSURANCE REQUIRES I AS PCP DO THE PAPERWORK.
>> Then the specialist office will call me and tell me to play
>> secretary and do all the paperwork for them.. I really feel that
>> maligning is going on behind the scenes. I thought about having
>> lunch with these docs, which I will, but there are so many,
>> especially when the patient later tells you, of a certain doc she
>> has seen since childhood..
>>
>> I have the American Academy of Family Physicians website Consult
>> Form, including the rules.. They are clearly breaking the rules,
>> and it is clearly disrespectful.. The problem is the patient is put
>> in the middle.. and I do feel that being an NP in private practice
>> is part of this passive agressive move that is occuring.. I will
>> continue to remain positive. I think I am going to answer part of
>> my own question right now... PRIOR to any referral, I will call
>> the doctor's office and ask to speak to the doctor directly. This
>> is when i have the most power. At that time BEFORE THE REFERRAL,
>> I will let the doc know that I need to be in charge of all
>> referrals as PCP, kept in the loop, and referred back to with
>> findings if specialty care is not needed. I ALSO am going to tell
>> the patient BEFORE the referral they are NOT TO CALL on their own
>> and set up with a different provider as it causes a lot of
>> confusion and fragmentation...The patient clearly can be in charge,
>> and tell
>> the specialist what needs to be done, as if they have good
>> insurance they are very powerful. And the patietns that have gone
>> to private NP practices know, and are very loyal, but the brand new
>> ones are easily influenced if no bond has developed. But these docs
>> MUST REALIZE I AM A GREAT REFERRAL SOURCE and I will not use them
>> again if they abuse this.
>>
>> Just for this one patient I had to fill out several work excuses,
>> medication rxs, the referral letters, the different imaging
>> studies, and the 6 pages of Family Medical leave act that had to be
>> faxed to both her employer and he employers insurance company. The
>> primary care provider (whether doc or NP or PA, needs to be the hub
>> of the wheel, and the specalists are the spokes). They are not the
>> one that coordinates the annual exams, all of the meds, the
>> testings, and making sure that all providers associated with the
>> patient are on the same page. Carla Anderson, FNP-Healing Presence
>> Family Practice, Oregon
>>
>> jlambertrn at comcast.net wrote:
>> Karen,
>> I echo your thanks to Stephen and David. I agree whole heartedly
>> with you and your thoughts and the fact that much of our knowledge/
>> training is similar to the apprentice concept that has been working
>> for centuries. (Sorry about the run-on sentence; my high school
>> english teacher is probably rolling over in her grave!) As you, I
>> too remain humbled by the amazing amount of knowledge that is out
>> there that we (including docs) need to be on top of. I treat people
>> with respect, and expect the same in return, docs included. For the
>> most part, I enjoy a very collegial relationship with the other
>> docs in the ED where I work. Occasionally, I have to call a
>> specialist for a consult. Most are receptive to me as a NP, however
>> you still run across the arrogant jerk every now and then. I always
>> remember who they are when I am moonlighting in primary care as I
>> frequently do. Does a doc really think I am ever going to refer a
>> patient to him/her after being disrespectful or unprofession!
>> al towa
>> rds me? If the offender treats a colleague in that manner, how will
>> he treat my patient? Nope, no referrals for you!
>> As far as Panda Bear is concerned, I feel he has way too much time
>> on his hands. His post was long, rambling and most of all B-O-R-I-N-
>> G. One of the AMA's beefs with us has always been "they take
>> patients away from us, and it will affect my ability to earn a
>> living". Does Panda Bear have any clue to the difficulty a patient
>> encounters when he/she calls their PCP on a day when they truly ill
>> and are told that the next available appt. is in two weeks? We see
>> these patients in the ED every day, so there goes the theory of
>> "us" stealing "their" patients. Paaaaallleeeeeze! There are plenty
>> of patients to go around and that is an unfounded, tired, mundane
>> talking point put forth by the AMA and other groups. That argument
>> impacts patients in a very negative manner. Yep, reading that blog,
>> made me get the same feeling in my gut that I get when I have to
>> call that arrogant ENT or surgeon, or whatever. The positive point
>> in all of this is that I LOVE WHAT I DO, and like Peg Fitzgera!
>> ld alwa
>> ys says "Being a NP is the BEST job on the planet". So what next?
>> We all go on doing what we always do- providing quality, evidence-
>> based care to our patients who put their faith and trust in us
>> every day. One patient at a time. I think it's time to join the
>> ACC- Dave Mittman, are you listening? I have my credit card in
>> hand. LOL.
>> Julie Lambert, FNP
>> Ocean County NJ
>> -------------- Original message --------------
>> From: karenfnp at comcast.net
>>
>>> Stephen and David,
>>>
>>> Thanks for your comments and the sample blog. As a champion,
>>> especially for
>>> NPs, I like to hear what others say about us in order to facilitate
>>> bridgebuilding. One aspect of health care provider training I like
>>> to stress
>>> with docs and advanced practice clinician students is that so much
>>> of what we
>>> learn in the medical aspect of what we do is apprentice based. We
>>> all have to
>>> learn the same new info when new diagnoses, treatments and meds
>>> emerge on the
>>> health care scene via CME and OJT to maintain quality evidence
>>> based practices.
>>> ( To have more residency programs for PAs and NPs in speciality
>>> areas would give
>>> us more credibility in specific content areas.) I like to maintain
>>> a posture
>>> of humility in terms of all that we need to know these days and
>>> respect docs who
>>> do the same. It looks like this "panda bear physician", per the
>>> content in this
>>> blog blurb, chooses to spend energy putting NPs PAs down and
>>> reminds me how we
>>> have to choose where to spend our energy in !
>>> buildin
>>> g our allies in the physician community and not waste it a la
>>> "casting pearls
>>> to swine" as Jesus said once.
>>>
>>> Karen Riesinger FNP
>>> Portland, OR
>>>
>>> _______________________________________________
>>> NPInfo mailing list
>>> NPInfo at nurse.net
>>> http://lists.nurse.net/mailman/listinfo/npinfo
>>> *****************************
>> _______________________________________________
>> NPInfo mailing list
>> NPInfo at nurse.net
>> http://lists.nurse.net/mailman/listinfo/npinfo
>> *****************************
>>
>>
>>
>> Carla R. Anderson, FNP-C
>> Healing Presence Family Practice, PC
>> carla_rayne at yahoo.com
>> 503 819 9726
>> _______________________________________________
>> NPInfo mailing list
>> NPInfo at nurse.net
>> http://lists.nurse.net/mailman/listinfo/npinfo
>> *****************************
>
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
>
>
>
> Carla R. Anderson, FNP-C
> Healing Presence Family Practice, PC
> carla_rayne at yahoo.com
> 503 819 9726
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
>
>
>
> ---------------------------------
> Looking for last minute shopping deals?  Find them fast with Yahoo! 
> Search.
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************

_______________________________________________
NPInfo mailing list
NPInfo at nurse.net
http://lists.nurse.net/mailman/listinfo/npinfo
*****************************