Quote:
Originally Posted by Perna
I have a doctor as a PCP and he does not use any NPs. I've seen him for 8 or so years and it's my impression PCP's don't really do much other than maintenance meds for chronic stuff? I definitely would use a psychiatrist for psychiatric meds but once I have gotten in a rhythm of what I need to take and see him for my 10 minutes every 3 month, have my lab testing done once or twice a year, etc. I can't see that it makes a difference to me other than that I have gotten to know him a bit over time so we have now gotten to a pretty good working arrangement. He's sometimes hurried and messes up but I have the same pharmacist too and can straighten things out.
I think medicine is much different than it use to be, not necessarily better or worse just that all PCP's really have now are meds you can try and they help or they do not? In 8 years, my PCP has not really touched me other than to check my lungs, heart, and carotid arteries in my neck. They don't look down one's throat or shine lights into one's ears, etc. I don't often have other complaints but at first I was surprised and disturbed when my husband would say he had complained about something and had taken a shower that morning thinking the doctor would examine him when all he did was throw a packet of trial pills his way and tell him to take them and see if they helped? But thinking about it, the doctor knows all the meds one is on and whether they'll interact or not and what is the likely cause of the complaint but not necessarily how one will react to a particular med so one has to "try" it to see. I now see it is just a faster way of getting to the bottom line where they prescribe something. Yes, last appointment I complained about numbness in my finger tips and he asked perceptive questions and made sure it was not something immediately worrisome and now we're "watching" until next time. Sometimes that is all that can be "done"?
For me, what happens at a clinic/"doc-in-a-box" ("Patient First" and other franchises like that for when your doctor is not available but it's not an ER situation) and the ER, they don't have my history so seem to take more care when they're actually just going over routine stuff. A lot of that my PCP doesn't need to do. Yes I get weight and blood pressure, but even there, I have a problem with blood pressure cuffs so I take my own at home daily for a week or two before my appointment and bring that in and that gets put in my file. It seems most of these sorts of things, an NP could do.
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What you say makes sense, I think, in a lot of cases. Maybe the majority of cases. But the thing is that a PCP acts as a gatekeeper to other care, particularly if you have an HMO. It's true that if you have some common illness that just needs an antibiotic or something an NP is up for the job. But is it possible that an NP might be more likely to mistake something more serious for the common illness because that's what they are expecting to see? (And because it's what they can handle themselves?) For example, a person who goes in with stomach issues may be told that it's acid reflux because that's most common and is what the NP can prescribe for (and also is probably what the patient expects to hear) that turns out to be something more serious that a specialist needs to see. Especially in the case of someone with an HMO, the PCP can shut (or open) doors to specialized care.
Now of course MDs can make the same type of mistakes as a gatekeeper that NPs can. I guess what I'm trying to say is that with an MD it might be less likely.
My sister saw an NP at her PCP's for a possible heart issue. The NP wrote her a prescription for heart medication and said, ok, you'll just have to take this for the rest of your life. My sister, not wanting to be on a powerful med for the rest of her life, asked for a referral to a cardiologist. The NP reluctantly gave her one. The cardiologist tells her nothing is wrong and there's no way she should have been on that med. If she hadn't pressed the issue and asked for a higher level of care, she would be popping those unnecessary pills until the day she dies.