Is this normal practice?

I debated putting this thread here or in psychotherapy and decided on here, since it is about my pdoc who I see for med management and not psychotherapy.

So, I've given myself almost a week to think about this; and I have decided that I am still uneasy about it and am now curious if this is normal practice or if anyone else's pdoc does this.

So I see my pdoc once a month for med management. Last Wednesday I went for my visit and the waiting room was packed. Normally I can find somewhere to sit where there is at least one seat between me and the person next to me (I'm more comfortable this way). However, this time I could not do that and took the only seat that was open. I thought it was weird that the waiting room had so many people in it...I'd never seen that many people in there at one time in the entire almost 2 years I have been a patient.

Then after an hour in the waiting room a lady calls me back. I found this a little odd, as she was not my pdoc. We get into an office and she introduces herself as my pdoc's nurse practitioner. Then, she tries asking me questions about my medication and symptoms and side effects and stuff. I really wasn't comfortable with her, so I answered as quickly as I could, hoping that this was just something new/preliminary before I saw my pdoc. Then she writes my prescription tells me to hold on so she could get my pdoc to sign it and leaves the room. She comes back hands me the script and says see you next month.

I was pissed. I pay out of pocket for my visits since I do not have insurance and I didn't get charged any less. If I am going to be seen by a nurse practitioner, they should at least charge less since she is not a pdoc. I drive from out of town to see my pdoc (I moved and decided I'd keep my pdoc since I was comfortable with him and didn't want to have to start all over with someone new) and I am passed off to a nurse practitioner?!? I felt like saying something before I left and I would have to the receptionist when I was making my next appointment, but my pdoc walked into the room and I chickened out complaining in front of him about it. I didn't want to seem like a bi**h with him in the room.

I'm now mad at myself. I should have said something about being uncomfortable about the situation. I made a late appointment for next time hoping that maybe the nurse practitioner is only there in the mornings (I usually see my pdoc in the afternoons). We'll see next month. Or maybe I can write a letter of my concerns. I've done that in the past and gotten a positive response from it. *shrug* It might be worth a try. If I pay full price out of pocket and drive from out of town I want to see my pdoc, not a nurse practitioner.

Is the nurse practioner a common thing, or has my pdoc lost his marbles?

Sorry for the length...I didn't realize how long it was until after I posted it.

I live in Canada and I don't think we have nurse practitioners here yet. Regarding the cost I'm not sure if it's less but you should certainly ask the receptionist. It would have been polite if the doctor himself said "would you mind if my NP takes care of this". I do know nurse prac. are allowed to renew meds and do basic routine things - since you were only there for meds this is why the nurse pract filled in. Nurse pract. help relieve the doc in areas that are routine like meds renewals etc. If you point out you're not comfy with this, I'm sure they'll accommodate you. Just say how you feel in a polite fashion

If it were me, I'd be seriously pissed off. NP's aren't as common in Canada, although we do have them. But if I were paying out of pocket to see the pdoc, I'd expect to see the pdoc. If you're comfortable with the NP and they're charging less to see her, then that's different. But it's definitly not cool to just spring it on you.

Personally I'd write a letter - but that's because I'm better at expressing myself in writing and I'm really afraid of in person confrontation.

Good luck with handling it.

--splitimage

GOOD decent practice by anyone with HALF a clue would mean introducing the concept to the patient and the intended NP FIRST. Not SURPRISE!!! This is psych med people, not walmart.

You have every right to be pissed and I would request an explanation and an apology, personally. The NP should have taken the time to talk to you. She should not have assumed it would be a-ok, that's just ignorant on her part IMO.

If you pay out of pocket to see the pdoc then SEE THE PDOC AND NOT THE PDOC-WANNA-BE. Tell them you pay to see the pdoc and that is what you insist on.

omg.. i'd be livid.

I would make a complaint because your mental health relies on things being done a certain way without interuption; anxiety isn't something you need extra of.

I don't think it's really fair to call the NP a wanna be; she has still attended university to be a Nurse and then University again to be certified as a practitioner.

The issue I believe resides with the pdoc palming you off. He was obviously busy, and as in any medical practice there could have been an emergency which held appointments back for an hour or more? The minimum expectation would be an explanation.

Having said that I do think that you should have been charged a heck of a lot less because you didn't actually take up any time and were sitting there waiting just for a script for meds.

Maybe ask him if you could see the NP for every medication related appointment and save yourself a lot of money. Hopefully they give you a free consult for your trouble

Good luck with this

I agree with you 100%.

A doctor can have a Nurse Practitioner, and many do. Not any that I choose to go to. The whole idea of the doctor's fee is that it is based on the doctor's education, expertise, and experience.

I believe you might be able to call and tell them that you want to see the pdoc each visit. I would certainly try that.

I would be very upset too. And it would have pushed my anxiety out the park too.
NP's I don't think exist in South Africa, but if my pdoc decided to do something similar to me, I'd go mad.
I'd write a letter, or maybe even try pluck up the courage to get the pdoc onto the phone and really voice my concerns.
I also think it is totally ridiculous to have to pay the same price - the pdoc now gets to go through twice the amount of patients...! I think you should definitely be paying less to see a NP.
And if the Pdoc has overcommitted himself, he needs to be honest and own up and make some serious business decision - the patients need to come first. Else I would honestly leave.

I think you have a legitimate complaint, Squirrel1983, and would write the letter.

I don't think it's usual practice for a pdoc to palm you off to a p-nurse without letting you know beforehand. It shouldn't be sprung on you as a surprise. That wasn't professional on part of the office.

That being said, I think in some parts of the USA, having a p-nurse do the medication management is not uncommon.

I think writing a letter saying that you did not expect the p-nurse and weren't told beforehand about her presence is fair enough. Although I'm not sure how much you can escalate it. Did you have anything urgent about your medication or symptoms that you needed to discuss with the pdoc, or was it more touching base about your medication and getting some scripts?

Btw, a p-nurse is not a "pdoc-wannabe".

The nurse practitioner is probably a new thing. I would call your pdoc's office and make sure you make an appointment with the pdoc, tell them specifically you don't want to see the nurse practioner (I prefer my doctor's nurse practitioners, they're female and listen better but I see my doctor still, followed a nurse practitioner from my old doctor's office to this one but then got scheduled with the doctor all this time) They have separate schedules, and if you saw her this time they will just assume everything is hunky dory and you will continue on like this. If you didn't particularly like her, might be time to find a pdoc closer to where you live?

So...update.

I wrote the letter and mailed it yesterday. They evidently got it today because I got a call from the receptionist while I was in an interview. She left a message saying that she just wanted to let me know that my next appointment would be with Dr. ______ and Dr. ________ only.

Guess the old saying is true. The squeaky wheel gets the grease.

At least my next visit is with him...at least then we can discuss the idea of the ARNP. I am totally against the idea, but maybe my pdoc will give me a good explaination next visit.

Now at least I can demand to see him next visit (since they said I would) if they try to pull the NP thing again.

In some cases, a NP or PA is actually more educated in the field than the actual doctor because they are so specialized. My father had a specialist, an excellent doctor that people traveled through several states (himself included) to see. One of that doctor's most valuable tools were his PAs and NPs. When a situation came up, he deferred to that particular sub-specialist.

My grandmother's oncologist was the same way. She had a rare form of cancer, and the PA was better informed on new techniques and new ways of using old techniques. When they would discuss a course of treatment, the PA would make his suggestions, the Dr would request the information to support this new treatment and off we'd go.

My FIL struggled to get his blood sugar under control for 20 years, his doctor referred him to a NP that specialized in diabetes and it made a world of difference.

A doctor, even a specialist has an infinate amount of things to choose from in his continuing eds, so many aspects that it would be impossible to investigate them all and still see patients. Specialized NPs and PAs are an extremely effective way of covering all of the bases.

So, for anyone who is curious, another update...

Had my appointment this past Wednesday. I went in, they said I was on Dr. xyz's schedule, but he was running behind. They then asked if I wanted to see the nurse practitioner. At least they asked this time. I said no and that I would wait for my pdoc.

After waiting 30 minutes (not too bad...it could always be worse), I'm called back. No mention of my letter at all, though I can see that it is in my file, so I know he has seen it. My appointment goes on. Then after he writes my script he says that I'll be seeing him from now on and he understands if I am not comfortable seeing the nurse practitioner. He said he understood if I didn't like change because he didn't either and that the NP was only trying to help patients not have to wait as long to be seen. So, I'm content now. I was a little nervous about my appointment beforehand after the 2 page letter I wrote, but pdoc was understanding and kind about it. All went well.

Oh ((((Squirrel)))) isn't is great when you get that validation from a professional? Ahhhh. I'm so proud of you for advocating for yourself...and that it worked out the way you needed is a real boost! Thanks for sharing.

That's great! That's as I've experienced it too. They don't know when they decide to implement the practice who isn't going to want to change (I didn't care so stayed with the NP) they assign you based on some internal need/interest and then sort it out as they see people again for the "first" time under the new practice.

High five ((Squirrel)) - good for you in handling this well.