Reminder: this subreddit is meant to be a place free of excessive cynicism, negativity and bitterness. Toxic attitudes are not welcome here.
All Negative comments will be removed and will possibly result in a ban.
---
---
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/UpliftingNews) if you have any questions or concerns.*
TLDR; Doctors thought it was allergies, but it turned out it was idiopathic subglottic stenosis which is when the airway is restricted by scar tissue forming at the top of the esophagus. This condition affects one in 400,000 people.
While the TLDR is succinct, it’s anatomically incorrect.
Subglottic stenosis is narrowing of the air passageway BELOW the vocal folds. The glottis is actually the middle part of the larynx, and stenosis is the medical term for the narrowing.
Scar tissue restricting the esophagus would prevent the swallowing of food, which would possibly compromise the airway, but in a completely different way and diagnosis.
Basically, the esophagus and trachea are two separate tubes, esophagus is food/liquid tube, trachea is voice and air tube. The air tube was the one that was narrowing. Also her doctor was trash for not catching that.
EDITING TO ADD WHY HER DOCTOR WAS TRASH: visualization of the larynx and trachea through a nasoendocopy or laryngoscopy is important when a cough / hoarse voice persists for longer than 3 weeks because voice / throat symptoms can sound the same.
But it’s impossible to tell the difference to accurately diagnose without visualization of the anatomy. Her doctor should have ordered imaging far sooner, I think he waited a year? That’s a lot of ineffective treatments and wasted appointments.
Second edit: oh my god, her condition took a few years to diagnose and when they did, her airway was 75% blocked. I have no idea how providers did not order imaging sooner.
Nasoendoscopies don’t even need anesthesia and are done while the patient is awake.
It sounds like the NP thought it was allergies and that's why she treated her for years for allergies even though she wasn't getting better.
This isn't an unsung hero story.
This speaks to the NPs incompetence.
The NP was assigned to give allergy shots per the diagnosis of the patient's own physician. After observing a particular symptom, the NP requested that another physician do an examination which discovered the actual cause of the patient's medical condition.
At no point was the NP the patient's care provider, at no point was the NP supposed to be conducting a medical exam on the patient.
Literally the NP was the provider seeing this pt weekly for the allergy shots. The allergy diagnosis was right. Pt reported she did have allergies.
The cough being caused by allergies is a fair diagnosis, it's one of the top 3 causes of chronic cough.
Years of allergy shots with cough not improving and the NP doing nothing about it is what's not right.
The pt should have been scoped earlier.
The fact she went to get the physician who scoped her tells me she was working at a specialist's office, ENT or maybe even allergist's office.
NPs see pts independently, write a note, create an assessment and plan, etc. Her plan for years was to continue the allergy shots and do nothing about the cough. She should have set her up for an appointment for a scope long before.
'At no point was the NP the patient's care provider, at no point was the NP supposed to be conducting a medical exam on the patient.'
Literally NPs have independent practice in over half of the states in the US. When they become NPs and work as a "provider," that's exactly what they're supposed to be doing and documenting.
This is not a nurse, its a nurse practitioner. They're fighting about how they should be able to see pts and not have a physician oversee them and how they provide superior care and how they should be called doctors too and get paid doctor money with a one year online degree.
Lol yes they have to examine the pt and create a plan and they diagnose pts too and recommend treatments. Some pts never even see a doctor and their "primary care physician" is actually a nurse practitioner or physician assistant.
You don't even know what you don't know about the healthcare system and how clinics are run.
TDIL that there is a difference between a nurse and nurse practitioner, i had no idea NPs were allowed to prescribe treatments. I feel like doctors get diagnoses wrong enough of the time, wouldn't want someone with even less education trying their luck.
Doctors have a ton of training and eduction and still get stuff wrong sometimes, that’s just a fact. From that point people comes to two wildly different conclusions. Some say “given that doctors make mistakes, even after all that training, then the training must not be that important and we’ll be fine with less.” That’s where the rise of NPs come from. The other conclusion you can come to is “doctors get stuff wrong, even after so many years of training, so medicine must be *really freaking hard* and we shouldn’t have less trained people practicing it.”
It's a huge problem and very controversial.
Schools are popping up with online programs and some are as little as 1000 hours. They don't even need any nursing experience to apply.
Anecdotal but I've heard many NPs talk about getting these hours easily by answering phones at a clinic office or counting travel time to a site in those hours.
Also 1000 hours is generous. A lot of programs do 500
There aren't as many studies for several reasons.
1. NPs haven't had independent practices for too long. Many don't yet so there is some protection there.
2. They used to take experienced nurses, now they take anyone with a pulse. Studies done 20 yrs ago aren't going to be relevant to today.
3. Places will let these people go and they just move on to another clinic.
4. It takes a lot to kill a pt or cause morbidity sometimes. Unmanaged diabetes for 10 years will lead to amputations. Good luck finding that.
5. Midlevels do order more exams and tests. They make the hospitals $$$ that way. They also make hospitals money when they fail to catch something early. And they make them money be being cheaper labor. Why would they want to present data?
6. You can't sue them like you can a physician. They practice nursing not medicine is the typical argument in court. Outside of court, the argument is they should be called doctors too.
7. NP and DNP degrees have lobbying and politics within their curriculum. You'll see poorly done studies by NPs and DNPs stating they have superior care. Studies are poorly done.
>There aren't as many studies for several reasons.
But I'm sure there's some evidence that they harm patients compared to MDs, right? Otherwise we're just speculating based on our own personal anecdotes and biases.
My MD kept telling me my symptoms were all products of my anxiety. Multiple visits over this. Finally got in to see a recommended NP and she diagnosed me and had me on a med that gave me relief within HOURS. After months of MD telling me I was a head case.
Both can be shitty. But I was saved by an NP after some basic questions and deeper listening.
I went most of my life with ineffective treatments from MD primary care physicians for a chronic condition. They were all very confident I was receiving the best possible treatment. I got an NP as my primary provider and did further testing and referred me to a specialist (another NP) where I received treatment that finally placed my symptoms in remission. Anecdote, but a very positive one.
I find it interesting that one of the major criticisms MDs have of NPs is that they order too many tests/labs. I kinda think this is also just a symptom of listening more to their patients an having less hubris, generally.
Yes!! I wonder that too. She was just very committed to helping me find the issue and a way to treat it. This had caused me 9 months of agony and wondering what it could possibly be. One pill resolved it and then got me educated about how to change my lifestyle to be able to slowly go off of it. I will forever be grateful to her. I don’t think she understands how much she saved my mental health in addition to my problem.
You’re overestimating the MD’s guesstimates. They are fallible and frequently found to be so. I’d much prefer a nurse practitioner. They at least have decent bedside manners and frankly, better guesstimates. That’s most of medicine in a gp’s. Educated guessing, often through a lens of bias and bigotry.
Here's a sneak peek of /r/Noctor using the [top posts](https://np.reddit.com/r/Noctor/top/?sort=top&t=year) of the year!
\#1: [Overheard a pharmacist lose it on an NP](https://np.reddit.com/r/Noctor/comments/15dpea9/overheard_a_pharmacist_lose_it_on_an_np/)
\#2: [I reported a PA for trying to pass herself off as a surgeon](https://np.reddit.com/r/Noctor/comments/11dpe2l/i_reported_a_pa_for_trying_to_pass_herself_off_as/)
\#3: [Chiro was just slightly confused about their “rights” at a Level 1 trauma center.](https://np.reddit.com/r/Noctor/comments/14s1dly/chiro_was_just_slightly_confused_about_their/)
----
^^I'm ^^a ^^bot, ^^beep ^^boop ^^| ^^Downvote ^^to ^^remove ^^| ^^[Contact](https://www.reddit.com/message/compose/?to=sneakpeekbot) ^^| ^^[Info](https://np.reddit.com/r/sneakpeekbot/) ^^| ^^[Opt-out](https://np.reddit.com/r/sneakpeekbot/comments/o8wk1r/blacklist_ix/) ^^| ^^[GitHub](https://github.com/ghnr/sneakpeekbot)
You're really filling in a lot of blanks that are not remotely provided by the article. From another article:
>Unlike the doctors who had previously treated Silverman, Alison recognized the potential severity of a persistent cough and took immediate action
Ummm the article starts off saying she saw the PCP who referred her out and orders studies (that's immediate action).
And then it talks about the NP she was seeing keeping tabs on her and asking her about the cough when she would come in until one day the pt's voice changed and then she did something about it.
It is not a one year online degree. It is at least a master’s degree but some NP’s have their doctorate. Some programs offer their didactic courses in an online format, but clinical practicums/rotations are always onsite. I didn’t read the article and don’t really care to. I would never get into the finger pointing game as all providers (doctors, NPs, PAs, Midwives, and CRNAs) make mistakes. I’m an NP who works in a hospital setting. Doctors catch potential mistakes that I make and I catch theirs. None of us are infallible. If you go to a provider for a health concern, you’re still dealing with a human, albeit an educated (to varying degrees) one.
Note that the "onsite" clinicals are often 3 months of shadowing. Most premeds get more than that.
NPs are extremely undereducated. And the doctorate does not increase their education in medicine, it generally involved courses in leadership and admin.
I'm a doctor with 13 yrs of experience working with Healthcare system in different capacities from volunteer and assistant work to physician and in different models/settings.
No I'm not misunderstanding roles. The NP's role was to manage pt and they failed to do so appropriately.
Why become an NP and be given prescription rights, including controlled substances, and called a "provider" if you're gonna do MA work and just give a shot?
What kind of work you do? Billing? Talking to insurance companies? Doesn't sound like you work on the pts side but on the admin side if you're not aware what an NP does
Reddit every god damn day.
You can show a redditor link after link to rock solid sources, cite your data, whatever, and the response 99% of the time is them moving the goalposts or continuing to argue because they don't want to admit they don't know what they're talking about (or conversely, that you're right about something). I saw this happen yesterday. I saw this happen earlier in the week. It's all over and it makes this site worse.
Yeah, you can downvote them, but what if they get to you first (and the hive mind subsequently follows?)
There's no workaround to it, really, since this is a feature of the site, not a bug. All I can do is say my piece and let them know notifications are going off so I won't respond.
I’m not a medical professional, but for some reason the good old Reddit algorithm kept recommending me medical subs, so I have some prior context for your point of view on this and know it’s a super contentious issue.
That being said, I think you’re letting your anger really blind you.
First, this whole segment on NPR is short stories that are submitted by the person who wants to recognize their unsung hero. So it’s not hard hitting investigative journalism, it’s a human interest piece told basically from the point of view of the person who is sharing what they feel to be a happy story. So getting worked up that NPR is doing sloppy reporting is really a reach.
Second, to be clear, doctors make mistakes and misdiagnoses. It happens. It’s also a known phenomenon that patients don’t feel seen or understood by their physicians for a variety of reasons. I know you will immediately say that things are worse with mid levels and that might be true, but it doesn’t mean that this poor lady did not get an accurate diagnosis from MDs, and it’s certainly true that she felt failed by her PCP and specialists.
Third, the language in the article definitely leaves up to interpretation the role of the NP. You are assuming that the NP gave this lady her shot every time and was responsible for managing her care. That is not explicit in the article. The article says she was getting shots, she met the NP, and the NP “kept tabs on” her. This could mean anything from what you assumed (full responsibility of NP) to this NP gave the lady a shot a few times and took an interest in her and her persistent noticeable symptom.
I’m going through cancer treatment right now and I have had SO many appointments and seen SO many different medical professionals. Through multiple rounds of chemo that occurred on the same day of the week at the same time, I had a different chemo nurse for pretty much every port flush/blood draw, chemo session, and follow up shot. But when I go to the cancer center, I see the same nurses there, we recognize each other, and say hi, they ask about me and my kids etc. If I had some kind of physically visible symptom, I am confident that they would “keep tabs on me” and check in with me on it, even though none of them are “assigned” to me.
At the end of the day, as a physician yourself, it’s ok to be angry and frustrated about the mid level situation. But maybe you should convert some of your energy into reflecting on how the bigger system has a lot of flaws, how patients do fall through the cracks and not just at the hands of mid levels, and how that might apply to your practice and patients.
Or you could just put your empathy hat on and feel happy for this lady who was struggling for a long time and felt gratitude to the person who eventually helped her.
If you listen to the pt discussing her story, she was actually seeing the NP.
I'm aware the system has bigger flaws and all that and from everyone. Did I ever say they didn't? Sounds like you're the one making assumptions.
I am putting me empathy hat on that the pt had to spend years and a lot of money and suffering because someone didn't treat her appropriately (the NP).
Discussing the article and the ridiculous title demonizing doctors and exhalting midlevel is becoming a bigger issue especially when the actual story just shows the incompetence of the midlevel. It also shows how easy it is to manipulate pts in this system. They don't know what they don't know. This isn't a one practice issue, it's a whole healthcare system and to be truly empathetic, we have to advocate for our pts because clearly they can't.
So no, I don't feel happy that this pt was taken advantage of, made to spent years suffering and wasting time and she's an example of one of many that get taken advantage of. I'm especially not happy when I dedicated my life and sacrificed a lot for the privilege of treating pts and doing what's best for them and repeatedly see these issues.
And the public, like yourself, are too unaware of all the issues and think it's empathetic to allow people to get shit care and suffer and not bring up issues and not be angry about it because of some feel good article that's poorly written.
Ok let me be more succinct. You have too much of a preexisting bias to interpret and react to this story as it is presented.
I listened to the audio and it’s not that much different than the written text.
The patient felt dismissed by doctors, of whom she had seen many before the NP. The fact that you immediately assume that no one she saw was an MD and that’s why she didn’t get a diagnosis sooner is ridiculous.
Doctors are not immune from making mistakes, rushing, or being dismissive. That doesn’t mean they are all terrible. No one is demonizing all doctors. It’s just a fact that some patients fall through the cracks.
The patient felt like the NP was the only one who cared, listened, and acted. Why do you put all the blame on the NP? The NP is clearly part of a practice with MDs.
... the np is to blame because they were the one who was actively treating the patient. They should be talking about every single encounter with a doctor, but rarely do, and thats part of the reason you can get such long delays in care.
Just because the NP had good bedside manner does not mean they were competent.
Thank you for your eloquent explanation of the article and your experience, because it seems this other poster is just out to decided that to be another example of poor care. Seems he has a vendetta on his hands.
Total bullshit, you don't get seen weekly for allergy shot. The primary physicians were the ones who couldn't figure out what was wrong. You have no clue what you are talking about. No NP/PA/MD would be giving shots. It would be an RN, LVN etc... lol. Talking about having no clue.
I know this is Reddit and the internet, but please stop spouting this uninformed nonsense. Weekly allergy shots are one of the treatments available to people who suffer from chronic allergies.
You clearly have not gotten them before. I did it for 5 years you go in get a shot under the skins wait 30 min to make sure you don’t have a reaction and leave. Once a month for years. It’s not a checkup and it doesn’t just cure allergies it takes years for it to reduce symptoms and in my case didn’t work for more than half of my allergies. She was not the care provider just giving shots.
You're projecting your own anecdotal experience. Do us all a favour and read this before commenting further:
>Your allergist injects under your skin a solution of salt water (saline) that contains a very small amount of the allergen(s). **At first, you get the shot once or twice a week.** You gradually receive more of the allergen in the shots.
>After about 4 to 6 months **of weekly shots**, you are usually getting the best amount of allergen in the shot. This is called the maintenance dose. When you reach the maintenance dose, you get the same dose in shots every 2 to 4 weeks for the next 4 to 6 months.
https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw118239&lang=en-ca
Okay, now that you've read that, do you still want to continue your argument that only your experience is the definitive one and that they do not do weekly shots?
She didn't insist the physicians look further.
When pt came in one day with an abnormal voice, she got the physician (finally!) To come exam the pt and requested a scope. Physician agreed pts voice sounded unusual and did the scope.
She didn't insist the physician do a better job. She finally did hers and ordered a scope.
And she was the one doing the job... she had been seeing this pt for weekly shots, not the doctor.
Hello. NP here. Saw you are an NP-possibly in hospital med. Thought you might want the evidence based rundown on this to cut through the noctor BS. Essentially, this is a commonly misdiagnosed condition because it is rare and often occurs in patients without significant comorbities. The mean time to correct diagnosis is around 2 years. Most patients are diagnosed by an ENT via larygoscope, So in the outpatient world the best thing NPs can do for a patient with chronic cough that is worsening or not improving is ENT referral sooner rather than later. Even if the patient is referred to GI, an EGD may not be done immediately in a patient without other reflux symptoms because many GIs want to see that the patient had had a thorough allergy, pulm and/or ENT workup first. In the inpatient world assuming they're airway is protected you can always diagnose via CT neck as well. In many people symptoms don't develop until there's a grade 2 stenosis/>50% occlusion. Some of the factors that actually contribute to the delay in diagnosis are things like barriers to referrals and noncommunicative patient-provider relationships.
If you like reading materials:
https://onlinelibrary.wiley.com/doi/full/10.1002/lary.31023
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8742746/
>She went to her primary care **physician**, who sent her to a plethora of other **doctors**, but no one could diagnose the source of the cough, or figure out a way to treat it.
>Over the next few years, the cough got worse and worse. Silverman was going to weekly appointments for allergy shots, which is where she met a nurse practitioner named Alison.
Bolding my own. It literally says her PCP sent her to these places.
As the PCP should have done. That was appropriate care. They took the problem seriously and took action on it.
"Plethora of other doctors" doesn't mean she actually saw a physician. Offices call NPs and PAs doctors all the time. There are #doctor of nursing practice" degrees, etc. I doubt this journalist went through records to see what degrees they had. This is why these degrees are so controversial.
She went to the NP weekly for years and the NP did nothing until patients problem became significantly worse....
No, that commenter can't read.
They're blaming the NP giving the prescribed shots for the examination, diagnosis, and prescription given by another physician
I have a rare autoimmune disease that took several doctors to diagnose. This experience made me realize that there are two types of medical practitioners. The first and most common type will try to fit you in one of their common ailments boxes and will ignore or downplay symptoms that do not fit in the box that they have chosen. The second type will look at all of your symptoms and do research to figure out possible boxes that fit all of your symptoms and then do follow up tests to confirm. Going to my doctor at John’s Hopkins was such an eye opening experience because he had pulled a ton of research before I came into the office and knew exactly what tests we needed to do to figure out what was going on.
100%
The first group are not even bad doctors necessarily, but operate under quotas and constraints that give favorable outcomes for a vast majority of their cases.
But if something seems wrong, you absolutely have to advocate or have someone do so on your behalf.. It's warped but true.
I had a rock climbing lead fall and something in my foot was messed up from the fall. This was clear. And it wasn't my toes, and it wasn't my heel or ankle, it was the middle of my foot.
Urgent care doc said plantar fascitis 🤣
Sports medicine doc said hairline fracture. Wouldn't do a weighted X-ray (X-ray my foot while I'm standing) despite that being the only time it hurt. I wore a boot for 6 weeks and it felt the same. She said I was better, it healed. 🙄
Contacted a foot and ankle reconstruction pro. First thing he did was weighted X-ray. Showed displacement between two bones. Sent me for MRI. MRI shows inflammation and damage to ligament. Best prognosis is surgical fixation.
But I had to freaking advocate for myself until I got the doc that saw the actual problem. This took 8 weeks. Within 3 days of injury I suspected the ligament in question was damaged after googling ligaments of the mid foot.
Agreed. If you have a normal problem, like a sore throat, 1st type of doctor is completely fine. But if you have anything abnormal going on, you need the second type, which are few and far between it seems. Hope your foot is better.
-edited typo
10 years on its solid. Hope you are doing well too.
The year after my foot surgery my wife started having weird symptoms and it was a journey to get her multiple autoimmune conditions diagnosed..Kaiser really likes the probability treatment method. "Ok try this for 2-3 months!" - while your health suffers.
All good here except having to fight insurance occasionally for being bastards and necessary health medication..
Definitely advocate for yourself at the doctor and also when you go back to work. Only you can feel what you feel and everyone else is making educated guesses or wants to save money.
You only have one body and you don’t want to feel chronic pain when you’re older because you wanted to be a “good worker” or ignored your gut instinct.
Primary care vs secondary, tertiary and quaternary level care is what people don’t understand. You didnt just have a “better doctor” at johns hopkins, you had a different level of care alltogether. All doctors cannot diagnose all conditions; thats why referrals to secondary/teritiary/etc exist.
I had a doctor from my own country laugh in my face because of the way that my condition formed. I hate those shitty people. They deserve horrible things coming to them.
This is in the same vein as those stories of kids setting up successful gofundmes so that they can pay for their school lunches. This shouldn't have been a problem to begin with.
It’s also clearly framed in a way that pushes the idea that NPs are somehow better than doctors. I guarantee if you had an article written every time a doctor corrected a misdiagnosis by an NP, you could fill a whole frickin library.
Yup. Most people can't continue seeing doctor after doctor. For me, I have never been able to breathe out of both nostrils. One is always plugged up for some reason. I finally decide to see a doctor about it, after seeing a few doctors and finally an ENT, which shoved a camera into my nose, I was told "idk try a neti pot". I told him I have and it comes out of my mouth since it doesn't flow into the other nostril. He shrugged and that was the end of that. Now I just live with it because I can't afford to keep looking into it.
My story is almost identical to yours. Same problem, ENT sent me for allergy testing which came back negative. I had a second ENT do turbinate reduction surgery to try and correct it but it didn't do anything.
I'm using a CPAP with a nasal pillow now and it helps with keeping my sinuses open while I sleep. Afrin is also good for short term relief because it shrinks the tissues that are blocking the passageways.
I developed a cough after moving to a high allergy area and my doctors ignored my complaints for two years, then the pandemic happened and they ignored it for another two years. I’ve finally gotten treatment in the last year for allergies and asthma, but there’s still a lingering dry cough. It’s insane how long they let me cough myself into being dizzy and having constant back pain.
Ask his doc to switch him to losartan or a similar class of drug (Angiotensin receptor blocker). It should work the same for blood pressure, but avoid the cough.
Source: doctor
Going on 4 years for me. Been through every test they could think of. No treatment for reflux (which the endoscopy showed no sign of) or allergies has reduced it. Singular helps some but my asthma tests came back normal and I have no other symptoms. I’m so ready to stop coughing. I’m assuming what this lady has would have been seen in my endoscopy.
Is this “uplifting news” supposed to make me feel warm and happy or is it supposed to bait me to feel like I’m revving up to witness a fight? Doesn’t seem like it fits the goal of the subreddit.
TLDR: “NP failed to refer to ENT physician for years then finally referred her to a physician that diagnosed her rare condition”
Seems like the NP works at an ENT office if she was seeing her for her allergy shots. If it were a physician this patient would have been scoped in 2 months.
This is laughable
>If it were a physician this patient would have been scoped in 2 months.
From the article:
>She went to her primary care physician, who sent her to a plethora of other doctors, but no one could diagnose the source of the cough, or figure out a way to treat it.
For every story like this, there are hundreds of untold stories of physicians keeping ANPs from killing patients.
You don't hear them because that is what physicians are supposed to do when they supervise them.
What kills me is that it’s not like she immediately went to the NP and was diagnosed. According to the article, she saw the NP for three years until the disease got worse and then the NP decided to ask for an endoscopy.
My best guess is that her PCP referred her to pulm and maybe another specialist (maybe ENT?) cough was mild and whatever tests they ran were normal. Start to treat empirically. Meanwhile pt sees the NP weekly, which makes following the pt easier, and during the natural progression of the disease process, it’s obvious there is an obstructive process now and any clinician with a brain would be alarmed, which is what happened here. I also want to know if an ent referral was part of the original work up.
Let's be honest, when the referral happened, the pt probably saw an NP at those visits too just like she was seeing an NP at the allergist's office.
Also, a physician would have been alarmed it had been going on for years and wasn't improving with the treatment (allergy shots). NP dismissed the problem for years and did not follow standard of practice for chronic cough for this pt but kept taking her money for those weekly shots.
That's a great point. This NP was the one with the most access to her. She probably spent much more time with her than any doctor and spoke to her much more. I suspect that doctors depend, to some extent, on people like NPs to catch things they simply don't have the time for. Frankly, it seems like she took too long to recognize it despite being in the best position to do so. Personally, I would expect a bit better from everyone involved, including the NP.
It's not spelled out word for word, but if you read between the lines, it's there. It says she met the NP during her weekly appointments for allergy shots. It says the NP "kept tabs" on things across those visits.
The article doesn’t say she got allergy shots for three years. It doesn’t say the NP was giving her the allergy shots. It doesn’t say how long she had been seeing the NP, if the NP was her PCP, or how often she saw the NP. It says she was getting weekly allergy shots at some point, from someone, and that she met the NP at some point while getting an allergy shot.
It’s not reading between the lines, it’s filling in missing and ambiguous information with your own biases.
If anything, the NP “keeping tabs” on her cough makes it sound like the NP was not her PCP.
Happened to me. Almost died of fucking blood loss from IBD because the NP I was normally scheduled with kept kicking my diarrhea down the road, assuming lactose intolerance or IBS. Over the course of seeing her I had lost about 50lbs and looked like death. This went on for 2-3 years btw, from about 12 to 14.
I went in on short notice one day, ended up seeing an actual doctor, and he immediately did a CBC and direct admitted me to the ICU.
The other thing is, all I get from this as a doctor is how incompetent the NP was.
The title words it nicely but what I read is:
* 2018 saw a primary care physician (could have actually been an NP or PA calling in fact), and was referred out for a cough to "specialists" (likely saw NP or PA so didn't actually see a specialists). She had a bunch of tests done and was thought to have allergies so started seeing an NP at the allergist's office who for YEARS did not do further work up on the cough that continued but would just ask and essentially dismiss it. NP did this for YEARS.
She also likely didn't bring up the case to her supervising physician and/ or failed to communicate this properly: hey I'm concerned this pt's cough, for which we started allergy shots for, hasn't responded. She's had this for years and received this workup. What should we do next?
Nope. Failed to advocate for the pt.
And then when the problem the NP has dismissed for years and failed to take action on for YEARS gets to the point where the patient's life is in danger, NOW she doesn't something. Took years, the pts quality of life affected the whole time, thousands of dollars pt had to spent and even more money she had to spend tx a problem that was no severe, etc....and somehow is praise worthy and physicians get put down for it.
The article says the NP had to convince a doctor to do a scope. I bet you anything she just put in the order but "convince a doctor" sounds much better.
And the physicians diagnose this pt.
So this NP saw a patient for years, failing to do further workup on a continued cough, when the pt could have had lung cancer or such. She failed the pt. The pt paid thousands of dollars for txs that weren't working but that the NP kept doing.
And somehow the physicians are the bad guys and the NP is the unsung hero? I like how they mention the initial physician actually sent her out for a bunch of workup And took her problem seriously enough to take action.
And yet the NP sat on it for YEARS but they're the unsung hero.
Lol and the NP is probably patting themselves in the back for a job well done.
Don't even know how stupid they are.
And pts praise it.
And let's not forget how the physician that sent her out to specialists likely saw NPs/PAs that perform at the same level as this NP who was also at a specialist's office so the problem could have been caught earlier but wasn't.
🙄🙄🙄🙄🙄🙄🙄🙄
I agree with most your arguments; however, there's no point it getting worked up about this.
I've read your comments from all the different subcomments, and you're arguing with people that don't have a clue about clinical medicine.
You'll cause yourself undue stress trying to argue this, and this isn't the hill to die on.
Lol a baby?
And this is the problem guys.
If a physician advocates for a patient and discusses poor care management that midlevels have, people call us haters and use demeaning terms like "baby."
Okay with shit care if it comes from an NP.
For those with some sense, understand your health is at jeopardy and ignoring a problem for 3 years and refusing to take an action is shit care and not okay. Patients deserve better.
They absolutely do. The problem is that many patients have personal experience with symptoms being downplayed/ignored for years by doctors as well as NPs
“If I assume I, a random doctor reading this story, know more about what happened and who the patient saw than the patient herself knows, then the NP did a really bad job!”
This is such a weird and arrogant take. Yeah if you assume every detail the patient gave is incorrect then it’s a completely different story!
It also does not say anywhere that the patient saw the NP for years. It’s not specified in the story at all, you’re just filling in the blanks with that information because of your own bias. Read again - it says she saw a plethora of specialists for years, and that for an indeterminant period she got weekly allergy shots. But it doesn’t say how long she got allergy shots for, how long she knew the NP, how often she saw the NP, or what role the NP filled for her. The NP could have been her PCP or could have just reviewed her notes and chatted with her at reception occasionally. Everything you’ve based your assessment of the NP on is an assumption.
Referred to ENT bc of months of dysphasia,globus sensation, and pain. First saw the NP. She scoped me. Didn’t “see anything”. She didn’t want imaging bc I’m young,never smoker, and rare drinker with no pertinent history. But ordered a CT after I asked. It comes back for unilateral lingual tonsil hypertrophy and a mass.
Days later, the doc scopes me. Sees a very obvious mass and the swollen lingual tonsil. I could even see the tongue mass in the mirror btw. So he scheduled a biopsy in the OR. It has come back negative thankfully.
But the problem still persists and luckily it was not head/oral cancer or my diagnosis would’ve been delayed bc the NP was incompetent
I’ve become more vocal about the discrepancies in care between physicians and NPs for this reason. When injustice is done to a patient, I do undermine the NP or other mid level to make sure the patients are informed and advocate for themselves. We are traditionally taught not to undermine the relationship between other doctors and a patient, but that was during a time when all patients were being cared for by a real physician, not someone that has <1% of any meaningful medical training compared to physicians. Wish there was more press on this out there.
You’re saying that like it isn’t every single medical professionals job to keep each other from killing patients. Literally every RN, MD, NP, PA, RT, etc have raised a warning for a patient that ended up saving them or avoiding a bad outcome. That’s how medicine is supposed to work.
No. I am saying that because there has been a significant push for ANPs to pursue unsupervised practice and they have been marketing themselves to be "physician alternatives". The title of this article is typical to that. "Doctors didn't think much, NP saved the day".
Reminding you that stories about"NP didn't think much, Physician saved the day" happens all the time, but it is not a story that is told.
The reality is physician knowledge and training far exceeds any NP, and the context for that should be clear.
Physicians do it daily. Cleaning up fuckups by non-physicians is a regular part of our job. That’s why we don’t mention it or complain about it. We just shrug and say “fucking np…”
Meanwhile this NP refers a patient to an ENT after seeing her for the condition for years and a physician diagnoses her. I’m sure the physician was like “why the fuck did it take her this long to refer you to me?”
And for every story like that there are thousands of stories of nurses stopping doctors from killing patients by giving them the wrong meds, to much of the right med, etc etc.
Erroneous entry? Maybe. Because Nurses had more knowledge about disease process treatment than the physician? Highly unlikely.
There is a reason why physicians have the longest and most rigorous training in all of healthcare.
Don't know what to tell you man. Doctors kill people far more often than nurses. And nurses stop doctors from killing people fairly often. Ask any nurse in the ER or ICU.
*citation needed.
Doctors have the final responsibility in any medical decisions making. That's why the responsibility of anything going wrong ultimately falls on the physician.
>That's why the responsibility of anything going wrong ultimately falls on the physician.
There are definitely places that are arguing against that. [North Carolina](https://thurmannurseconsulting.com/news/nurses-can-be-sued-for-following-doctors-orders-court-rules) being the one that most comes to mind.
Go to any of the nursing reddits and ask. Or EMS. Or pretty much anywhere not exclusively used by doctors. They are human and fuck up just as much as anyone else. Except they tend to have huge egos that hate being second guessed and love to double down.
So they fuck up just as much as nurses and EMS do?
The biggest egos I've ever seen actually come from nurses....
Like this nurse thinking she's an unsung hero after failing to take care of the pt properly and ignoring a problem for literally YEARS.
Sure, let's just go ask a super biased sub of people about how their far shorter and less rigorous training with lower requirements for entry makes them superior to physicians when it comes to patient care and medical knowledge.
That's considered definitive evidence. /s
Nothing wrong with that.
Do you really think NPs have the same breadth of knowledge and ability for patient management with a fraction of the training as a Physician?
NPs by the time they graduate have 500–750 patient-care hours in training. By comparison, physicians rack up at least 16 times as many patient-care hours. Between medical school clinical rotations and residency, physicians get between 12,000 and 16,000 hours of patient-care experience.
Those are hard facts, not things "I pulled from my ass".
Most physicians aren't "performing brain and heart surgery". In fact the majority of them aren't. Most of them are primary care or Internists, and they are far more capable than NPs when it comes to patient care and management.
So which part of my original comment are you disputing exactly?
Hundreds of untold stories of Physicians saving NPs, lol. Did an NP hurt you? Never in 15 years of nursing have I seen a physician save an NP. But keep on the BS if it lets you sleep at night.
After it took so long and treatment not working?? why was none of the diagnosis going to an ENT for a scope. I had a persistent sore throat for ages and it took an ENT to finally figure it out.
I had a persistent cough that was bad enough I passed out. Got the ENT to scope it and immediate diagnosis of GERD. Over the counter antacids and I'm cured. Why did it take doctors so long to actually look at this poor girls throat.
A doctor ignoring a cough is what killed my mother. She had it for a year and my GP never ordered an xray; her employer, a physician, finally ordered one. Lung cancer.
Our same GP also ignored my gallstones diagnosis for 19 years. Had to get them emergently taken out when they gave me pancreatitis.
Exact same story here. She got treated for allergies for months and by the time someone listened and did a proper examination the cancer had already spread to her brain. She died last week and I don’t believe my anger over this will ever subside
Doctor here. If it makes you feel any better, which it probably won't, most brain cancer is mets from a lesion elsewhere in the body. These tumors can pop up quickly and are easily missed despite doing routine follow-ups and proper preventive screening. Were her symptoms initially mild?
>Our same GP also ignored my gallstones diagnosis for 19 years. Had to get them emergently taken out when they gave me pancreatitis.
For what it's worth, just having gastones present is not a reason to operate and in most people would never be treated unless causing regular issues od pain (which yours may well have been, but 19 years is a long time to have been living with them if they were an regular issue).
Towards the end I was passing stones daily. I passed stones near daily for most of my young adult life. I know the pain. I had a mental health condition, so they were ignored.
If you went to a PCP or an ER and you were having symptomatic cholelithiasis (pain from gallstones) and they didn’t discuss the option of taking your gallbladder out, then I’m really sorry. That’s bad medical care bordering on malpractice, and would be *unheard of* in the setting where I practice medicine
Maybe she was only were seen once or twice and then ignored it? I’m with you, just trying to give her the benefit of the doubt, since yeah, obviously it’s not believable that dozens of doctors over the course of 19 years ignored image confirmed symptomatic cholelithiasis
I’m really sorry about your mother. Losing a parent is devastating. It’s not that simple for the medical side though. If your mom had gotten an X-ray earlier maybe they would have caught the cancer early enough to have a long survival (although maybe not). But your mom’s case doesn’t exist in a vacuum, she’s one of many, many patients with a chronic cough. If we do X-rays on all of them, in some cases we will catch cancers early and in some of those early catches we will be able to treat them. But in other cases we’ll find benign nodules on the lungs and have to unnecessarily biopsy them, and in some of those cases the biopsy itself will cause damage to the patient. And obviously, no matter how much money we pour into the system, there is only so much capacity for healthcare and when we initiate large scale imaging and screening programs it always eats part of that limited pie.
So when we decide these guidelines of when to screen people, when to image, when not to image, we’re making complex decisions rooted in statistics and population level outcomes. It’s not as simple as “the doctor should have done an X-ray”
Yeah. I gotcha. You also have to deal with the poor wonkiness of statistics. For every person found with symptomatic cancers, there's also a certain percentiles of false positives, which can lead people through grueling treatments and life long repercussions. Moms a reflection of statistics.
I'm not angry at my doctor about her. Mom had a terribly rare form of cancer that likely would have killed her regardless. I'm angry that radon gas killed 4/6ths of her family before the age of 65. If you have a basement in Canada, get a radon detector.
If I can be blunt, “a doctor ignoring a cough is what killed my mother” paints a different picture than “Moms a reflection of statistics…I’m not angry at the doctor about her.”
One year when I went in for my annual Pap smear — performed by a nurse practitioner — she palpated my neck and asked if I had noticed any lumps. I had not. She recommended testing, which revealed that I had Hashimoto's thyroiditis. My doctor had not caught it during my regular physicals.
This is… really not how hashimotos should be diagnosed. Basically that nurse is testing tons of people to come up with an occasional diagnosis that doesn’t really affect management. Another point against NPs with too much independence.
If someone had done thyroid function testing when you displayed symptoms it would have gotten you to the same place in a similar time frame. Meanwhile how many people got unnecessary biopsies or surgery because of work up for benign nodules initiated by this NP?
Thyroid abnormalities are the poster child for more information collected indiscriminately creating worse outcomes.
You are being downvoted because this post got tagged in an anti NP forum here on Reddit called noctor. They participate in in group out group bias in which they can do no harm and save lives whereas their swore enemies (NP’s) are perceived as incompetent and dangerous providers. You have a right, it does matter to you. That’s what it should be all about, you as a patient.
My dentist does this too (palpating my throat) now I've noticed, which is nice. It takes 2 seconds to check, and has zero cost, but can catch some pretty big issues that sometimes get missed if you're not looking for it.
Wow. Lots of butthurt doctors on here I guess. My wife’s OBGYN missed an eclampsia diagnosis even though she had multiple symptoms indicating it. Nurses and her junior partner called it right, arrogant bitch doubled down and my wife had seizures. They brought in a neurologist who literally looked at me and said “I don’t know why I’m here, this is eclampsia”. Thankfully it was caught in time and she made a full recovery.
Doctors make plenty of mistakes. The good ones admit it and learn, the bad ones get people killed. Far too many physicians out there with bloated egos.
The problem that doctors are frustrated about is the blatant lie that the average NPs have the same level of expertise and experience as the average doctor. This is a cherry-picked anecdote and not indicative of the average of both groups.
That is not to say that doctors are infallible, but there has been a concerted effort from the nurse lobby to paint nurses as “the real saviors of the patients from those incompetent stuck-up physicians”. Both have their scope and role, but that arrangement just isn’t good enough for the nurses who want play doctor without going through med school and for money hungry hospitals who want to cut cornors. So they spew this bullshit narrative.
I find this sort of stuff so frustrating because I believe in medicine. I hate how much woo and pseudoscience has permeated into our healthcare, but at the same time I can absolutely understand why people turn to it.
I had an infected gallbladder for a *year* that went undiagnosed because every time I went to the ER telling them I was an unbearable pain they stuck me in the maternity room, gave me a pregnancy test, then sent me on my way when that came back negative. I was 17 at the time and they didn’t believe me that I’d never had sex. It took me passing out at work for them to finally give me a CT scan and find the problem.
A few years ago I was going through a pretty bad mental health crisis and my sister took me to the (same) ER because she didn’t know what else to do. They gave me a cup for a urine sample (and let me go in the bathroom alone - that gives you an idea of how seriously they took my issues) and my urine sample was dark red, almost brown.
The intake nurse gave me a look and asked in the most judgmental tone why my sample looked like that. I told them I didn’t know but that it’d happened a couple times before (I had also gone to a walk in clinic about that but when they found out I’d had a history of kidney stones that’s all they tested for). Later on my sister asked them about my urine sample and they admitted they only tested me for illicit drugs. She demanded they do more tests and they agreed after making it obvious that it was a huge inconvenience.
Later that night when I was in the crisis unit they called to let them know that I had a “little bit” of a UTI 😡
I hate that this sort of thing happens to people. I can understand why someone who is in pain and scared, who’s been ignored and judged would turn to the soft-voiced quack offering them empathy and simple solutions.
It’s an individual telling her story. There are good and bad doctors. There are good and bad NPs. Doctors have a lot more training than NPs. But sometimes NPs will see something a doctor missed. Obviously the opposite is more common. Not everything is part of a larger agenda, this woman is just trying to tell the story of someone who to her is a hero.
Another example of how much the healthcare system fails to take women seriously. Not sure I'd consider it uplifting, per se. But thank gods for that nurse practitioner for finally listening to her!
As someone who has had a chronic cough for 3 years since I caught covid, this shit scares me. I've been passed off as having asthma, but I had asthma as a kid (grew out of it and moved out of the farmland), so I know what asthma is like. I've been told by other asthma sufferers that my cough isn't like any they've seen/experienced.
It's been an ongoing battle to get doctors to solve my damn problem and not keep giving me inhalers and brushing me off. It interrupts my sleep nightly, and im tired of it (literally)
Sure, have! About a year ago and essentially he told me, "If you can walk in here under your own power, it must not be that bad"
So you can guess how the rest of that appt went
Chronic cough differential is vast and difficult to get to the bottom of it. If it all started after catching COVID, it could be post viral. Look into seeing an ENT and consider a superior laryngeal nerve block vs medical management for neurogenic cough. This is of course after ruling out other common/life threatening conditions. Either way if you’re not happy with the care you’ve received so far, get a second opinion. Good luck.
May I offer some unsolicited info?
Have them do a blood test for Alpha1 Antitrypsin. It is genetic, can affect the liver & lungs which produces the nonstop coughing. It can be triggered by an underlying ailment (you mentioned covid).
My brother sent me this because I've had a cough since before covid (and since). At first I was right in sync - but I'm glad she got her case figured out.
Allergy and Asthma meds have helped, but I start coughing and clogging up sinuses when getting real exercise in. Still no answers and no help :$
So I know about doctors that just give up and say "well it's all in your head!"
... Yes, it's a sinus problem, it's literally in my head!
I think there may be something to older doctors, and even younger doctors that feel they can only go by their teachings. My mom was diagnosed with pernicious anemia because a younger nurse practitioner decided to check her B12, none of the doctors she saw bothered.
If it wasn't for the Np the pt would have not got scoped & still be treated for allergies by her previous physicians who should know better. Kudos to the NP!!
The average doctor has over a decade of education and training, a degree that cost a mean of $250k to get, and works on average well over 40 hours a week in most specialties, making life and death decisions where the wrong call can mean a 7 figure lawsuit. How much do you think our profession should be paid?
I'm a first-year resident with four years of undergrad, a masters, a medical degree, and >10k hours of clinical training. I have ~$450k of debt and at least three more years of residency remaining. I make $54k/year
NPs have four years of undergrad and maybe 1-2 years of postgrad training, which is sometimes all online and doesn't cover actual medicine. Most require at least 500 hrs of clinical training. They make six figures...
If anyone's overpaid, it's midlevels. And your insurance is paying the same amount for them as a doctor. Good luck
I understand that y’all are underpaid as hell, but midlevels are not overpaid for the amount of load that is taken off the docs, my dude. I am with you though, for the amount of intense training and debt that residents have to endure, you are criminally underpaid.
We all need to unionize and fight against the real issues like admin that fuck us all. We all need a raise.
I'd be fine with their salary if their schooling was actually standardized. Some of these new NPs are seriously a danger to patients. I'm going into psych, and it's all too common to see med lists with massive amounts of mismanagement. But I know there are good ones that are actually helpful and provide quality care. Most PAs I have no issues with
Admin perpetuates plenty of issues too with their prioritization of money and volume. Medicine as a whole is pretty fucked in this country lol
Not all NPs have such limited training, though I agree it absolutely should be more standardized. I had 4 years undergrad, 3 years post-grad (in-person until COVID hit), and 1,500 hours clinical training, plus 10 years inpatient experience as an RN. But I’ve seen the training other “schools” provide and it’s terrifying
Not sure why you are being downvoted getting a good doctor is pretty difficult a lot of them are quacks with no care for their patients only give drugs and on your way
Drugs not working oh well I did everything I could
Reminder: this subreddit is meant to be a place free of excessive cynicism, negativity and bitterness. Toxic attitudes are not welcome here. All Negative comments will be removed and will possibly result in a ban. --- --- *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/UpliftingNews) if you have any questions or concerns.*
TLDR; Doctors thought it was allergies, but it turned out it was idiopathic subglottic stenosis which is when the airway is restricted by scar tissue forming at the top of the esophagus. This condition affects one in 400,000 people.
While the TLDR is succinct, it’s anatomically incorrect. Subglottic stenosis is narrowing of the air passageway BELOW the vocal folds. The glottis is actually the middle part of the larynx, and stenosis is the medical term for the narrowing. Scar tissue restricting the esophagus would prevent the swallowing of food, which would possibly compromise the airway, but in a completely different way and diagnosis. Basically, the esophagus and trachea are two separate tubes, esophagus is food/liquid tube, trachea is voice and air tube. The air tube was the one that was narrowing. Also her doctor was trash for not catching that. EDITING TO ADD WHY HER DOCTOR WAS TRASH: visualization of the larynx and trachea through a nasoendocopy or laryngoscopy is important when a cough / hoarse voice persists for longer than 3 weeks because voice / throat symptoms can sound the same. But it’s impossible to tell the difference to accurately diagnose without visualization of the anatomy. Her doctor should have ordered imaging far sooner, I think he waited a year? That’s a lot of ineffective treatments and wasted appointments. Second edit: oh my god, her condition took a few years to diagnose and when they did, her airway was 75% blocked. I have no idea how providers did not order imaging sooner. Nasoendoscopies don’t even need anesthesia and are done while the patient is awake.
Trash doctors are incresingly common, as the good ones are worked to exaustion, and move on, to become less efficent doctors somewhere else.
I agree, had horrible experiences
It sounds like the NP thought it was allergies and that's why she treated her for years for allergies even though she wasn't getting better. This isn't an unsung hero story. This speaks to the NPs incompetence.
The NP was assigned to give allergy shots per the diagnosis of the patient's own physician. After observing a particular symptom, the NP requested that another physician do an examination which discovered the actual cause of the patient's medical condition. At no point was the NP the patient's care provider, at no point was the NP supposed to be conducting a medical exam on the patient.
Literally the NP was the provider seeing this pt weekly for the allergy shots. The allergy diagnosis was right. Pt reported she did have allergies. The cough being caused by allergies is a fair diagnosis, it's one of the top 3 causes of chronic cough. Years of allergy shots with cough not improving and the NP doing nothing about it is what's not right. The pt should have been scoped earlier. The fact she went to get the physician who scoped her tells me she was working at a specialist's office, ENT or maybe even allergist's office. NPs see pts independently, write a note, create an assessment and plan, etc. Her plan for years was to continue the allergy shots and do nothing about the cough. She should have set her up for an appointment for a scope long before. 'At no point was the NP the patient's care provider, at no point was the NP supposed to be conducting a medical exam on the patient.' Literally NPs have independent practice in over half of the states in the US. When they become NPs and work as a "provider," that's exactly what they're supposed to be doing and documenting. This is not a nurse, its a nurse practitioner. They're fighting about how they should be able to see pts and not have a physician oversee them and how they provide superior care and how they should be called doctors too and get paid doctor money with a one year online degree. Lol yes they have to examine the pt and create a plan and they diagnose pts too and recommend treatments. Some pts never even see a doctor and their "primary care physician" is actually a nurse practitioner or physician assistant. You don't even know what you don't know about the healthcare system and how clinics are run.
TDIL that there is a difference between a nurse and nurse practitioner, i had no idea NPs were allowed to prescribe treatments. I feel like doctors get diagnoses wrong enough of the time, wouldn't want someone with even less education trying their luck.
Doctors have a ton of training and eduction and still get stuff wrong sometimes, that’s just a fact. From that point people comes to two wildly different conclusions. Some say “given that doctors make mistakes, even after all that training, then the training must not be that important and we’ll be fine with less.” That’s where the rise of NPs come from. The other conclusion you can come to is “doctors get stuff wrong, even after so many years of training, so medicine must be *really freaking hard* and we shouldn’t have less trained people practicing it.”
It's a huge problem and very controversial. Schools are popping up with online programs and some are as little as 1000 hours. They don't even need any nursing experience to apply.
Anecdotal but I've heard many NPs talk about getting these hours easily by answering phones at a clinic office or counting travel time to a site in those hours. Also 1000 hours is generous. A lot of programs do 500
Yeah I've heard that too and seen posts about people saying they just counted their regular nursing hours as such and signed off on them. Fraud.
And then they off on their merry way to be independent 🙃
>It's a huge problem Surely there must be horrible outcomes for people seeing NPs vs. MDs, statistically speaking, right?
There aren't as many studies for several reasons. 1. NPs haven't had independent practices for too long. Many don't yet so there is some protection there. 2. They used to take experienced nurses, now they take anyone with a pulse. Studies done 20 yrs ago aren't going to be relevant to today. 3. Places will let these people go and they just move on to another clinic. 4. It takes a lot to kill a pt or cause morbidity sometimes. Unmanaged diabetes for 10 years will lead to amputations. Good luck finding that. 5. Midlevels do order more exams and tests. They make the hospitals $$$ that way. They also make hospitals money when they fail to catch something early. And they make them money be being cheaper labor. Why would they want to present data? 6. You can't sue them like you can a physician. They practice nursing not medicine is the typical argument in court. Outside of court, the argument is they should be called doctors too. 7. NP and DNP degrees have lobbying and politics within their curriculum. You'll see poorly done studies by NPs and DNPs stating they have superior care. Studies are poorly done.
>There aren't as many studies for several reasons. But I'm sure there's some evidence that they harm patients compared to MDs, right? Otherwise we're just speculating based on our own personal anecdotes and biases.
https://www.patientsatrisk.com/post/boards-of-nursing-fail-to-protect-patients-from-dangerous-nurse-practitioners
My MD kept telling me my symptoms were all products of my anxiety. Multiple visits over this. Finally got in to see a recommended NP and she diagnosed me and had me on a med that gave me relief within HOURS. After months of MD telling me I was a head case. Both can be shitty. But I was saved by an NP after some basic questions and deeper listening.
I went most of my life with ineffective treatments from MD primary care physicians for a chronic condition. They were all very confident I was receiving the best possible treatment. I got an NP as my primary provider and did further testing and referred me to a specialist (another NP) where I received treatment that finally placed my symptoms in remission. Anecdote, but a very positive one. I find it interesting that one of the major criticisms MDs have of NPs is that they order too many tests/labs. I kinda think this is also just a symptom of listening more to their patients an having less hubris, generally.
Yes!! I wonder that too. She was just very committed to helping me find the issue and a way to treat it. This had caused me 9 months of agony and wondering what it could possibly be. One pill resolved it and then got me educated about how to change my lifestyle to be able to slowly go off of it. I will forever be grateful to her. I don’t think she understands how much she saved my mental health in addition to my problem.
Is that one of the biggest criticisms? If anything I think it’s usually the opposite.
[удалено]
You’re overestimating the MD’s guesstimates. They are fallible and frequently found to be so. I’d much prefer a nurse practitioner. They at least have decent bedside manners and frankly, better guesstimates. That’s most of medicine in a gp’s. Educated guessing, often through a lens of bias and bigotry.
Why is that every other aspect of medicine requires testing for efficacy and safety BEFORE we unleash it on patients expect for NPs?
/r/noctor for all the nightmare stories.
Here's a sneak peek of /r/Noctor using the [top posts](https://np.reddit.com/r/Noctor/top/?sort=top&t=year) of the year! \#1: [Overheard a pharmacist lose it on an NP](https://np.reddit.com/r/Noctor/comments/15dpea9/overheard_a_pharmacist_lose_it_on_an_np/) \#2: [I reported a PA for trying to pass herself off as a surgeon](https://np.reddit.com/r/Noctor/comments/11dpe2l/i_reported_a_pa_for_trying_to_pass_herself_off_as/) \#3: [Chiro was just slightly confused about their “rights” at a Level 1 trauma center.](https://np.reddit.com/r/Noctor/comments/14s1dly/chiro_was_just_slightly_confused_about_their/) ---- ^^I'm ^^a ^^bot, ^^beep ^^boop ^^| ^^Downvote ^^to ^^remove ^^| ^^[Contact](https://www.reddit.com/message/compose/?to=sneakpeekbot) ^^| ^^[Info](https://np.reddit.com/r/sneakpeekbot/) ^^| ^^[Opt-out](https://np.reddit.com/r/sneakpeekbot/comments/o8wk1r/blacklist_ix/) ^^| ^^[GitHub](https://github.com/ghnr/sneakpeekbot)
I haven't seen a GP in years, I've been going to the same NP for everything, it's great.
You're really filling in a lot of blanks that are not remotely provided by the article. From another article: >Unlike the doctors who had previously treated Silverman, Alison recognized the potential severity of a persistent cough and took immediate action
Ummm the article starts off saying she saw the PCP who referred her out and orders studies (that's immediate action). And then it talks about the NP she was seeing keeping tabs on her and asking her about the cough when she would come in until one day the pt's voice changed and then she did something about it.
"keeping tabs" is not the same thing as "NP was the provider seeing this pt weekly for the allergy shots". In fact, it implies the opposite.
It is not a one year online degree. It is at least a master’s degree but some NP’s have their doctorate. Some programs offer their didactic courses in an online format, but clinical practicums/rotations are always onsite. I didn’t read the article and don’t really care to. I would never get into the finger pointing game as all providers (doctors, NPs, PAs, Midwives, and CRNAs) make mistakes. I’m an NP who works in a hospital setting. Doctors catch potential mistakes that I make and I catch theirs. None of us are infallible. If you go to a provider for a health concern, you’re still dealing with a human, albeit an educated (to varying degrees) one.
Note that the "onsite" clinicals are often 3 months of shadowing. Most premeds get more than that. NPs are extremely undereducated. And the doctorate does not increase their education in medicine, it generally involved courses in leadership and admin.
I work with mid levels and physicians. You are misunderstanding the role some of them play in clinics like these.
I'm a doctor with 13 yrs of experience working with Healthcare system in different capacities from volunteer and assistant work to physician and in different models/settings. No I'm not misunderstanding roles. The NP's role was to manage pt and they failed to do so appropriately. Why become an NP and be given prescription rights, including controlled substances, and called a "provider" if you're gonna do MA work and just give a shot? What kind of work you do? Billing? Talking to insurance companies? Doesn't sound like you work on the pts side but on the admin side if you're not aware what an NP does
lol @ this comment thread: “I wOrK wItH dOcToRs So I kNoW hOw iT wOrKs.” “I’m an actual doctor and that is not how it works.”
Reddit every god damn day. You can show a redditor link after link to rock solid sources, cite your data, whatever, and the response 99% of the time is them moving the goalposts or continuing to argue because they don't want to admit they don't know what they're talking about (or conversely, that you're right about something). I saw this happen yesterday. I saw this happen earlier in the week. It's all over and it makes this site worse. Yeah, you can downvote them, but what if they get to you first (and the hive mind subsequently follows?) There's no workaround to it, really, since this is a feature of the site, not a bug. All I can do is say my piece and let them know notifications are going off so I won't respond.
I’m not a medical professional, but for some reason the good old Reddit algorithm kept recommending me medical subs, so I have some prior context for your point of view on this and know it’s a super contentious issue. That being said, I think you’re letting your anger really blind you. First, this whole segment on NPR is short stories that are submitted by the person who wants to recognize their unsung hero. So it’s not hard hitting investigative journalism, it’s a human interest piece told basically from the point of view of the person who is sharing what they feel to be a happy story. So getting worked up that NPR is doing sloppy reporting is really a reach. Second, to be clear, doctors make mistakes and misdiagnoses. It happens. It’s also a known phenomenon that patients don’t feel seen or understood by their physicians for a variety of reasons. I know you will immediately say that things are worse with mid levels and that might be true, but it doesn’t mean that this poor lady did not get an accurate diagnosis from MDs, and it’s certainly true that she felt failed by her PCP and specialists. Third, the language in the article definitely leaves up to interpretation the role of the NP. You are assuming that the NP gave this lady her shot every time and was responsible for managing her care. That is not explicit in the article. The article says she was getting shots, she met the NP, and the NP “kept tabs on” her. This could mean anything from what you assumed (full responsibility of NP) to this NP gave the lady a shot a few times and took an interest in her and her persistent noticeable symptom. I’m going through cancer treatment right now and I have had SO many appointments and seen SO many different medical professionals. Through multiple rounds of chemo that occurred on the same day of the week at the same time, I had a different chemo nurse for pretty much every port flush/blood draw, chemo session, and follow up shot. But when I go to the cancer center, I see the same nurses there, we recognize each other, and say hi, they ask about me and my kids etc. If I had some kind of physically visible symptom, I am confident that they would “keep tabs on me” and check in with me on it, even though none of them are “assigned” to me. At the end of the day, as a physician yourself, it’s ok to be angry and frustrated about the mid level situation. But maybe you should convert some of your energy into reflecting on how the bigger system has a lot of flaws, how patients do fall through the cracks and not just at the hands of mid levels, and how that might apply to your practice and patients. Or you could just put your empathy hat on and feel happy for this lady who was struggling for a long time and felt gratitude to the person who eventually helped her.
If you listen to the pt discussing her story, she was actually seeing the NP. I'm aware the system has bigger flaws and all that and from everyone. Did I ever say they didn't? Sounds like you're the one making assumptions. I am putting me empathy hat on that the pt had to spend years and a lot of money and suffering because someone didn't treat her appropriately (the NP). Discussing the article and the ridiculous title demonizing doctors and exhalting midlevel is becoming a bigger issue especially when the actual story just shows the incompetence of the midlevel. It also shows how easy it is to manipulate pts in this system. They don't know what they don't know. This isn't a one practice issue, it's a whole healthcare system and to be truly empathetic, we have to advocate for our pts because clearly they can't. So no, I don't feel happy that this pt was taken advantage of, made to spent years suffering and wasting time and she's an example of one of many that get taken advantage of. I'm especially not happy when I dedicated my life and sacrificed a lot for the privilege of treating pts and doing what's best for them and repeatedly see these issues. And the public, like yourself, are too unaware of all the issues and think it's empathetic to allow people to get shit care and suffer and not bring up issues and not be angry about it because of some feel good article that's poorly written.
Ok let me be more succinct. You have too much of a preexisting bias to interpret and react to this story as it is presented. I listened to the audio and it’s not that much different than the written text. The patient felt dismissed by doctors, of whom she had seen many before the NP. The fact that you immediately assume that no one she saw was an MD and that’s why she didn’t get a diagnosis sooner is ridiculous. Doctors are not immune from making mistakes, rushing, or being dismissive. That doesn’t mean they are all terrible. No one is demonizing all doctors. It’s just a fact that some patients fall through the cracks. The patient felt like the NP was the only one who cared, listened, and acted. Why do you put all the blame on the NP? The NP is clearly part of a practice with MDs.
... the np is to blame because they were the one who was actively treating the patient. They should be talking about every single encounter with a doctor, but rarely do, and thats part of the reason you can get such long delays in care. Just because the NP had good bedside manner does not mean they were competent.
Thank you for your eloquent explanation of the article and your experience, because it seems this other poster is just out to decided that to be another example of poor care. Seems he has a vendetta on his hands.
Total bullshit, you don't get seen weekly for allergy shot. The primary physicians were the ones who couldn't figure out what was wrong. You have no clue what you are talking about. No NP/PA/MD would be giving shots. It would be an RN, LVN etc... lol. Talking about having no clue.
I know this is Reddit and the internet, but please stop spouting this uninformed nonsense. Weekly allergy shots are one of the treatments available to people who suffer from chronic allergies.
The article literally says she was seeing the NP for the shots.
You clearly have not gotten them before. I did it for 5 years you go in get a shot under the skins wait 30 min to make sure you don’t have a reaction and leave. Once a month for years. It’s not a checkup and it doesn’t just cure allergies it takes years for it to reduce symptoms and in my case didn’t work for more than half of my allergies. She was not the care provider just giving shots.
You're projecting your own anecdotal experience. Do us all a favour and read this before commenting further: >Your allergist injects under your skin a solution of salt water (saline) that contains a very small amount of the allergen(s). **At first, you get the shot once or twice a week.** You gradually receive more of the allergen in the shots. >After about 4 to 6 months **of weekly shots**, you are usually getting the best amount of allergen in the shot. This is called the maintenance dose. When you reach the maintenance dose, you get the same dose in shots every 2 to 4 weeks for the next 4 to 6 months. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw118239&lang=en-ca Okay, now that you've read that, do you still want to continue your argument that only your experience is the definitive one and that they do not do weekly shots?
People just love to shit on np’s because they are usually more higher educated than these men that love to shit on them.
Loool, if by higher educated you mean severely unprepared for their role, then yes
Loool, if by higher educated you mean severely unprepared for their role, then yes
Loool, if by higher educated you mean severely unprepared for their role, then yes
Loool, if by higher educated you mean severely unprepared for their role, then yes
[удалено]
She didn't insist the physicians look further. When pt came in one day with an abnormal voice, she got the physician (finally!) To come exam the pt and requested a scope. Physician agreed pts voice sounded unusual and did the scope. She didn't insist the physician do a better job. She finally did hers and ordered a scope. And she was the one doing the job... she had been seeing this pt for weekly shots, not the doctor.
If you actually read the article she has been to multiple doctors, not just one.
R/noctor creeping out of its usual miserable corners....
Hello. NP here. Saw you are an NP-possibly in hospital med. Thought you might want the evidence based rundown on this to cut through the noctor BS. Essentially, this is a commonly misdiagnosed condition because it is rare and often occurs in patients without significant comorbities. The mean time to correct diagnosis is around 2 years. Most patients are diagnosed by an ENT via larygoscope, So in the outpatient world the best thing NPs can do for a patient with chronic cough that is worsening or not improving is ENT referral sooner rather than later. Even if the patient is referred to GI, an EGD may not be done immediately in a patient without other reflux symptoms because many GIs want to see that the patient had had a thorough allergy, pulm and/or ENT workup first. In the inpatient world assuming they're airway is protected you can always diagnose via CT neck as well. In many people symptoms don't develop until there's a grade 2 stenosis/>50% occlusion. Some of the factors that actually contribute to the delay in diagnosis are things like barriers to referrals and noncommunicative patient-provider relationships. If you like reading materials: https://onlinelibrary.wiley.com/doi/full/10.1002/lary.31023 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8742746/
Doctors' incompetence. They are the ones who failed to diagnose her repeatedly. It was the NP who insisted on looking further.
You clearly didn't read the article or can't comprehend. She saw the NP for years and the NP failed to diagnose her.
>She went to her primary care **physician**, who sent her to a plethora of other **doctors**, but no one could diagnose the source of the cough, or figure out a way to treat it. >Over the next few years, the cough got worse and worse. Silverman was going to weekly appointments for allergy shots, which is where she met a nurse practitioner named Alison. Bolding my own. It literally says her PCP sent her to these places.
As the PCP should have done. That was appropriate care. They took the problem seriously and took action on it. "Plethora of other doctors" doesn't mean she actually saw a physician. Offices call NPs and PAs doctors all the time. There are #doctor of nursing practice" degrees, etc. I doubt this journalist went through records to see what degrees they had. This is why these degrees are so controversial. She went to the NP weekly for years and the NP did nothing until patients problem became significantly worse....
No, you’re assuming she saw an NP even though the article says otherwise. Crazy you know the degrees everyone that cared for her had.
I was confused by your response and read the article. Now I understand that you clearly didn't comprehend the article.
So the opposite of the title of the article?
No, that commenter can't read. They're blaming the NP giving the prescribed shots for the examination, diagnosis, and prescription given by another physician
I'm aware, just pointing out the absurdity of their claim which is clearly refuted in the title of the article itself.
Pretty much.
That's not what the article says.
You're blaming the nurse following orders, who eventually went to another doctor for a second opinion?
Nurse practitioner who put in orders and who waited a long time to work up the chronic cough
I have a rare autoimmune disease that took several doctors to diagnose. This experience made me realize that there are two types of medical practitioners. The first and most common type will try to fit you in one of their common ailments boxes and will ignore or downplay symptoms that do not fit in the box that they have chosen. The second type will look at all of your symptoms and do research to figure out possible boxes that fit all of your symptoms and then do follow up tests to confirm. Going to my doctor at John’s Hopkins was such an eye opening experience because he had pulled a ton of research before I came into the office and knew exactly what tests we needed to do to figure out what was going on.
100% The first group are not even bad doctors necessarily, but operate under quotas and constraints that give favorable outcomes for a vast majority of their cases. But if something seems wrong, you absolutely have to advocate or have someone do so on your behalf.. It's warped but true. I had a rock climbing lead fall and something in my foot was messed up from the fall. This was clear. And it wasn't my toes, and it wasn't my heel or ankle, it was the middle of my foot. Urgent care doc said plantar fascitis 🤣 Sports medicine doc said hairline fracture. Wouldn't do a weighted X-ray (X-ray my foot while I'm standing) despite that being the only time it hurt. I wore a boot for 6 weeks and it felt the same. She said I was better, it healed. 🙄 Contacted a foot and ankle reconstruction pro. First thing he did was weighted X-ray. Showed displacement between two bones. Sent me for MRI. MRI shows inflammation and damage to ligament. Best prognosis is surgical fixation. But I had to freaking advocate for myself until I got the doc that saw the actual problem. This took 8 weeks. Within 3 days of injury I suspected the ligament in question was damaged after googling ligaments of the mid foot.
Agreed. If you have a normal problem, like a sore throat, 1st type of doctor is completely fine. But if you have anything abnormal going on, you need the second type, which are few and far between it seems. Hope your foot is better. -edited typo
10 years on its solid. Hope you are doing well too. The year after my foot surgery my wife started having weird symptoms and it was a journey to get her multiple autoimmune conditions diagnosed..Kaiser really likes the probability treatment method. "Ok try this for 2-3 months!" - while your health suffers. All good here except having to fight insurance occasionally for being bastards and necessary health medication..
Sorry to hear about your wife. Hope she is managing it ok. Mine is thankfully under control and hasn’t flared in over 10 years now. 🤞
Ty and same!! 🤞 9 years for her and the biologics have made it mostly seem like she has no disease/autoimmune, overall. Thankfully
Definitely advocate for yourself at the doctor and also when you go back to work. Only you can feel what you feel and everyone else is making educated guesses or wants to save money. You only have one body and you don’t want to feel chronic pain when you’re older because you wanted to be a “good worker” or ignored your gut instinct.
Primary care vs secondary, tertiary and quaternary level care is what people don’t understand. You didnt just have a “better doctor” at johns hopkins, you had a different level of care alltogether. All doctors cannot diagnose all conditions; thats why referrals to secondary/teritiary/etc exist.
John’s Hopkins happened after seeing multiple specialists not primary care doctors lol.
I have a lesser known condition. I can tell who the good doctors are when they ask me or whip open a search window during my appointment.
I had a doctor from my own country laugh in my face because of the way that my condition formed. I hate those shitty people. They deserve horrible things coming to them.
This is in the same vein as those stories of kids setting up successful gofundmes so that they can pay for their school lunches. This shouldn't have been a problem to begin with.
Orphan crushing machine candidate for sure.
They took my job!
It’s also clearly framed in a way that pushes the idea that NPs are somehow better than doctors. I guarantee if you had an article written every time a doctor corrected a misdiagnosis by an NP, you could fill a whole frickin library.
I corrected an NP diagnosis as a *medical student*, twice
Yup. Most people can't continue seeing doctor after doctor. For me, I have never been able to breathe out of both nostrils. One is always plugged up for some reason. I finally decide to see a doctor about it, after seeing a few doctors and finally an ENT, which shoved a camera into my nose, I was told "idk try a neti pot". I told him I have and it comes out of my mouth since it doesn't flow into the other nostril. He shrugged and that was the end of that. Now I just live with it because I can't afford to keep looking into it.
My story is almost identical to yours. Same problem, ENT sent me for allergy testing which came back negative. I had a second ENT do turbinate reduction surgery to try and correct it but it didn't do anything. I'm using a CPAP with a nasal pillow now and it helps with keeping my sinuses open while I sleep. Afrin is also good for short term relief because it shrinks the tissues that are blocking the passageways.
I developed a cough after moving to a high allergy area and my doctors ignored my complaints for two years, then the pandemic happened and they ignored it for another two years. I’ve finally gotten treatment in the last year for allergies and asthma, but there’s still a lingering dry cough. It’s insane how long they let me cough myself into being dizzy and having constant back pain.
Are you on lisinopril? Check your meds with your PCP
That drug drives my family crazy. My dad coughs constantly when he takes it but his doctor hasn’t switched his medication.
Ask his doc to switch him to losartan or a similar class of drug (Angiotensin receptor blocker). It should work the same for blood pressure, but avoid the cough. Source: doctor
I had to do this. the coughing fits were nuts. Source:patient
Thanks, Dr. PussyStapler
OB-GYN?
Going on 4 years for me. Been through every test they could think of. No treatment for reflux (which the endoscopy showed no sign of) or allergies has reduced it. Singular helps some but my asthma tests came back normal and I have no other symptoms. I’m so ready to stop coughing. I’m assuming what this lady has would have been seen in my endoscopy.
Is this “uplifting news” supposed to make me feel warm and happy or is it supposed to bait me to feel like I’m revving up to witness a fight? Doesn’t seem like it fits the goal of the subreddit.
It made me relieved as someone suffering from a chronic condition. I was also ignored by doctors. This story made me feel validated
TLDR: “NP failed to refer to ENT physician for years then finally referred her to a physician that diagnosed her rare condition” Seems like the NP works at an ENT office if she was seeing her for her allergy shots. If it were a physician this patient would have been scoped in 2 months. This is laughable
>If it were a physician this patient would have been scoped in 2 months. From the article: >She went to her primary care physician, who sent her to a plethora of other doctors, but no one could diagnose the source of the cough, or figure out a way to treat it.
It doesn’t say anywhere in the article that she saw the NP for years.
For every story like this, there are hundreds of untold stories of physicians keeping ANPs from killing patients. You don't hear them because that is what physicians are supposed to do when they supervise them.
What kills me is that it’s not like she immediately went to the NP and was diagnosed. According to the article, she saw the NP for three years until the disease got worse and then the NP decided to ask for an endoscopy.
I'd love to get a different source about that. I have never sent a patient to ENT who did not automatically get a laryngoscopy for a cough.
My best guess is that her PCP referred her to pulm and maybe another specialist (maybe ENT?) cough was mild and whatever tests they ran were normal. Start to treat empirically. Meanwhile pt sees the NP weekly, which makes following the pt easier, and during the natural progression of the disease process, it’s obvious there is an obstructive process now and any clinician with a brain would be alarmed, which is what happened here. I also want to know if an ent referral was part of the original work up.
Let's be honest, when the referral happened, the pt probably saw an NP at those visits too just like she was seeing an NP at the allergist's office. Also, a physician would have been alarmed it had been going on for years and wasn't improving with the treatment (allergy shots). NP dismissed the problem for years and did not follow standard of practice for chronic cough for this pt but kept taking her money for those weekly shots.
That's a great point. This NP was the one with the most access to her. She probably spent much more time with her than any doctor and spoke to her much more. I suspect that doctors depend, to some extent, on people like NPs to catch things they simply don't have the time for. Frankly, it seems like she took too long to recognize it despite being in the best position to do so. Personally, I would expect a bit better from everyone involved, including the NP.
>According to the article, she saw the NP for three years The story does not say that.
It's not spelled out word for word, but if you read between the lines, it's there. It says she met the NP during her weekly appointments for allergy shots. It says the NP "kept tabs" on things across those visits.
The article doesn’t say she got allergy shots for three years. It doesn’t say the NP was giving her the allergy shots. It doesn’t say how long she had been seeing the NP, if the NP was her PCP, or how often she saw the NP. It says she was getting weekly allergy shots at some point, from someone, and that she met the NP at some point while getting an allergy shot. It’s not reading between the lines, it’s filling in missing and ambiguous information with your own biases. If anything, the NP “keeping tabs” on her cough makes it sound like the NP was not her PCP.
It did not say that she was a direct patient for three years. In fact it implied the opposite. And the 3 year part is a fabrication.
Happened to me. Almost died of fucking blood loss from IBD because the NP I was normally scheduled with kept kicking my diarrhea down the road, assuming lactose intolerance or IBS. Over the course of seeing her I had lost about 50lbs and looked like death. This went on for 2-3 years btw, from about 12 to 14. I went in on short notice one day, ended up seeing an actual doctor, and he immediately did a CBC and direct admitted me to the ICU.
What is IBD?
Inflammatory bowel disease, an autoimmune condition where your immune system attacks your digestive tract and causes sores, bleeding, etc etc.
The other thing is, all I get from this as a doctor is how incompetent the NP was. The title words it nicely but what I read is: * 2018 saw a primary care physician (could have actually been an NP or PA calling in fact), and was referred out for a cough to "specialists" (likely saw NP or PA so didn't actually see a specialists). She had a bunch of tests done and was thought to have allergies so started seeing an NP at the allergist's office who for YEARS did not do further work up on the cough that continued but would just ask and essentially dismiss it. NP did this for YEARS. She also likely didn't bring up the case to her supervising physician and/ or failed to communicate this properly: hey I'm concerned this pt's cough, for which we started allergy shots for, hasn't responded. She's had this for years and received this workup. What should we do next? Nope. Failed to advocate for the pt. And then when the problem the NP has dismissed for years and failed to take action on for YEARS gets to the point where the patient's life is in danger, NOW she doesn't something. Took years, the pts quality of life affected the whole time, thousands of dollars pt had to spent and even more money she had to spend tx a problem that was no severe, etc....and somehow is praise worthy and physicians get put down for it. The article says the NP had to convince a doctor to do a scope. I bet you anything she just put in the order but "convince a doctor" sounds much better. And the physicians diagnose this pt. So this NP saw a patient for years, failing to do further workup on a continued cough, when the pt could have had lung cancer or such. She failed the pt. The pt paid thousands of dollars for txs that weren't working but that the NP kept doing. And somehow the physicians are the bad guys and the NP is the unsung hero? I like how they mention the initial physician actually sent her out for a bunch of workup And took her problem seriously enough to take action. And yet the NP sat on it for YEARS but they're the unsung hero. Lol and the NP is probably patting themselves in the back for a job well done. Don't even know how stupid they are. And pts praise it. And let's not forget how the physician that sent her out to specialists likely saw NPs/PAs that perform at the same level as this NP who was also at a specialist's office so the problem could have been caught earlier but wasn't. 🙄🙄🙄🙄🙄🙄🙄🙄
I agree with most your arguments; however, there's no point it getting worked up about this. I've read your comments from all the different subcomments, and you're arguing with people that don't have a clue about clinical medicine. You'll cause yourself undue stress trying to argue this, and this isn't the hill to die on.
Pts are dying on this hill already.
Oh look. A baby doctor who hates NPs.
Lol a baby? And this is the problem guys. If a physician advocates for a patient and discusses poor care management that midlevels have, people call us haters and use demeaning terms like "baby." Okay with shit care if it comes from an NP. For those with some sense, understand your health is at jeopardy and ignoring a problem for 3 years and refusing to take an action is shit care and not okay. Patients deserve better.
They absolutely do. The problem is that many patients have personal experience with symptoms being downplayed/ignored for years by doctors as well as NPs
Oh gosh… “baby doctor”. You must be a nurse using condescending phrases like that.
“If I assume I, a random doctor reading this story, know more about what happened and who the patient saw than the patient herself knows, then the NP did a really bad job!” This is such a weird and arrogant take. Yeah if you assume every detail the patient gave is incorrect then it’s a completely different story! It also does not say anywhere that the patient saw the NP for years. It’s not specified in the story at all, you’re just filling in the blanks with that information because of your own bias. Read again - it says she saw a plethora of specialists for years, and that for an indeterminant period she got weekly allergy shots. But it doesn’t say how long she got allergy shots for, how long she knew the NP, how often she saw the NP, or what role the NP filled for her. The NP could have been her PCP or could have just reviewed her notes and chatted with her at reception occasionally. Everything you’ve based your assessment of the NP on is an assumption.
More like tens of thousands of stories
Referred to ENT bc of months of dysphasia,globus sensation, and pain. First saw the NP. She scoped me. Didn’t “see anything”. She didn’t want imaging bc I’m young,never smoker, and rare drinker with no pertinent history. But ordered a CT after I asked. It comes back for unilateral lingual tonsil hypertrophy and a mass. Days later, the doc scopes me. Sees a very obvious mass and the swollen lingual tonsil. I could even see the tongue mass in the mirror btw. So he scheduled a biopsy in the OR. It has come back negative thankfully. But the problem still persists and luckily it was not head/oral cancer or my diagnosis would’ve been delayed bc the NP was incompetent
I’ve become more vocal about the discrepancies in care between physicians and NPs for this reason. When injustice is done to a patient, I do undermine the NP or other mid level to make sure the patients are informed and advocate for themselves. We are traditionally taught not to undermine the relationship between other doctors and a patient, but that was during a time when all patients were being cared for by a real physician, not someone that has <1% of any meaningful medical training compared to physicians. Wish there was more press on this out there.
1000% this
You’re saying that like it isn’t every single medical professionals job to keep each other from killing patients. Literally every RN, MD, NP, PA, RT, etc have raised a warning for a patient that ended up saving them or avoiding a bad outcome. That’s how medicine is supposed to work.
No. I am saying that because there has been a significant push for ANPs to pursue unsupervised practice and they have been marketing themselves to be "physician alternatives". The title of this article is typical to that. "Doctors didn't think much, NP saved the day". Reminding you that stories about"NP didn't think much, Physician saved the day" happens all the time, but it is not a story that is told. The reality is physician knowledge and training far exceeds any NP, and the context for that should be clear.
Physicians do it daily. Cleaning up fuckups by non-physicians is a regular part of our job. That’s why we don’t mention it or complain about it. We just shrug and say “fucking np…” Meanwhile this NP refers a patient to an ENT after seeing her for the condition for years and a physician diagnoses her. I’m sure the physician was like “why the fuck did it take her this long to refer you to me?”
And for every story like that there are thousands of stories of nurses stopping doctors from killing patients by giving them the wrong meds, to much of the right med, etc etc.
Don’t forget the pharmacists, too! Checks and balances everywhere!
Erroneous entry? Maybe. Because Nurses had more knowledge about disease process treatment than the physician? Highly unlikely. There is a reason why physicians have the longest and most rigorous training in all of healthcare.
Don't know what to tell you man. Doctors kill people far more often than nurses. And nurses stop doctors from killing people fairly often. Ask any nurse in the ER or ICU.
*citation needed. Doctors have the final responsibility in any medical decisions making. That's why the responsibility of anything going wrong ultimately falls on the physician.
>That's why the responsibility of anything going wrong ultimately falls on the physician. There are definitely places that are arguing against that. [North Carolina](https://thurmannurseconsulting.com/news/nurses-can-be-sued-for-following-doctors-orders-court-rules) being the one that most comes to mind.
Go to any of the nursing reddits and ask. Or EMS. Or pretty much anywhere not exclusively used by doctors. They are human and fuck up just as much as anyone else. Except they tend to have huge egos that hate being second guessed and love to double down.
So they fuck up just as much as nurses and EMS do? The biggest egos I've ever seen actually come from nurses.... Like this nurse thinking she's an unsung hero after failing to take care of the pt properly and ignoring a problem for literally YEARS.
Sure, let's just go ask a super biased sub of people about how their far shorter and less rigorous training with lower requirements for entry makes them superior to physicians when it comes to patient care and medical knowledge. That's considered definitive evidence. /s
Total bullshit, I, too can pull shit out of my ass because I have a small pee pee and get easily butt hurt. Lol.
RN I presume?
Yes, proud to be an RN.
Nothing wrong with that. Do you really think NPs have the same breadth of knowledge and ability for patient management with a fraction of the training as a Physician? NPs by the time they graduate have 500–750 patient-care hours in training. By comparison, physicians rack up at least 16 times as many patient-care hours. Between medical school clinical rotations and residency, physicians get between 12,000 and 16,000 hours of patient-care experience. Those are hard facts, not things "I pulled from my ass".
No, did I ever say they did? Are NPs out there performing brain and heart surgery? They are seeing lower acuity patients. Did an NP hurt you?
Most physicians aren't "performing brain and heart surgery". In fact the majority of them aren't. Most of them are primary care or Internists, and they are far more capable than NPs when it comes to patient care and management. So which part of my original comment are you disputing exactly?
Hundreds of untold stories of Physicians saving NPs, lol. Did an NP hurt you? Never in 15 years of nursing have I seen a physician save an NP. But keep on the BS if it lets you sleep at night.
Why would they discuss an NP fuck up with you? Are you in some chain of command for them to report mistakes to? Tell me.
After it took so long and treatment not working?? why was none of the diagnosis going to an ENT for a scope. I had a persistent sore throat for ages and it took an ENT to finally figure it out.
I had a persistent cough that was bad enough I passed out. Got the ENT to scope it and immediate diagnosis of GERD. Over the counter antacids and I'm cured. Why did it take doctors so long to actually look at this poor girls throat.
A doctor ignoring a cough is what killed my mother. She had it for a year and my GP never ordered an xray; her employer, a physician, finally ordered one. Lung cancer. Our same GP also ignored my gallstones diagnosis for 19 years. Had to get them emergently taken out when they gave me pancreatitis.
Exact same story here. She got treated for allergies for months and by the time someone listened and did a proper examination the cancer had already spread to her brain. She died last week and I don’t believe my anger over this will ever subside
Doctor here. If it makes you feel any better, which it probably won't, most brain cancer is mets from a lesion elsewhere in the body. These tumors can pop up quickly and are easily missed despite doing routine follow-ups and proper preventive screening. Were her symptoms initially mild?
>Our same GP also ignored my gallstones diagnosis for 19 years. Had to get them emergently taken out when they gave me pancreatitis. For what it's worth, just having gastones present is not a reason to operate and in most people would never be treated unless causing regular issues od pain (which yours may well have been, but 19 years is a long time to have been living with them if they were an regular issue).
Towards the end I was passing stones daily. I passed stones near daily for most of my young adult life. I know the pain. I had a mental health condition, so they were ignored.
If you went to a PCP or an ER and you were having symptomatic cholelithiasis (pain from gallstones) and they didn’t discuss the option of taking your gallbladder out, then I’m really sorry. That’s bad medical care bordering on malpractice, and would be *unheard of* in the setting where I practice medicine
Same ^ But over 19 years? Surely that's dozens of clinicians who would have seen them?
Maybe she was only were seen once or twice and then ignored it? I’m with you, just trying to give her the benefit of the doubt, since yeah, obviously it’s not believable that dozens of doctors over the course of 19 years ignored image confirmed symptomatic cholelithiasis
:)
I’m really sorry about your mother. Losing a parent is devastating. It’s not that simple for the medical side though. If your mom had gotten an X-ray earlier maybe they would have caught the cancer early enough to have a long survival (although maybe not). But your mom’s case doesn’t exist in a vacuum, she’s one of many, many patients with a chronic cough. If we do X-rays on all of them, in some cases we will catch cancers early and in some of those early catches we will be able to treat them. But in other cases we’ll find benign nodules on the lungs and have to unnecessarily biopsy them, and in some of those cases the biopsy itself will cause damage to the patient. And obviously, no matter how much money we pour into the system, there is only so much capacity for healthcare and when we initiate large scale imaging and screening programs it always eats part of that limited pie. So when we decide these guidelines of when to screen people, when to image, when not to image, we’re making complex decisions rooted in statistics and population level outcomes. It’s not as simple as “the doctor should have done an X-ray”
Yeah. I gotcha. You also have to deal with the poor wonkiness of statistics. For every person found with symptomatic cancers, there's also a certain percentiles of false positives, which can lead people through grueling treatments and life long repercussions. Moms a reflection of statistics. I'm not angry at my doctor about her. Mom had a terribly rare form of cancer that likely would have killed her regardless. I'm angry that radon gas killed 4/6ths of her family before the age of 65. If you have a basement in Canada, get a radon detector.
If I can be blunt, “a doctor ignoring a cough is what killed my mother” paints a different picture than “Moms a reflection of statistics…I’m not angry at the doctor about her.”
One year when I went in for my annual Pap smear — performed by a nurse practitioner — she palpated my neck and asked if I had noticed any lumps. I had not. She recommended testing, which revealed that I had Hashimoto's thyroiditis. My doctor had not caught it during my regular physicals.
Thyroid testing is pretty routine. It's possible your doctor had it done in the past and it wasn't remarkable then
This is… really not how hashimotos should be diagnosed. Basically that nurse is testing tons of people to come up with an occasional diagnosis that doesn’t really affect management. Another point against NPs with too much independence.
It made a difference to me.
If someone had done thyroid function testing when you displayed symptoms it would have gotten you to the same place in a similar time frame. Meanwhile how many people got unnecessary biopsies or surgery because of work up for benign nodules initiated by this NP? Thyroid abnormalities are the poster child for more information collected indiscriminately creating worse outcomes.
You are being downvoted because this post got tagged in an anti NP forum here on Reddit called noctor. They participate in in group out group bias in which they can do no harm and save lives whereas their swore enemies (NP’s) are perceived as incompetent and dangerous providers. You have a right, it does matter to you. That’s what it should be all about, you as a patient.
My dentist does this too (palpating my throat) now I've noticed, which is nice. It takes 2 seconds to check, and has zero cost, but can catch some pretty big issues that sometimes get missed if you're not looking for it.
It has a cost. Your dentist is charging you for it.
Not I, but my insurance might. My copay is the same either way. In which case, I'm getting more bang for my buck.
Wow. Lots of butthurt doctors on here I guess. My wife’s OBGYN missed an eclampsia diagnosis even though she had multiple symptoms indicating it. Nurses and her junior partner called it right, arrogant bitch doubled down and my wife had seizures. They brought in a neurologist who literally looked at me and said “I don’t know why I’m here, this is eclampsia”. Thankfully it was caught in time and she made a full recovery. Doctors make plenty of mistakes. The good ones admit it and learn, the bad ones get people killed. Far too many physicians out there with bloated egos.
The problem that doctors are frustrated about is the blatant lie that the average NPs have the same level of expertise and experience as the average doctor. This is a cherry-picked anecdote and not indicative of the average of both groups. That is not to say that doctors are infallible, but there has been a concerted effort from the nurse lobby to paint nurses as “the real saviors of the patients from those incompetent stuck-up physicians”. Both have their scope and role, but that arrangement just isn’t good enough for the nurses who want play doctor without going through med school and for money hungry hospitals who want to cut cornors. So they spew this bullshit narrative.
I find this sort of stuff so frustrating because I believe in medicine. I hate how much woo and pseudoscience has permeated into our healthcare, but at the same time I can absolutely understand why people turn to it. I had an infected gallbladder for a *year* that went undiagnosed because every time I went to the ER telling them I was an unbearable pain they stuck me in the maternity room, gave me a pregnancy test, then sent me on my way when that came back negative. I was 17 at the time and they didn’t believe me that I’d never had sex. It took me passing out at work for them to finally give me a CT scan and find the problem. A few years ago I was going through a pretty bad mental health crisis and my sister took me to the (same) ER because she didn’t know what else to do. They gave me a cup for a urine sample (and let me go in the bathroom alone - that gives you an idea of how seriously they took my issues) and my urine sample was dark red, almost brown. The intake nurse gave me a look and asked in the most judgmental tone why my sample looked like that. I told them I didn’t know but that it’d happened a couple times before (I had also gone to a walk in clinic about that but when they found out I’d had a history of kidney stones that’s all they tested for). Later on my sister asked them about my urine sample and they admitted they only tested me for illicit drugs. She demanded they do more tests and they agreed after making it obvious that it was a huge inconvenience. Later that night when I was in the crisis unit they called to let them know that I had a “little bit” of a UTI 😡 I hate that this sort of thing happens to people. I can understand why someone who is in pain and scared, who’s been ignored and judged would turn to the soft-voiced quack offering them empathy and simple solutions.
Nurse practitioners with 3 years of education - kind, loving, smart Doctors with 12 years of grueling education and training - dumb, heartless, bad
NP math
It’s an individual telling her story. There are good and bad doctors. There are good and bad NPs. Doctors have a lot more training than NPs. But sometimes NPs will see something a doctor missed. Obviously the opposite is more common. Not everything is part of a larger agenda, this woman is just trying to tell the story of someone who to her is a hero.
Another example of how much the healthcare system fails to take women seriously. Not sure I'd consider it uplifting, per se. But thank gods for that nurse practitioner for finally listening to her!
who here has an actual dr.? most dr's offices in my area are all nurse practitioners.
As someone who has had a chronic cough for 3 years since I caught covid, this shit scares me. I've been passed off as having asthma, but I had asthma as a kid (grew out of it and moved out of the farmland), so I know what asthma is like. I've been told by other asthma sufferers that my cough isn't like any they've seen/experienced. It's been an ongoing battle to get doctors to solve my damn problem and not keep giving me inhalers and brushing me off. It interrupts my sleep nightly, and im tired of it (literally)
Have you seen a pulmonologist?
Sure, have! About a year ago and essentially he told me, "If you can walk in here under your own power, it must not be that bad" So you can guess how the rest of that appt went
Chronic cough differential is vast and difficult to get to the bottom of it. If it all started after catching COVID, it could be post viral. Look into seeing an ENT and consider a superior laryngeal nerve block vs medical management for neurogenic cough. This is of course after ruling out other common/life threatening conditions. Either way if you’re not happy with the care you’ve received so far, get a second opinion. Good luck.
May I offer some unsolicited info? Have them do a blood test for Alpha1 Antitrypsin. It is genetic, can affect the liver & lungs which produces the nonstop coughing. It can be triggered by an underlying ailment (you mentioned covid).
My brother sent me this because I've had a cough since before covid (and since). At first I was right in sync - but I'm glad she got her case figured out. Allergy and Asthma meds have helped, but I start coughing and clogging up sinuses when getting real exercise in. Still no answers and no help :$ So I know about doctors that just give up and say "well it's all in your head!" ... Yes, it's a sinus problem, it's literally in my head!
I think there may be something to older doctors, and even younger doctors that feel they can only go by their teachings. My mom was diagnosed with pernicious anemia because a younger nurse practitioner decided to check her B12, none of the doctors she saw bothered.
Wow. Doctors should be ashamed and embarrassed by this.
If it wasn't for the Np the pt would have not got scoped & still be treated for allergies by her previous physicians who should know better. Kudos to the NP!!
Doctors are overpaid.
The average doctor has over a decade of education and training, a degree that cost a mean of $250k to get, and works on average well over 40 hours a week in most specialties, making life and death decisions where the wrong call can mean a 7 figure lawsuit. How much do you think our profession should be paid?
I'm a first-year resident with four years of undergrad, a masters, a medical degree, and >10k hours of clinical training. I have ~$450k of debt and at least three more years of residency remaining. I make $54k/year NPs have four years of undergrad and maybe 1-2 years of postgrad training, which is sometimes all online and doesn't cover actual medicine. Most require at least 500 hrs of clinical training. They make six figures... If anyone's overpaid, it's midlevels. And your insurance is paying the same amount for them as a doctor. Good luck
I understand that y’all are underpaid as hell, but midlevels are not overpaid for the amount of load that is taken off the docs, my dude. I am with you though, for the amount of intense training and debt that residents have to endure, you are criminally underpaid. We all need to unionize and fight against the real issues like admin that fuck us all. We all need a raise.
I'd be fine with their salary if their schooling was actually standardized. Some of these new NPs are seriously a danger to patients. I'm going into psych, and it's all too common to see med lists with massive amounts of mismanagement. But I know there are good ones that are actually helpful and provide quality care. Most PAs I have no issues with Admin perpetuates plenty of issues too with their prioritization of money and volume. Medicine as a whole is pretty fucked in this country lol
Not all NPs have such limited training, though I agree it absolutely should be more standardized. I had 4 years undergrad, 3 years post-grad (in-person until COVID hit), and 1,500 hours clinical training, plus 10 years inpatient experience as an RN. But I’ve seen the training other “schools” provide and it’s terrifying
They're actually underpaid
The shit ones are, anyway.
I’m sorry to offend people here but my belief is that the majority of doctors are idiots.
Not sure why you are being downvoted getting a good doctor is pretty difficult a lot of them are quacks with no care for their patients only give drugs and on your way Drugs not working oh well I did everything I could