Thursday, February 17, 2011

Patients With Abnormal Labs And No Insurance?

One of the biggest problems that I face as a Primary Care nurse practitioner is when I see abnormal labs on a patient that has no insurance. The main worry is whether or not I am missing a bad diagnosis. Many of my patients barely have the ten dollars to get the tests done to begin with, let alone do anything about it if it comes back badly.

We have little resources out here in "rural health land". Most do not have gas money to drive anywhere to be seen by whatever specialist that might do a favor for me. Having Medicaid isn't much better. I can do just about any testing that I want but God forbid that I need a Urologist to do a prostate biopsy or take care of a woman's incontinence issues.

What happened to the medical profession that used to care for their patients instead of the almighty dollar? I understand the whole overhead issue. It's hard to maintain an office and pay your employees and try to make some money, but where is some compassion for your fellow man?

Please remember one day you or a loved one may be on the other side of the medical glass door looking in and needing help.

Wednesday, February 16, 2011

Who Pays When Medical Providers Step Outside Of The Box Of Medicine?

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Below is part of a recent post that I found on Kevin MD and written by Dr. Kelly over at Mothers in Medicine:

“Fast forward then to my first job out of residency. I was in a small rural community in a group practice with a nurse practitioner whose husband was her supervising physician. After a few months of working there, I started becoming really incensed at some of the practices she had, which to me, were questionable in some instances, and in others, outright harmful. They were not supported by any kind of scientific evidence, and in some cases, even actively discouraged by the evidence. I printed out guidelines and papers for this nurse practitioner to review, and in return, she gave me a book written by a layman which supported her practices. Feeling helpless and outraged, I vented to other staff members and was ultimately confronted by her husband, who called me rigid and inflexible for not being able to accept that there were different ways to practice medicine. They threatened to fire me, and “demoted” me to a separate office location in another part of the medical building.

I did apologize to the nurse practitioner just to make peace, but have always maintained that her practices are wrong and detrimental to patients. I have even contemplated reporting her to the board of nursing and him to the medical board, but have been afraid of repercussions (which is a separate discussion in and of itself). I established my own patient base and kept my practice separate from hers. With that separation, I was able to regain a sense of sanity.”

My reply was the following to which I was also responding to Fam Med Doc’s reply:

While I agree that we should all be allowed to think outside of the box at times due to individualized patient care, I do think that the Nurse Practitioner was wrong not to follow standard practice. I would have welcomed any printouts or constructive criticisms and learned from them. I am sorry that you felt that you had to pull patients into “your” practice in order to feel more comfortable. It’s hard having to work in a group setting especially when you are the “low man on the totem pole” and don’t want to make waves. I don’t however agree that “all” NPs are inadequately trained. That’s too much of a generalization. Great post!

I found it odd and coincidental that the same scenario has been playing out at the office I work in. My collaborating MD and I have a differing opinion on a particular topic of which I can’t elaborate because he would probably recognize it. Needless to say, we’ve had a few conversations weighing the pros and cons and our boss has stopped by to put in his 50 cents worth that the MD doesn’t understand is akin to a probable strike two. He’ll learn.. I figure that there is no one way to do things as long as the patients are not paying the price.

Welcome to Because Your Nurse Practitioner Says So!

Welcome! Here is the place for nurse practitioners to vent about practice issues, including ones that keep patients from being healthy. One of the issues that I have is non-compliance which is causing all kinds of chaos! Is this happening to you in your practice? Do your patients continue to show up at the office with uncontrolled blood pressures and blood glucose levels over 200s?
How do you deal with these problems? Chime in and let's get the conversation started!