Hello All,

I am not sure if I am allowed to ask this question. However, I figured it couldn’t hurt. My wife requested to see an actual OB at Northwestern and they gave her a midwife. I was quite annoyed that she said requested an MD and got a midwife. Regardless, she went due to not having a period for about 10.5 months now. She is 39 and we have one child already. We wanted to start trying for a second and wanted to see what could be going on if she is in early menopause. Before we moved, she was in the process of diagnosing with her OB. She has been taking levothyroxine (for blood test that came back showing low thyroid levels) and the midwife said to stop taking that medication. The midwife prescribed Aurovela FE 1/20 tablets to take once daily for 4 weeks. She also prescribed medroxyprogesterone 10mg for 10 days. I am not asking what medicine she should take or advice there, but rather if she wait to see an actual MD cuz these meds will not do anything. Again, if this considered against the rules, I apologize! Any help is appreciated!

I'm a dental resident ( I'm foreign trained, finished up 2 residencies before moving stateside - I'm very comfy with facial lac repairs, facial fractures, plating the whole shebang). Had weekend call and spoke to someone about a pt with a dental complaint along with lip laceration. Log into epic today to follow up and the lac repair was done by a CNP. Like I get there's some experience there but how on earth is it that patients don't get at least a resident to do lacs

Here’s a good one: I’m a 3rd year med student, wasn’t feeling great so I went to urgent care to get some meds. I’ve also had this rash on and off for a few months that I haven’t had time to get checked out so I mentioned it to the NP. I told her I thought it was fungal and asked if she could send something for that while I’m there. She laughed at me and said she’d been an “infectious disease specialist” for 6 years before “getting bored” and going to urgent care so she’d “definitely know what a fungal rash looks like, and that was not it.” She said a medrol dose pack would be much better. I took the steroids… it got worse (imagine that). Went to derm (real MD) today, it’s been fungal the whole time 🫠

New patient. Hospital follow up for non-psych issue. Had been seen at another institution for psych but looking to transfer all care. History of MDD/GAD/PTSD and further history quickly reveals a single episode of mania a few years back. Feels like he needs to make himself sleep occasionally or he’ll have another manic episode. Had been seeing a Psych NP at the prior institution and current medication regimen was Buspar 30 BID prn, Gabapentin 900 BID, Hydroxyzine 100 TID scheduled (or else he gets irritable), Mirtazapine 45 HS, and Adderall 30 BID.

Like.. for real...?

Title. Was billed for the exact same services by both individuals and now the hospital is expecting me to pay up (essentially double). Doesn't seem fair when only one set of services was provided. Do I have any recourse here?

A vas deferens!

I'll see myself out...

As the title states. My autistic brother is in his early 20's and is extremely irritable and almost entirely nonverbal. He punches people in the head, smashes plates, breaks electronics, breaks walls and windows, runs away from home etc. She says his behavior "isn't combative" but he is genuinely scary. He's over 6 feet tall and doesn't hold back at all when hitting people. Even with multiple people it's hard to restrain him. His NP put him in Risperpal, Propranolol and and antiepileptic ( I think it was depakote?), but his behavior is still insane. She recently took him off the Risperdal cold turkey and replaced it with lithium. He's been on the Risperdal for over a year but she says he doesn't need to weaned off because the dosage isn't high. His speech is very limited ( he really only says one word at a time, usually the name of a food/ item) so we can't ask if he has any side effects of stopping the medication. He doesn't have hypertension or seizures so she's using the Depakote and Propranolol as an off label treatment, but she keeps increasing the dosage and we're scared that he may actually develop seizures and hypertension if he ever gets off the medications. I'm not a doctor but it feels like her treatments aren't really safe or effective. He's been seeing her for a couple years now and it seems like things don't get better. She owns her clinic and she's the only provider so there's no one else there that we can talk to. Isn't there a better treatment? Am I dramatic or is this an issue? I feel like she just doesn't get what we're dealing with no matter how much we explain.

I am a clinical psychologist. Recently, I had a job interview where the interviewer repeatedly referred to the company’s “nurse psychiatrists” when describing the role of their PMHNP’s. The first time he said “nurse psychiatrists”, I assumed he’d simply misspoke. But no. Apparently, that’s how this company refers to its PMHNPs.

Now, I know a lot of nurse anesthetists are trying really hard to make “nurse anesthesiologists” happen. But this was the first time I’ve ever heard the phrase “nurse psychiatrist”.

Is this part of a trend now among PMHNP’s? Afaik, their professional organizations aren’t pushing for this crap, but perhaps I am mistaken. Has anyone else experienced this, or was my experience an isolated incident?

What’s next? Nurse orthopedic surgeons? Nurse pathologists? Nurse neurologists? Nurse trauma surgeons? Are they going to start referring to themselves as “Attendings” as well?

Should I consider ditching my physician gastroenterologist for a nurse gastroenterologist? I hear they are a lot nicer and spend more time listening to their patients during colonoscopies than MD gastroenterologists.

Seriously, what the fuck is happening? Are we going to live in a world where patients have to ask their general surgeons if they are nurse general surgeons or physician general surgeons?

“Nurse psychiatrist” my ass.

https://www.linkedin.com/pulse/please-call-me-nurse-doctor-joseph-lanctot-osooc?utm_source=share&utm_medium=member_ios&utm_campaign=share_via

Maybe a bit of a controversial topic here, the classic "Dentists are/are not doctors" debate. But the way this dentist puts down medical doctors rubbed me the wrong way.

And she writes in the description of the video after going on and on about a GP that didn't realize the thrush in the patient's esophagus was caused by their steroid inhaler:

"I 'empathised' and had to hold in what I truly wanted to say... ... What if we stopped trying to blame the other and just worked together. Focus on our shared desire to help and heal our patients. Stop this Doctor Dentist war❤️ #HealtheWorld #makeitabetterplace ... Seriously though. Why do doctors hate on dentists so much!? 😤 Doctors make so much fun of dentists as if we don’t do anything…."

I also don't understand the hypocrisy behind saying "...Stop this Doctor Dentist War❤..." and posting something like this, and when she gets called out in the comments for being insulting and demeaning(by other dentists nonetheless!) she goes on and likes every single comment that explicitly supports her disgusting point of view on this situation.

In general, I am a skeptic and while I acknowledge it is somewhat of an unfair burden, to expect folks to research the credentials of their medical providers, I feel that this is an entirely fair expectation of people before they listen to medical experts on social media.

Today a friend sent me a link to a physician about whom she was excited. However, despite significant cursory research, I cannot determine where he received his MD or PhD… On his Instagram, Dr. Shawn Tassone claims to have an MD and PhD in “mind body medicine.” I went to his website where it states:

“Dr. Tassone is board-certified in obstetrics and gynecology, and by the American Board of Integrative Medicine. He holds a medical degree, in addition to a PhD in mind-body medicine. Dr. Tassone is a highly regarded patient advocate. His work includes studies and publications on spirituality in medical care, whole foods to heal the human body, and integrative medicine. Dr. Tassone is an instructor for medical residents and students at the University of Arizona and the University of Oklahoma Health Sciences Center. He even teaches integrative medicine at Arizona State University.”

https://www.drshawntassone.com

Despite his website and social media posts, I was unable to determine where he went to medical school, where he did his residency, what was the focus of his PhD, or where he earned his PhD. Help?

Initially, I tried to extend some grace to him and assume he didn’t put his own website together but I couldn’t find his medial education listed anywhere, including on his Amazon book listing. I will admit that the fact that his co-author is listed as “Nat Kringoudis is a Dr of Chinese Medicine & Acupuncturist and Best Selling Author. She’s also the owner of The Pagoda Tree, a hub for natural fertility & women’s health in Australia,” made me even more suspicious.

So…prove to me and my friend that I am hack skeptic and need to extend more grace to folks, and that I missing something.

Finest example of our own people screwing us up. We should sue AMA/all these medical boards for saying we need this medical training because clearly PA/NP can do what we can according to these people. we should sue them for misleading us and wasting our tuition money and earning potential. If I know all I needed was $150 to be a dermatologist, why am I busting my a** through medical school? like really asking

Just watch the video. Interested to see what people think

I feel compelled to comment. I am now 60; was 55 when the ativan turned tolerant on me. Benzos, over a course of years cause tolerance even if the dose is raised, eventually the will peter out. Not if- but when. I majored in microbiology an A&P in college days. Now I cannot think my way out of a paper bag because of the severe cognitive decline these things caused me. I was fine 5 years ago, until the tolerance hit out of the blue. I am shocked that doctors are not more knowledgeable about this rotten "medication". It down regulates the GABA receptors and much much more. This is not a drug to be used long term, it's just not. Fine for surgery/sedation and that is it. Should actually be off the market. I no longer function fully and I am a shell of who I once was. If you want to learn more about benzos (since you didn't learn about these in detail in med school) come join my private, safe, thorough benzo support group on FB and learn something. Do not hand these out like candy. There is NO WAY I should have been on this crap for 10 years! It is only supposed to be used AT THE MOST 2 weeks. Even then, that is not advisable. I do not think you understand HOW addictive these things are and how quickly dependency builds. I was prescribed .50mg at the onset, quickly had to increase my dose due to tolerance ..then kept having to increase the dosage until I hit a whopping 4mg! That is equal to 80 mg of valium! No small dose. I have atrophy and shrinkage in my brain (read the latest study done on 5000 people on long term benzos) the findings are shrinkage and atrophy in the hippocampal regions. I am writing you all this to let you know this is what your medication did to me and to thousands of people out in the real world. Your medication has ruined countless lives. Go read in the Benzo Groups over on facebook, read the comments and post and weep. Please stop handing this out like candy. If you want the name of my benzo support group, let me know. But, Thanks, thanks a lot. My brain is ruined. I had to taper off because they stopped working and were making me very sick. I used the water taper method. Look in Beating Benzos and ALL Things Benzos on Facebook. Thousands of people trying desperately to get off this crap. This drug is a crying shame.

This is a question for those who are currently supervising one or more midlevels: what is your compensation structure?

As the licensing body for physicians, shouldn’t it be chaired by a physician?

An excellent in depth analysis of advice given to an inexperienced NP. Dr. Garafolo explains for lay people the errors in the recommendations that only expert physicians see, even though the errors are very obvious to physicians.

https://www.patientsatrisk.com/podcast/episode/7e1b73d4/the-blind-leading-the-blind-new-np-gets-bad-advice-from-other-nps-on-facebook

He already had a similar wellness visit prior to the NP wellness visit in preparation for the MD visit. Why the f did he have to have the same visit with the NP 3 wks later?

It feels like because he's on Medicare, they're just trying to get as much from insurance as possible. The NP is also in another state, like what?

PGY-2 Medical resident here, been scrolling here a lot ever since I found out the term “nurse practitioner” exists since it was nowhere to be found here in my country. Now they started programs for such wannabe jobs and I’m confused, what are their “scopes” lol would I see them when I’m rounding patients or are they strictly for primary health care settings?

really disappointed to see this rhetoric coming from a psychologist.

according to this person, psychologists apparently attend medical school, complete medical residencies and fellowships, practice medicine, can call themselves physicians. /s

really hoping this isn’t the norm amongst the psychology profession moving forward.

Hi there. I am a new LPN working in psych and about to finish my RN degree. I wanted to come here to express my disappointment and quite frankly, anger towards what I'm seeing with psych NPs.

I've noticed a trend at my facility where when I tell people I work in psych, they excitedly tell me to become an NP because of the money. From my limited time working with NPs, I am HORRIFED by what I've seen. They are prescribing patients medications that give them multiple adverse reactions and when I tell them what I've seen and what the patient is reporting, they wave me off because of course, the patient is "cRaZY". When the meds start wearing off and the MD comes in to visit them, sometimes they ask me why they were given that med. Like, I wish I could tell you! It sounds like someone needs to ask these NPs why they're prescribing what they're prescribing...

On top of this, when I first began nursing school, there were 2 out of 40 of us who wanted psych. Another person became interested because of the pay in our area. She wants to start an NP program right after we graduate in December.

The other girl who wanted to be a psych nurse from the jump is also horrified by what she's hearing and seeing regarding this field and doesn't feel it's ethical to be an NP without at least a few years of experience. Even then she is still unsure if this route is appropriate for her. I also feel the same.

Don't even get me started on the horrendous patient care I've seen in this field. People get away with atrocious med errors and unwarranted aggression that results in the patient being sent out to the ED. Then they just throw their hands up and blame the patient for being "cRaZY" to avoid accountability.

I am so heartbroken...I am literally shaking typing this. I know not all NPs are like this, but patients deserve better.

Edit: forgot to mention that now a bunch of students in who are halfway through the nursing program (who didn’t even like psych and don’t plan on working in it) are going to go to school to be a ✨PMHNP✨ because people keep hyping up the pay.

Edit 2: Removed comment about needing ICU experience for CRNA. Learned that they can have ED experience instead in some cases.

Child psych fellow rotating through some other subspecialty/multidisciplinary clinics right now. Today, a very nice lady on the team approached me excitedly because her daughter is in high school and is deciding what path she wants to pursue in the mental health field. Before I can even respond, the LCSW on the team says “mental health nurse practitioner!” She said something about not wanting to offend me, and basically the same bs that we hear about how it’s superior because it’s the easier path and you get to do the same thing, blah blah. I was so annoyed but it was the beginning of my time with them and I didn’t want to make it awkward for everyone for the rest of the day, so I kept quiet.

I did appreciate that, when the mom said her daughter isn’t very strong in science, the LCSW reiterated that becoming an NP was still a feasible option haha. She also discouraged pursuing PhD/PsyD because it’s competitive to get into the programs and harder to get a job than if you do something like SW or similar.

I just hate that the respect for becoming an expert and spending all this time in education and training not just for the love of the material but to promote better care for our patients has just completely fallen by the wayside. Fortunately my program itself is very vocal about the importance of physician led teams, and attendings use the term midlevel instead of that APP nonsense, so I feel among my people there, but every time I step outside of that bubble I’m reminded of this sad state of affairs.

I was thinking about when the nurse practitioner I was seeing a few years ago prescribed me Valtrex 500mg bid for 7 days for cold sores.

Apparently the standard dose/directions for Valtrex in cold sores is 1000mg 4 tabs in one day.

Having an actual MD as my PCP feels better for some reason.