To not want to see a Nurse Practitioner.

(149 Posts)
Selks Thu 07-Nov-13 08:27:31

Have just rung the GP for a Drs appointment today after being ill for a fortnight and having a suspected kidney infection. The collective advice of MN and NHS direct said I should see a Dr ASAP.
The only appt offered to me was with a nurse practitioner. I spoke to the duty Dr and that is all they will offer me. No disrespect intended to nurse practitioners but after being misdiagnosed by the nurse practitioner before for an unrelated issue I am not keen to see them again for a condition that if misdiagnosed could potentially end me up in hospital. Dr was unwavering when I voiced my concerns.
AIBU to want to see an actual Dr?

elfycat Thu 07-Nov-13 10:12:41

I'd see the NP as sometimes it's a way to get in the door to see a GP rather than wait. If it's something more serious they usually get a doctor to see you too.

I've had GP tell me I didn't have an ear infection, without looking in my ear, and a throat infection without looking in my throat because I didn't put on a rasping fake voice. When I insisted the doctor actually look down my throat (at the streaks of grey yukkiness) she wanted to cancel my holiday 2 days time as I shouldn't be flying or doing anything but taking it easy. I was not to scuba dive for a month, and it was a 10 day diving holiday to the Red Sea I ignored her. I only wanted to take the antibiotics with me just in case it got any worse as we were on a boat. The GP made me take the first tablet in front of her, knowing I would take the whole course and not add to the misused AB issue.

NP on the other hand listen and look IME.

VivaLeBeaver Thu 07-Nov-13 10:19:31

I saw a NP in a&e once who sent me for an x-ray, diagnosed a fracture and sorted it. She was very good.

AngelicaFirestar Thu 07-Nov-13 10:29:03

I prefer nurse practitioners. They are more willing to be sympathetic and helpful when you are a fraught mother with a child with a chronic ear infection, they are more willing to prescribe or recommend something actually helpful than tell you its just a virus and get on with it only for you to have to go back a few days later to get the kick arse drugs you thought you needed in the first place. The very fact that they can prescribe means to me that they are just as useful front line service as a GP. If the nurse wants a second set of eyes, they can always get a doc in to see you.

Selks Thu 07-Nov-13 17:01:02

Well, I had my appt with the nurse practitioner, and it was a mixed bag really. Good sides were that she listened well and took the time to do a thorough examination, tested a urine sample and was able to diagnose that I do indeed have a kidney infection. She was very pleasant and I was able to discuss a couple of other Heath concerns while I was there which I would not have had the chance to witan the doctor.
The side that perhaps was not so good was that it was very much a question of her going by what the computer said she should do re prescribing - she said she was only able to prescribe three days worth of antibiotics "as that is what the computer says to do". I queried that this seemed a very short course and was it likely to be effective, and she just said "well, that's what it says and just come back if it is not". I wonder whether a GP would have had more flexibility with the actual prescribing.

So a positive enough experience, and I'll feel happier to use the nurse practitioner for some health matters but I would still feel more confident in a GP's ability to prescribe.

Selks Thu 07-Nov-13 17:04:42

Hmm NHS website says antibiotics for kidney infection are usually a course lasting 7 - 14 days...confused

Mellowandfruitful Thu 07-Nov-13 17:05:20

I have had good experiences with mine as she does listen and treat you like an adult - which not all doctors do - but 3 days does sound like a very short course. Maybe try and get another appt in a few days and ask for it to be reviewed?

Mim78 Thu 07-Nov-13 17:08:46

YANBU.

NP once advised me to take Ibuprofen for a persistent cough. Turned out cough was due to acid reflux and taking Ibuprofen was very worst thing i could have done - actually makes it worse!

10outof10 Thu 07-Nov-13 17:13:08

3 day course of Trimethoprim is the recommended treatment for UTI's.

Floralnomad Thu 07-Nov-13 17:13:20

Last time I had a UTI I was prescribed a 3 day course ,I think its the norm now and for many people it is sufficient and on the plus side it cuts AB use , if you are not better it may well be that they will prescribe something else on the phone IYSWIM . That's what happens where we are .( I am a nurse BTW)

Arriettyborrower Thu 07-Nov-13 17:18:33

selks did she say you had a kidney infection? I am guessing you've been prescribed trimethoprim? A 3 day course would be prescribed for a low grade UTI.

Nurse prescribing can be very restrictive, so it may be more to do with her having to follow protocol (as NP is relatively new role) whereas GP's have little more autonomy re prescribing....

Arriettyborrower Thu 07-Nov-13 17:19:45

I mean in terms if her saying the computer says its a 3 day course..

Sidge Thu 07-Nov-13 17:19:50

Three days is standard prescribing (certainly in our area) for a course of trimethoprim or nitrofurantoin.

Many nurse practitioners have far more knowledge, training and experience than junior GPs. Of course not all of them, and the use of locums and GP registrars (trainee GPs) means that you could be seeing a pretty inexperienced GP instead.

Yes nurses and NPs can and do diagnose. It will depend on their knowledge, training, qualifications and experience. IME nurses tend to be more cautious in diagnosing as their registration is much more precarious and would refer on to a GP pretty swiftly if in any doubt.

Sirzy Thu 07-Nov-13 17:23:59

I was going to say the same as others 3 days is the normal length of course of antibiotics in this situation.

Personally I have more faith in the nurse practitioner at our GP surgery than I do the GP - actually once I bumped into her on the way out of the GP with DS who I thought needed steroids for his asthma but the GP said not and that he was fine, she took one look at DS and told me to get him to A and E - we got home 3 days later!

crankbadger Thu 07-Nov-13 17:24:38

Sounds appropriate for a urinary tract infection but not a kidney infection; did she def say she thought a kidney infection? Because a true kidney infection (pylonephritis) is a different ballgame really.

hiddenhome Thu 07-Nov-13 17:27:05

I always ask to see the NP rather than a GP because it's the GPs that I find are rubbish. I only see a GP if a referral is needed.

whatever5 Thu 07-Nov-13 17:33:39

It sounds as if she has diagnosed a lower urinary tract infection rather than a kidney infection which would be more serious. Are you sure she said it was a kidney infection?

rumbleinthrjungle Thu 07-Nov-13 17:36:01

Our practice NP is far more practical help and support than any of the GPs and if she feel a dr is needed, she nips straight up the corridor and gets one. I'd always rather see her!

Selks Thu 07-Nov-13 17:37:14

Arrietyborrower, yes she did prescribe trimethoprim.

She definitely said it sounds like a kidney infection. When I was laid on the couch she was prodding around my abdomen and prodded my kidney and I nearly shot off the couch in pain!

HicDraconis Thu 07-Nov-13 17:38:13

Doctors are trained to diagnose, think critically and problem solve. Nurses' training is more protocolised with heavy use of guidelines, flow diagrams etc. Nursing is now a degree level course (and many older school nurses will tell you it went to the dogs as a profession when that came in).

NP are like any other hcp group (GP, hossy docs, ward nurses, allied therapists) - you get the really good ones, occasionally really crap ones, mostly middlingly ok ones. A NP is fine for most of the minor ailments people see a GP with. A specialised NP (eg diabetes nurse) is better than most hospital juniors for management of long term chronic conditions.

3 days of antibugs is recommended for simple UTI (lower urinary tract). If you have pyelonephritis (upper urinary tract) problems you need 1-2 weeks.

My husband saw a string of NP who all reassured him that a trace of blood on urine dip was completely normal for a fairly fit young man who cycled / had just got over a cold / had exercised that day. The one that checked his BP also reassured him that 150/95 was normal at 30. The trainee GP he saw for his asthma checkup was the one that diagnosed the uncommon chronic kidney failure, ordered the tests and got him referred.

I still don't think they're all useless because a few of them missed something a trainee spotted. But for every "doctors are crap" story, there can always be the reverse.

Doctors and nurses are a team with different roles and responsibilities within the team. When those limitations on both sides are recognised and worked with, the team works and more importantly patients get better outcomes.

Ifcatshadthumbs Thu 07-Nov-13 17:40:43

I have just had a kidney infection and was also prescribed 3 days of trimethoprim so I guess that is standard. Had to go back for more but I thinks it's because I'd had the infection for a couple of weeks.

Selks Thu 07-Nov-13 17:45:10

It's definitely not a UTI. No UTI symptoms...have had that before and know what it's like!

Pain in my side is quite severe now, after having been out for the Drs appt.

I have no problem with a three day anti-biotics course if that is what will do the job, but I don't want to have an ineffective course which would delay rectifying the problem. Anyway I've rung the surgery back and the duty doctor is going to give me a ring back to discuss.

Selks Thu 07-Nov-13 17:45:50

Ifcats, interesting; thanks. Hope you got better ok.

HicDraconis Thu 07-Nov-13 17:53:06

Sounds more like pyelonephritis in which case 3 days is going to do sfa. You need a week with review at the end to see whether 2 weeks is needed.

HicDraconis Thu 07-Nov-13 17:55:01

(You may also need completely different antibiotics!)

DinoSnores Thu 07-Nov-13 17:56:37

YANBU. Nurses just don't have the training in diagnosis and treatment that doctors do. I would never see a NP for something that I needed a diagnosis for.

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