To not want to see a Nurse Practitioner.(149 Posts)
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?
You are blaming all NPs for one mistake from one NP. I have had much better care from NPs than from Drs many many times.
If you are ill enough to see someone, see someone.
Are you seein the same Np as before?
Tbh I don't think you have a choice. Seeing someone is better than seeing no one and theoretically if you need a dr they will get you an appointment.
I am happy to be persuaded that I am wrong, by the way.
And drs make mistakes all the time. Don't r under any illusion seein a dr will instantly mean u get treated. I wish we had a NP. Our drs are rubbish
YABU for listening to the collective advice of MN and NHS direct. An NP I perfectly capable of arranging urine tests and prescribing some trimethoprim, nitrofurantoin, cefalexin or similar - if she needs GP input she will go and get one for a second opinion.
That's kind of like saying "I don't want to see a Dr because one got something wrong once".
Tbh I would be more than happy to see a NP, I'm just generalizing here but I've found their knowledge to frequently be more up to date than GP's.
The NP will only do what the GP would do anyway- if you have ?kidney infection- take a urine sample and send it off.
Yes, I admit I have only seen a nurse practitioner once before, it was a bad experience and it has coloured my response in this instance. I'm quite relieved by your responses that I am BU actually and I'm prepared to accept that I might get a decent nurse practitioner this time.
NPs have more time to give you, so will hear all of your symptoms and will go consult with GP if there is any doubt about the course of treatment needed.
You have a right to a second opinion anyway so see what happens and go from there. It's also very common fir one lot of ABs to not shift it so again that's not a mistake if that
Having a NP must be a great device. All those people who wouldn't have seen a dr as a result of minor issues a nurse could deal with easily
and probably do a better job
Giles, in our GP practice NPs aren't used along side Drs though, they are used instead of.
I'd take what's on offer Op. Certainly don't allow this to drag on, you will feel dreadful. I've had alot of contact with Drs in the past 2 years (both in hospital and at the Gps)and could write a book about the mistakes they've made, misdiagnosis, paperwork lost etc. I've had nothing but great advice and care from NP. I might add I've also got a fantastic Dr now. Go and see the Np s/he will call the Dr if necessary anyway.
Glad to hear of people's faith in NPs, it's making me feel better about it.
But if you otherwise wouldn't have seen anyone .......
Lila, I am attending the appt with the NP.
I saw a nurse practitioner a couple of weeks ago for a 'sensitive issue' I was 34 weeks pregnant and my appointment ended up over running from a 10
Minute appointment into 50 minutes because she was so thorough and wanted to make sure i got the best treatment I could have whilst pregnant...
That was my 1st experience and I would now see a NP over a GP any day
Giles, I wouldn't have seen no one, I would have seen the Dr.
Diagnosed by a Nurse Practitioner? Nurses do diagnosis now? From cold, not just variations on pre-existing conditions?
I admit I'm not clear on what the roles used to be, but that has actually shocked me.
Is there some medical benefit to doing things like this?
Or is this using nurses as cutprice doctors and hoping no one ends up in front of them with something serious they're not qualified to recognise?
Selks, the nurse will refer you straight to a doctor if she thinks you need to see one, dont worry about that! Alternatively she can certainly get a prescription made up for you.
An NP has more training than a nurse, Parsing. I am not sure where the line between NP and GP lies, but NPs can and do diagnoses illnesses.
My experience with the NP before was rubbish. Went in regarding a chest infection. They clearly had a huge bee in their bonnet about anti-biotics and how they are over prescribed and gave me a big lecture about it. They refused to prescribe, telling me it was not a chest infection, and sent me away. I ended up very poorly eventually got the correct treatment from the Dr. That's why I am wary.
But GPs do the same thing all the time Selks. Read MN for 10 minutes and you'll see the threads.
All HCPs are human. Humans make mistakes.
Apparently - but why would you want them to?
I can completely understand specialist nurses for management of longterm conditions - they'll get much better at it than a GP, as they'll see so many cases and have a better idea of day-to-day living with the condition.
But walking in cold off the street when you might have indigestion or you might have cancer.. enough GPs miss stuff like that, I can't see how reducing the years of training and other professional requirements is going to improve diagnosis.
Nurse practitioners can write prescriptions and are very experienced. Give me one of them over some junior doc any day. They are generally fab.
But aren't their lists that both drs and nurses are aware of. Ones where if symptoms tick certain boxes it flags up.
I don't think drs are any more likely to pick it up than NPs or nurses.
I remember watching an undercover doc where they sent in people with textbook symptoms and drs missed it completely.
The NP will only generally be given patients with UTIs, chest infections etc.
They're really very capable and have usually been doing their job for a very long time.
The NP where I work even does home visits (not the sort district nurses do but the ones GPs do)
Our NP's are bloody amazing. I saw one for a lump in my breast (fibrous lump so no worries) and she was so calm and reassuring.
Also, I think in our practice they have areas of speciality so our receptionists (also brilliant!) discreetly ask if you'd mind giving an indication of the issue so they can place you where you will be best seen.
As with most things in life, it will depend on the person.
Although I'm very happy to be treated by specialist nurses for my long term chronic condition (in hospital) I would not be very happy with being told I have to see a nurse practitioner and not a GP at my GP surgery.
Obviously it would depend on what I thought was wrong with me but although NP may able to diagnose a lot of things they can't replace a GP for everything. A GP has had a lot more training. I would try and switch practices after this is sorted out.
Whatever NP are generally only given patients with minor ailments. Would you really not be happy for a NP to see you for a uti? All they need to do is dip it, and if needed send it off to the lab. Or if you had an ingrown hair? A chesty cough? A dog bite? (These are the things our NP has seen people for recently).
Doctors are busier than ever so if a very capable nurse can treat a patient then why not?
Op I hope you get better soon
I'd rather see a NP any day than 'Dr. There is Nothing Wrong with You'
Mind you so would everyone else in the town, Dr TNWWY is the only one who ever has any appointments
I'm not sure why people have oases with nurse practitioners? They have to be degree educated and in my experience have a better bedside manner than doctors. They're always so knowledgable, (need to prove themselves more than a GP does, maybe?)
I've been misdiagnosed by GP's twice. Not once by NP's. Go figure.
NP's arent just "NP'S" they have done 3 years nurse training plus 18 months on top to of that plus all their experience. Throughout my training I met charge nurses/NP's even staff nurses that were more knowledgable than doctors on the wards! I think that's a bit of a rubbish attitude to have to dismiss all NP's on one experience. As I said, I have been misdiagnosed by two doctors but I still go and see other doctors as the majority are good at their job.
Also selks if the NP thinks you need to see the duty doctor you will likely get to see him/her straight away rather than waiting ages for an appointment
I think doctors are a lot more qualified than nurses, and I would demand to see a doctor for a serious issue.
The only reason yo are fobbed off with a nurse is "cost".
But maybe you need to see a nurse first before you can see a doctor?
Our NP is brilliant. She mainly does minor ailments from what I know - certainly that's what we've seen her for. She's a v experienced nurse, ex-HV and now the Community Matron for our GP practice and has obviously had extra training to do this role. She's actually an excellent person to see with small kids. Also I think there are strict guidelines as to what she can deal with herself, I have known her go and grab a GP for their opinion where what you are presenting with goes beyond her role.
Our np is really quite good. I prefer to see her over some of the gp's in the practice. If she wasn't good I would insist on seeing someone else. Same if the gp wasn't good.
Spotty, in every one of your examples, the diagnosis has actually been done by the patient before they came in - which is how they were "given" to the NP.
They've come in saying, "I have an ingrown hair, dog-bite, a UTI. I'll see the NP for treatment."
So actually the NP didn't diagnose anything.
Fiscal NPs only deal with minor ailments ime so if it's serious you should definitely get to see a gp
Oh I so get you
I just wish my GP could mark my file since I am lucky enough to go there about once every 5 years (outside pregnancy) so when I go I have no interest in seeing the middle man last time I went the first thing she said in response when I told her what was wrong was you need to see a Doctor
Urrr yes I told you that myself when I phoned.
I should bill them for my wasted time ha ha!
Don't get me wrong, I'm not suggesting NPs aren't trained or don't have degrees, or aren't lovely, smiley people.
But by definition they are less trained and qualified than GPs. And I can't see a medical argument for using a less knowledgeable person for diagnosis - only a cost one.
Sadly it seems you have to go through the NP just to see a doctor these days.
In our Gp they work alongside the doctors, so will fetch a doctor if there are any concerns.
At the last GP I was registered with, the NP diagnosed pneumonia, and gave me 5 days of antibiotics. I asked her if that was long enough for pneumonia, and she said "yes of course, dont you trust me? And you can always come back for more". I ended up on 4 courses of antibiotics, steroids and an inhaler, as the bacteria had developed resistance to the first course and took over completely as the course was so short. I dont remember ever having been so ill. (aside from when I had viral meningitis)
Downstairs doctors have done more 'training' than a NP just at university that is before they even start their training
Although what we seem to be saying is it depends on why you go!
True but lots of people who come in to see a gp know what the problem is, or at least suspect it. If they suspect a uti or chest infection it's still the NP who needs to diagnose it. I don't think a patient would be told to see a NP if it was something really complicated. That's the whole point of NP, to take the work load of minor ailments from the GP.
I think it depends on the doctors surgery too, my own surgery doesn't even have a NP! But yes definitely depends on why you're going
(And BTW I've had some pretty shit GPs, so I'm not exactly putting them on a pedestal. But they would have been just as shit if they'd been NPs, but known less. And I'd have had the time, cost and hassle of getting to the surgery twice as often.)
Well exactly, Spotty, there's clearly an immensely valuable role for NPs.
But when a patient wants to see a doctor because it's been going on for a while, and the possibilities of what it is are very broad, then refusing to allow them to see a GP is... well, interesting.
A gp sent my dd home with "a cold"
Ended up in a&e and admitted for 4/5 days.
Another prescribed movicol for when she needed a special milk.
I don't trust drs at all.
The nurse in hospital however figured what was probably wrong with dd five days before the drs "got results back"
Not saying that they don't have to wait for test results but there was no mention of UTI at any time as a possibility, despite the nurse stating that the dip results were indicative of a UTI.
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.
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.
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.
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.
Hmm NHS website says antibiotics for kidney infection are usually a course lasting 7 - 14 days...
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?
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!
3 day course of Trimethoprim is the recommended treatment for UTI's.
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)
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....
I mean in terms if her saying the computer says its a 3 day course..
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.
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!
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.
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.
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?
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!
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!
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.
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.
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.
Ifcats, interesting; thanks. Hope you got better ok.
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.
(You may also need completely different antibiotics!)
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.
My last UTI / kidney infection (not sure what they decided in the end) had 3 days of ab's but in the interim they sent the urine off to see if it needed anything else - they called me back on day 4 to confirm my ab's were sufficient and that I wouldn't need anything further (with the usual caveats about still feeling ill etc etc).
If you have a kidney infection you should have been given a longer course of antibiotics. A GP would know that, I'm sure.
When I had pyelonephritis I had to go and see one of the GPs to tell her that I'd been given the wrong antibiotics by another GP she consulted her computer then gave me new ones.
And given the pain, you probably need to have a renal tract calculus excluded as well (kidney stone). Don't assume pain = infection, may be mechanical.
Duty Doc has just rung back and I'm pretty annoyed....after the lengthy exam and her TELLING me it is a kidney infection she has logged it on the computer as a UTI! I said to the Dr I know it is not a UTI as have had them before and this is very different. Anyway the Dr was quite sheepish and has made the prescription up to a week now (which is good but means I have to go down again and pay for another prescription, grrrr).
Humph. Not impressed.
AND....hopefully I will be ok for work on monday (this is the plan) but if I am not I will not now be able to get a sick note that says kidney infection if it is wrongly listed as a UTI....
OP- did the NP send off a urine sample for testing?
I wouldn't be impressed either. It upsets me to see the standards within the NHS fall year after year. A nurse should not be diagnosing someone with a suspected kidney infection. A UTI yes but not a kidney infection.
Im not a doctor but living here in the US I have had a very positive experience with a nurse who is able to write scripts. At the paediatrican office the nurse writes the scripts up when they are really busy and they are double checked before being send to the pharmacist. It is very efficient and our pharmacist delivers to our house. Sometimes the medicine is at home by the time we get back.
whatever, yes, the sample has been sent off, which is a good thing I expect.
Renal colic = calculus
Lower flank pain upon palpitation or continual = UTI/Pyelonephritis.
Some UTI's cause pain in the flank (renal pain). Mine always do but the kidneys are clear. Don't assume that kidney pain always means kidney infection. Pain can and often is referred.
I don't assume all MW's are bad because both of my births went wrong because of their incompetence.
I don't assume all Doctors are incompetent because of the ones I have worked with who i wouldn't want near a pet fish let alone a human.
If you want to see a GP then upon calling reception, tell them it is a condition that needs to be seen by a GP and tell the receptionist you do not wish to discuss with her, the precise nature of your condition. This is what I do and everybody I know does. It works.
Well the pain is all on my side and back all the way from top of buttock to mid back ribs, so nowhere near my bladder. I can't imagine that pain this strong is referred pain. I don't understand why she would say 'kidney infection' then write on notes UTI?
When I had pyelonephritis, I could actually feel that my kidneys had swollen up. They were painful and I could feel the pressure inside. I could hardly walk.
Ok, I had terrible ear infection and could not get docs appt for nearly two weeks . After your doctors surgery has closed, dial 111, tell them your symptoms. Lay it on a bit if you have to, and you will get an out of hours appointment at your local hospital. Dont bash me. I had no choice but to do this as my surgery had no appts or emergency appts and I needed anti-bios. It might be your only option to see a doctor quick. All the best and hope you feel ok and get it sorted soon
Many UTI's have no bladder pain. UTI's in the elderly and in pregnant women are frequently asymptomatic w/ regards to pain. That is why they can be insidiously dangerous in those patient groups.
She clearly made a documentation error. It happens and it is not right but I have met so man great NP's (my sister was one of the first) and some not so good. They are however, not a second best option. We have been conditioned to equate GP=best option when in fact they often are not. I would choose drug/Px advice from a pharmacist, a GP nurse for jabs and a smear for example. I would never want a jab from a GP- they don't do enough of them! i'd rather do it myself.
There are a lot of nerve endings in the urinary tract. It may or may not be partially referred pain but it would be inappropriate for me to say. However I would encourage you to contact out of hours if the pain worsens, becomes colicky (wave like), you develop rigours, frank blood in the urine or retention of urine.
Until the cultures come back, broad spectrum is all they can offer. this is because of the irresponsible patients who do not take their antibiotics properly or who take them inappropriately. It has caused local HA's to need PX protocols to rotate what drug is PX and when to try to mitigate resistance.
I hope you begin to feel better soon. Fill a hot water bottle up and hold against your flank. Keep well hydrated and Pass urine frequently. Keep a close eye on its colour and specific gravity- is it getting cloudy or clearing?
Its not whether you were seen by a GP or an NP that makes the difference, its whether either one of them is any good at their job.
OP please contact out of hours. Myself and everyone on here have all good intentions for your well being but enough is enough, Its gone on too long. Leaving these things only makes matters worse. Out of hours is actually easier and quicker than some (especially mine) doctors surgeries can be.
MrsWedge I second you on that one
I've noticed that a lot of people seem to confuse UTI and kidney infection.
Mylovely, thanks but I have antibiotics to take, so I'm going to see how it goes. I can contact the surgery again tomorrow if I'm concerned.
MrsWedge for lots of people it does make a difference, in my case if I know I have a problem that needs a nurse I see a nurse, if I have something that needs a Dr I want to see a Dr, it is a waste of time and the taxpayers money to make me see a nurse first (hers and mine!)
Mignonette that's great advice but perhaps you could tell us how to keep an eye on urines specific gravity
Did she check your heart rate/temp? For a true pyelonephritis to be diagnosed you'd be pyrexial and tachycardic. The UTI/kidney infection terminology debate strikes me as a bit tomayto/tomahto tbh, as technically speaking the urinary tract starts at the kidneys, with the ureters forming the top of the urinary tract. So, the infection could've climbed as high as the ureters - some would (incorrectly but understandably) refer to this as a kidney infection, but UTI is the correct term. If your temp and pulse are within normal range, 3 days of abx is the correct initial treatment. If they're not, or they become abnormal, you need to be seen by OOH ASAP for different treatment.
I do hope it doesn't become pyelonephritis OP, I had this and was in hospital on IV abx for 3 days, I remember the pain (6 years ago) better than I remember the pain of analgesia-free childbirth (2 years ago)! Drink lots and lots of water, and if it's nitrofurantoin you've been prescribed make sure you don't take them on an empty stomach, they're evil!
I wouldn't see a nurse, it's a two tier service and nurse training is not academic at all. I did the np training 10 years ago and some of the people on the course were severely thick
YABU. Take the appointment and if you're unsatisfied then see a doctor. It was an NP that saved my life, literally. She referred me immediately after looking at my cervix during a smear test.
I am not very confident with NP - fine for a narrow range of conditions but my experience has been that they tend to under diagnose. Both dd and I have ended up pretty poorly after being told that we had something minor and not being treated (or given the wrong treatment).
and there is this thread which is frankly astonishing - how could the symptoms not have concerned the NP that the mner saw?
Can anyone clarify the training as [[ http://www.brighton.ac.uk/courses/study/nurse-practitioner-bsc-hons this course]] seems to be a year long, I presume on top of a nursing degree. It doesnt seem very equivalent to a gps training. Happy to be educated on this!
You can buy clinistix from chemists and they have a little chart that interprets results.
In the meantime, check out the density and colur visually. An increase in cloudiness and 'denseness' (it looks turgid and 'thickened') is a sign that infection is there and/or the kidneys are not doing their job as well as they could.
Speaking as a RMN w/ specialist nurse practioner status and possessing a first class MA I'd have to disagree with you Theo as to the academic nature of nurse training.
Maybe your cohort was an abherration?
My sister is a NP and GPs consult her on many occasions. She has GPs in training placed with her because she is so good at her job (proud big sister here). She runs the asthma and Diabetic services and is an expert on Diabetes and the community management of it. I would much rather go to her with her specialist knowledge of these conditions than a GP with his/her bog standard generalist knowledge because alongside the clinical, physiological management my sister takes into account the social, economic and psychological factors that affect every patient.
No the training is not the same as a GP's. They are two very different professions. But a NP is not second best, you are not being fobbed off if you are sent an appt with one. And remember that like GP's, all nurses have CPD-continuing professional development as a legal condition of registration. They have to develop their practice and maintain portfolios that demonstrate reflective learning. You wouldn't believe how much research and professional development nurses like my sister and I undertake and most of it is not funded by my trust.
There are good and bad in all HCP's. How silly of anybody to write off an entire profession because of poor care by a few.
If we can have appointments with NP why do we bother having doctors we could have three or four times as many NP than we could doctors and then all get to see a medic quicker.
Perhaps my judgement is clouded as NP misdiagnosed and that was with me telling her what was wrong as dd had had it before - took her to gp but it took a week to get appointment and he confirmed I was correct and asked why I hadn't brought her in sooner as it spreads and I know that as she has had it before - and as dd is allergic to penicillin it is import her mother gets it sorted asap. I explained that he should perhaps look at dd's note and see the NP refused to believe me. Gp was then very quite.
Saw her a second time and gave her the benefit of the doubt and again she got it wrong, this time I changed gp's as I had enough.
"the training is not the same as a GP's. They are two very different professions."
Which is why people are complaining when one profession is being used to do the job of the other.
They are not doing the job of a GP!
That comment shows a lack of understanding regarding the two roles. They are complimentary.
The OP asked to see a GP for a diagnosis of something unknown. She was refused an appointment and told she was only permitted to see a NP.
The OP's surgery clearly is using an NP to do the job of an GP.
(Could these abbreviations get more confusing?)
Mignonette, perhaps rather than expanding further on the (very fine) role of an NP, you could explain what a GP's role is?
And highlight where this differs from an NP's role.
That might help me understand the roles better.
There is enough information online to tell you that Parsing. it'd take me all afternoon . Your surgery can also tell you.
There has always been an overlap between the tasks and role of many many HCP's- visit a CMHT and you will see that. Each HCP has tasks they can NOT legally or professionally do, tasks they can do upon registration and tasks they can do w/ post reg training.
I can do what an OT does in part. I also fulfill some of the role of a physio w/ regard to advice. I give benefits and basic legal advice (doesn't make me a lawyer or DWP worker). I give PX advice and deal w/ dosset boxes. Doesn't make me a pharmacist.
In my hospital clinical prcedures are carried out by clinical assistants and nurses that in other hospitals, only Drs carry out. Not because the doctors cannot be arsed, but because roles expand,. change, morph.
If you want the best advice, treatment and support for many many chronic conditions, a NP will have far more knowledge than the GP because it is their specialist area. There are clear protocols for treating UTI's/kidney infections and if you think somebody will get it wrong because they are a NP and will always get it right because they are a GP then you are mistaken.
Oh, and try getting the best most informed advice about MI from a GP! They really only know the basics gained from a rotation of a few months MH during GP training. And ask a GP how many lectures they had on prescribing and on pharmacology beyond med school. Most of my Dr colleagues admit most of their information comes from what the drug companies tell them!
"if you think somebody will get it wrong because they are a NP and will always get it right because they are a GP then you are mistaken."
I don't think any has said anything even remotely like that? Quite the opposite.
So not even a loose summary of the difference in roles, with two or three key points, mignonette?
After all, you've had time to write yet another few paragraphs on how NPs are better than GPs.
Parsing - might I suggest you get off your butt and research it yourself?
If it is that important to you I figure you'd have done it rather than rely on what you seem to infer is my incorrect and subjective opinion?
Ans you are misunderstanding what I said. I have made it quite clear that NP's are not always the also ran nor GP's the best. Reverse those and that is correct also. I have pointed out where you might be better off with a NP seeing as the thread is querying that
Incorrect and subjective opinion? No, no one's saying that.
I was just hoping for your fuller opinion, covering areas you hadn't previously, since you have so many examples at your fingertips as to how NPs are the same as GPs (professional development) and areas where they are better (specialist long term day to day care).
So I thought you'd have similar examples already in mind about where GPs are likely to be a better first bet.
It seems you don't, so that's fine.
Kidney infections and cystitis are both types of urinary tract infections (UTIs).
3 days is the recommended antibiotic length for cystitis, kidney infections usually have 7-10 days depending on symptoms.
Sorry, shouldn't say you don't have examples, just that you haven't chosen to share them here. Which of course is also fine.
I'd prefer to see a doctor over a NP if one is available. If not, I'd see a NP if I felt I couldn't wait.
Likely to get flames, but AFAIK, the way GP is funded at the moment means that loads of partners are opting to employ NPs rather than make-up one of their trainees/salarieds/locums. I can't help but think that this is for their own financial gain and there will be a load of highly trained un or under employed GPs about soon whilst the more mature business owners see their drawings improve.
I take serious exception when a nurse calls themself a consultant though - that's plain misleading in my book.
Coding pyelonephritis or a kidney infection (Latin or English) as a UTI is not incorrect. Coding pyelonephritis as cystitis would be. Both you and the nurse are confusing cystitis and UTI. They are not synonymous.
Your urinary tract includes your kidneys, ureters, bladder and urethra so infection of any part is a UTI.
You do understand I'm completely agreeing with you, mignonette, about the excellent professionalism and work of nurses and nurse practitioners? How could I do otherwise - you're the (comparative) expert.
But I'm not prepared to let that gloss over the issue the OP raised. Is it appropriate in this sort of case for a NP to be doing diagnosis, from cold, of someone who's walked in off the street with something unknown.
Because if we allow our pride in the professionalism of nurses to dull us to issues like NPs potentially being used as cutprice doctors in areas where it's medically inappropriate, then we're doing no one any favours. Not the nurses, not the patients, not the doctors.
I have great faith in NPs - one correctly diagnosed a relatively minor ailment that my doctor was investigating as possible MS! Was a fantastic relief to realise it was nothing so serious, and all down to the common sense of my NP.
Doctors refer to other doctors. Some NP's will refer to say a Diabetic clinic/respiratory clinic and other specialities that concur w/ their own training whilst a GP doesn't need specialist knowledge bar his own GP training of a condition to refer. Many GP'#s have their own specialist areas of interest and knowledge of course-one of mine is interested in MI within certain imiigrant communities and is excellent at calling services in to liaise.
Doctors can do out of area transfers
Doctors know what other doctors do best
Doctors can prescribe all the 'interesting' drugs (although MW's can write you up for opiates)
Doctors usually perform minor surgery (although in my surgery a NP does some of it)
Doctors pronounce death, write certs, do medicals.
Doctors tend to have the wider remit of diagnostical responsibility although that doesn't apply across the board
Doctors 'pronounce' pregnancy
Doctors are more likely to see first time visits for symptoms and will also see more complicated multi-system diseases requiring secondary care
Doctors will do DV's to Px and administer drugs.
There's more but it all depends upon your own area- our area has quite far ranging NP/DN/CN powers and I have a great deal of 'power' (if you want to call it that) over what GP's in my area do re mental illness.
It is very variable and the roles will merge even more over the next ten years. No longer is nursing a job people go into because they don't have the grades or ability for medicine or other comparable professions. I know plenty of rote nurses, plenty of rote doctors but on the whole I like and respect NP's and think that the experiences related on here are not representative as a whole.
Did you know that my sister had to achieve 100% on her prescribing examination? No room for error. And it was really really demanding too.
Parsing yes I agree that they must not become a doctor substitute and I apologise for speaking rudely to you. Have had a crap few days and unfortunately you bore the brunt .
As for the other comment by Helsp. In the broader sense of what 'Consultant' means, there shouldn't be an issue with a nurse consultant. It just points to a level of in depth knowledge and research based practice that stands shoulders above standard nursing practice.
As an example I can talk about the Nurse Consultant for Wound Care. She works to develop national protocols and the local implementation of. She liaises with doctors in all areas of medicine and nursing to reduce the morbidity and mortality from wound infections, pressure sores and other problems. She trains, advises and supports junior doctors, the Professions Allied to medicine (physio/Ot/Speech therapy etc) and visits nursing and retirement homes, hospices, home carers etc. She is involved in the research, implementation and evaluation of wound care products, trials or products or techniques, the clinical benchmarking process and other audit trails.
She also does direct patient care, teaching at the bedside. She also attends the school of nursing and the medical schol to lecture and hold training there.
She is an expert-a Consultant. People consult her. The doctors who work with her would be the first to acknowledge this.
And this is just one example.
Thanks for that, that's very helpful.
It looks from that (and I get it's just a quick sketch), as if the biggest differences are that GPs do more admin than NPs.
And they can also do a bit more surgery, a bit more prescribing and a bit more diagnosing.
Sorry you've had a bad few days, Mignonette.
Sadly nursing admin is just as horrendous as they have their own notes to keep. NP's are also involved in audit, benchmarking, clinical meetings, group practice meetings......It is endless. The admin is tandem, often duplicated but legally every professional involved in patient care has to have their own system of records. GP's have the business side to deal with though and that is what is killing patient time I am afraid. One day Nurses will be able to buy into a partnership (GP's won't like that) god help them.
You should see the notes I lug around. My patients all have notes the thickness of an old Bible, bless them.
I envy the Doctor collegiate system of professional support although its negative effects can be seen in the aeons it can take to expose malpractice or get action from a complaint. There is an old saying - Nurses eat their own young in that historically there has been less support and professional protection from within the nursing system towards new nurses.
YANBU to not want to see your nurse practitioner. Some NPs may be excellent and very competent, some not so (like all professionals in all roles).
The NP in our practice made me feel like I was making a fuss over something very minor this week. I sought a second opinion from the GP a couple of days later and ended up admitted to hospital. No one quite understands why the NP wasn't more worried about my symptoms.
If you have had a poor experience with this individual in the past, it will of course cloud your judgment. I will think twice about seeing her again in future.
Talking of which, after choking your thread up with theoretical stuff, hope you're feeling better today, Selks.
Yes, ditto Selks. I apologise for being a bit self indulgent there and hope you are feeling better.
Might I also suggest you write to the surgery with your concerns because if indeed the NP is incorrect and more importantly not listening to your concerns (because sometimes even the best get it wrong), then she won't be able to correct her mistakes if she doesn't know about them.
I realise that when you feel ill, this is the last thing you really want to do. However i have spoken to GP's in the past about a concern I had regarding a regular practice nurse (not an NP) who 'diagnosed' over the phone my allergy to penicillin as 'don't think its a rash from an allergy'. I went to see the GP anyway and ended up seriously unwell with a form of bullosa from the allergic reaction. He was VV concerned that I had been diagnosed over the phone and asked if i wanted to complain formally. I said not but could he ensure the nurse received some decent in house training and guidance on phone consultations. He happily did this (and was very relieved to not have to deal w/ a formal procedure).
The other surgery nurse is excellent BTW and gives good needle _ i'd never want a Jab from a GP
Get well soon Selks and drink plenty of [tea]
Thanks ParsingFancy and Mignonette, I'm not feeling any better, but not feeling any worse! Early days with the anti-b's though.
I welcome the 'theoretical' contributions to this thread, and I'm happy for it to take that direction as it's been very interesting and educational. Thank you all who posted, and do keep up the discussion if you feel like it.
I only ever see a particular NP at my GP for everything. They can basically do everything a Doctor can do. I absolutely love this particular lady, and she always, always goes that extra mile for me and my family. Even gives me a call every now and then to check how I am doing if I haven't been in for a few weeks (I have health problems).
Never known any GP to be as good as she is. She is awesome! I accept not all will be as good as her, but not all Doctors will be perfect either. Give the NP a chance if it isn't the same one as before.
Selks - Are you able to access out of hours over the weekend? Hopefully the scales will tip back in your favour by later today and that will be a moot question.
Keep a hot water bottle cosied up to your kidneys and remember to drink loads. I always glug Robinsons Lemon Barley Water by the shed load when I have any form of UTI. Might be placebo but it seems to soothe.
Sorry, bit late to the conversation. Just wanted to quickly add a positive story before having to rush out and then saw your last post!
I do hope you feel better soon. I have never had a problem with my NP prescribing things, maybe it is just that system at your GP? It does sound rubbish.
Also late to the conversation.
Our surgery has physicians assistants. see here. I would rather see a NP than a PA. They are forever checking in their books and looking things up and generally not looking like they have a clue. And they can't sign prescriptions so you then have to wait ages after your appt for your script to be signed by a GP. I'm a nurse btw.
A 3 day course of broad spectrum antib is usual. If the lab is doing its job it will test the sample and then gram stain it and the result will tell the doctor which antib it will respond best to so it may be changed anyway after a few days.
Hope you feel better soon. I had kidney stones in June and nothing like the pain after a kidney
mignonette some nurses can pronounce and certify death. Usually in the community so they don't need to wait for a gp to come.
Meerkat I didn't know that. Makes a lot of sense as so ridiculous to wait for a doctor.
re 'consultant'. If you introduce yourself to a patient as a 'nurse consultant' well fair dos. What is distinctly off is to say that you are the 'consultant' as, for better or worse, the public and medical colleagues will think they mean the medical/surgical/other consultant and no matter how fab and capable any NP is, they aren't the med/surg consultant. An introduction such as this is misleading.
I have been on the recieving end of this and, as some of the advice was not as expected, I queried the status of the advice giver and discovered the omission of 'nurse' infront of consultant. Elderly relatives of mine have been surprised when they got their copy letter to see that they didn't see 'the head man' (don't get me started on that one.... ) after all.
Well that is wrong and your code of professional conduct is explicit re properly identifying yourself and the limits to your knowledge.
However i will say that the nurse consultants and specialist practitioners I have worked with are in possession of far more knowledge of their subjects (wound care/infection control/ than the consultant doctors. These are areas of specialism with no absolute medical equivalent.
As for what people expect re consultant' that will change over time. Of course many elderly people will expect the consultant to not be a nurse. It is up to the professional to make this crystal clear. I'm surprised she/he did not wear a name badge either on her chest or on a lanyard. Everybody I work with/come across has to wear an I.D badge, security tag, and/or name badge. That rather surprises me.
l agree that the care from nurse practitioners is often better than the care from GP. l would put a urine test in ASAP, they will give antibiotics without seeing you if it is positive for UTI. You may not need to see anyone.
"the roles will merge even more over the next ten years. No longer is nursing a job people go into because they don't have the grades or ability for medicine or other comparable professions."
How does that fit with what you were saying about doctors'/nurses' tasks being different and complementary?
Merging is more like the tasks being the same, but carried out by people with a variety of job titles.
I much prefer NP's OP I've found them excellent, and the Doctors crap , twice I've been misdiagnosed, only for it to be picked up by a NP. Hope your feeling better.
Our NPs are really useless. Every time I've seen one, either by myself or with the kids, they have followed a script on a screen, rigidly stuck to the algorithm , and twice when I queried their diagnosis and treatment they sought advice form a doctor who completely changed the diagnosis and treatment, once to have my son admitted to hospital immediately with a tonsillar absess who the nurse dip said was a viral throat needing no treatment!
I've been hospitalised 4 times with acute pyleonephritis (which you definitely don't have, luckily) and had countless UTIs so you have my sympathy! UTIs do make you feel so rotten I hope the antibiotics work and that it doesn't progress further.
"One day Nurses will be able to buy into a partnership (GP's won't like that) god help them"
It's already happening Mignonette. In some areas NPs are partners in practices.
Also with the difficulties in recruiting new GPs and so many due to retire over the next few years I foresee a huge rise in the numbers of NPs employed by surgeries. Practices are caught between a rock and a hard place IMO - patients expectations, volumes of consultations needing to be seen, large list numbers and demand for appointments mean that GPs need staff to see their patients. They can't recruit GPs, can't afford locums, can't afford for their patients to go to OOH (we get charged per OOH attendance) so must employ NPs who are qualified to carry out assessment and treatment.
Many NPs are hugely qualified and experienced (ours is involved with GP training) and are more than capable. I imagine the problems arise when GPs employ underqualified, inexperienced NPs or they are unsupported in practice.
Where are all these practices that can't recruit GPs? Amongst my friends that went down that path there are loads of fully qualified GPs out there can't get into a partnership for love nor money.
For my education, who carries the can if (god forbid) an NP makes a mistake. Regrettably it is human nature that we all make mistakes, but if my CNS does, she does it under my guidance so I am jointly accountable as I will have left her overexposed or inadequately trained for the activity that I have asked her to extend her role into. Not sure what happens with indemnity insurance too.
Parsing, what I really meant was the status of the roles will merge. Typo caused by inattention. sorry.
The Nurse carries the can because she is professionally and legally accountable for her own practice under NMC regulations. Just as an OT, Physio, Speech Therapist, Radiographer, Doctor of Medicine and Paramedic all are.
The issue of indemnity will have to be worked out just as is happening w/ private MW's. It will happen.
Helspopje in my town I believe there are 5 practices with unfilled GP partnerships. The one I work in is one of them.
Like any nurse a NP is responsible for her own practice by the NMC registration Code. Indemnity insurance may be provided by the MDU but membership of a nursing union is often also advised.
The RCN had its teeth pulled years ago. I think they are bloody useless and I would not trust them to represent me in any malpractice/tribunal/misconduct case.
Oh I absolutely agree! They are spineless and I would rather represent myself than involve them...
Exactly Sidge. I have seen some breathtaking acts of collusion between the RCN and Trusts which caused irreparable harm to some amazing nurses.
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