To not agree with the nurse practiser's view that my DS has asthma and to think a diagnosis should come from a doctor?

[PolkadotCircus]

Soooo my v healthy but skinny boy 9 has had a nasty winter virus that he has had problems shaking off,symptoms involve a cough that won't go away.Loads of other kids and adults have had/got it here.

The same happened last year and our fab doctor gave him temp inhalers to calm his airways down which worked a treat and were never used again.

His grandad is the same(very skinny and some times gets a chest infection in winter it takes a whole to shake off) but still cycling 16 miles a day at 80.

Anyhow dtwin 1 keeping dtwin 2 awake so tried to get an appointment with our fab GP but because he is so fab it is nigh on impossible so was offered an appointment with a nurse which I reluctantly accepted as all I wanted were temp inhalers and ds better ASAP.

Anyhow after a very lengthy appointment when his puff was measured,history looked at,records filled in,weighed etc she finally gave us some inhalers.Puff was poor(errr yes he has a virus and a temp) and we were told to come back for a follow up asthma review.I said but he doesn't have asthma only to be told well this happened last year etc,etc.

So we went to the review puff beyond normal now and very good,virus over so no surprise.Nurse then said as he had asthma she'd like to see him again,keep him in her records,how many inhalers did he have etc,to keep him topped up when tight in the chest etc etc.

I said very firmly he doesn't have asthma and never gets tight in the chest.She then asked if he had eczema or hay fever.He had eczema as a baby and gets a bit sneezy in the summer ahhhh then they are linked so he does have asthma.Me-no he doesn't he just gets a cough he can't shake some winters.
I don't want asthma on his records unnecessarily.We politely agreed to disagree.

So aibu to think a)he doesn't have asthma and b) a diagnosis should come from a doctor.

The doc prescribed an inhayler last year or the year before to get rid of a persistent cough after a virus.I wanted the same this year,nothing else as it worked so well last year.Would have been happy with a prescription left on the desk,next thing I know we're at the chest clinic with an asthma diagnosis..

So yes now I'd like to see my gp.

But they can't just represcribe without seeing your ds after so long. I had similar last year, now have a daily inhaler and am under the Respiratory clinic at the hospital to see if it is an allergy, asthma or post viral narrowing of small airways. You don't have to be wheezy to be classified as asthmatic. gp referred me to the practice nurse in the first instance and she referred me to hospital. By all means chat to gp but ime it is the nurse who handles ongoing asthma care.

Merry - How old is your DS? If he is under 12 then it is being used outside it's product license, but that is something that we do see (although not that often( if the patient needs the higher steroid dose. (only the steroid dose increases from one strength to another, the salmeterol dose remains the same).

It sounds like it is working well for him - long may it continue!

Why is it such a big deal to you that he has asthma on his record??

Montelukast/Singulair has been great in reducing night time coughs here, no Dr had ever recommended it but the NP.did and it's pretty much improved DDs asthma ten fold. She uses it in conjunction with 400mg of Flixotide daily.

YABU.
Your son has a history of allergic disorders (eczema and hay fever), making asthma more likely.
This is the second winter he has had the same problem, prolonged cough, worsening at night by the sound of things (typical asthma cough), eased by inhalers.
The NP took a spirometer test which showed decreased lung function, recheck after inhaler therapy showed normal function. This is one of the tests for asthma. Not entirely sure how much more you want her to test before the diagnosis.
Your GP didn't diagnose as it was a first time occurrence when he saw him last year.
It's wrong that she didn't give you more information, though I imagine that she wants to get him over this initial crisis before going into more general stuff. She has asked you to go back to see her, I hope she would use that to give a wider education session.
I work in a particular speciality of nursing (not asthma) and generally give only the bare minimum education at initial appointments, as ensuring the patient simply has the right treatment, knows how and when to use it is a lot of stress for the patient, and me waffling on about less urgent stuff is likely to distract or overload. Follow ups are when I build on advice/eduction/ information. First make the patient safe, then the education and empowerment.
I would also say that often GPs will phone me for advice in my specific speciality, as they understand that I spend all day, everyday dealing with (and studying) this condition, so they expect me to know the most current treatment advice/research evidence. They have to know a bit about absolutely everything, so can't be expected to be experts in every field as well. The clinic you went to was a speciality clinic, so I imagine the NP has a specialist interest in breathing disorders.

Nurse practitioners are extremely well qualified and highly trained. Unless you are a respiratory consultant yourself you should listen and yes you are being u reasonable.

How weird that you would put your child's health at risk in this way. You are not a qualified medic and yet you are deciding your child's diagnosis and arguing with a nurse who sounds like she has been very thorough. There WILL be a note in your son's records make no mistake - you have been obstructive for no reason other than you don't believe that your son has this illness. WTF?

Plus - you have waxed lyrical about your amazing GP and how wonderful he is and then in another breath you say that you rarely use the surgery as a family and rarely see him...doesn't quite add up does it?

I think you have one or two issues to sort out but please, please don't make your child a victim of your own short sightedness/prejudices. Although what the problem is with being 'labelled' asthmatic is I am not sure....

And I find your 'we politely agreed to disagree' rather chilling to tbh- this is your son's health you are talking about not a discussion about which is your favourite kind of biscuit.

PolkaDot - it makes NO sense at all that you would rather have a prescription written for you by someone who hasn't seen your son for a year for this condition, than have him assessed, tested, and a full history taken by a fully-qualified healthcare professional!

YABVVVU for your attitude to Nurse Practitioners, and for your utter inability to accept that an experienced, qualified person might be right about your son's diagnosis. If she is running the Chest Clinic, that says to me that she knows her stuff about chest complaints - I'd be willing to bet she's your GP's asthma nurse - and it sounds like she gave your son excellent care.

You're really mixed up - on the one hand, you would be more than happy with a repeat prescription handed over by a mere receptionist, without any accompanying examination, information or discussion. On the other, you feel it is terrible that you saw only a nurse, not a god gp. In some posts you comment tiredly on how long the appointment took,how in depth it was, how ypu returned for a review as requested. In other posts you portray that the nurse had a hurried, slap dash approach, and that you had no information or chance to ask questions.

Regardless, you are not remotely interested that 10 pages of 90% of replies deem YABU.

Country kitten - I picked up on the OP waxing lyrical about the GP, who knows the family really well - but rarely sees them! That does not add up.

regarding inhalers.
for dc we get prescribed 2 lots, one to keep at school and one for home. as dc doesn't wheeze as well the school is informed of his symptoms (coughing, throat clearing, sighing).

OP you are coming across as utterly bonkers.

For some reason you've got the hump about this whole thing - why? Your child is ill, it has been diagnosed, be happy.

And it wasn't a referral by the receptionist, she just made you an appointment with the NP.

He has never been diagnosed or treated as having hay fever,just a bit sneezy,thought it was a dust allergy tbf.

The inhalers originally were given out in a pretty relaxed fashion by the gp so I assumed the same stance this year.

Not putting him at risk,did exactly what the nurse said but following it up as didn't get the info I wanted and surprised at the diagnosis.

Have said thanks and taken much of the info on board however at the end of the day it is best to actually see my gp which I am more inclined to do considering the info on here.NP has given me no other date or prescription if he does have asthma I'd like some more inhalers at the very least.

Li my child isn't ill,far from it.

That was toAli.

Oh go and see your gp , wtf post you clearly think you know better thsn a highly qualified medical practitioner.

Can't you just as for a repeat prescription so you have one for school - we get a form to request another every time you pick one up. I had an annual review as part of the system for asthma patients but obviously it may be more frequent for a child or you can make an appointment.

The GP saw your child before handing out the inhalers last time, though, didn't he?

And you would rather have powerful drugs prescribed for your child WITHOUT ANYONE SEEING HIM rather than him seeing someone who, as many people have said, is probably your surgery's expert on asthma??! That is ridiculous.

My child isn't ill, far from it

Then why did you want him seen at all?

If he was wheezy,out of breath or had a cough all the time I'd understand but he has none of those things. 2 coughs in the last however many years is pretty good,he just couldn't shake them both.

I am after however after reading posts on here going to follow it up.Said nurse couldn't answer my questions so pointless getting another appointment with her,gp who has treated him since birth(first time nurse had seen him) will perhaps be more able to answer said questions.

I kind of hope that your GP whom you hero worship says 'well I need to refer you to our excellent nurse practitioner who is an asthma specialist who heads up the chest clinic - she knows much more about this than I do.'

Now THAT would be karma for your awful op which I have just re-read. 'I said very firmly he does not have asthma'....honestly,how rude were you?

The NHS gets a bashing constantly but here is a nurse doing what sounds like a great job...and the OP gives her a bashing.

I wanted the inhalers and patients often have a repeat prescription without an appointment. Fine we saw a nurse which I was happy to do for safety but didn't bargain with getting an Asthma diagnosis out of the blue too.

"Nurse then said as he had asthma she'd like to see him again,keep him in her records,how many inhalers did he have etc,to keep him topped up when tight in the chest etc etc."

So she asked about how many inhalers you had, and you didn't ask for more? I can't help but think that if you'd used the review appointment more appropriately, ie thought about questions beforehand, asked & then listened to the answers, you may have had a positive outcome. Insead, you "firmly" told her she was wrong, ignored anything she daid, and tgen came to moan on here about the excellent, attentive, thorough care your ds received.

I've just reread the OP. The nurse was very thorough. She prescribed treatment. At the subsequent review he had improved since being treated. She quite reasonably diagnosed asthma. And the majority here agree with her.

What are you upset about exactly?