To not want to see a Nurse Practitioner.

[Selks]

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?

[Mignonette]

Aro

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.

[Mignonette]

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.

[ivykaty44]

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.

[ParsingFancy]

"the training is not the same as a GP's. They are two very different professions."

Well exactly.

Which is why people are complaining when one profession is being used to do the job of the other.

[Mignonette]

They are not doing the job of a GP!

That comment shows a lack of understanding regarding the two roles. They are complimentary.

[ParsingFancy]

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?)

[ParsingFancy]

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.

[Mignonette]

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!

[ParsingFancy]

"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.

[ParsingFancy]

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.

[Mignonette]

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

[ParsingFancy]

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.

[2rebecca]

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.

[ParsingFancy]

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.

[Helspopje]

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.

[2rebecca]

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.

[ParsingFancy]

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.

[Callani]

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.

[Mignonette]

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.

[Mignonette]

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.

[ParsingFancy]

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.

[ParsingFancy]

Sorry you've had a bad few days, Mignonette.

[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.

[nancerama]

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.

[ParsingFancy]

Talking of which, after choking your thread up with theoretical stuff, hope you're feeling better today, Selks.