r/Noctor

hi all. i read about it here but it actually happened lol. a distant friend of mine and I caught up recently- they told me they just started school to become a doctor, i ask what kind, they say NP.. alright.

come to find out, they have not worked a single year as an RN. got their RN years ago, worked in a few different healthcare sectors, applied to this (online) program and boom.

same person always posts about “doctor”-title related things. it is just so cringey. i don’t know if it’s bc they don’t interact with actual healthcare professionals so they can fool other ppl but sheesh.

I hope it’s ok for patients to vent here - I just switched from a psych NP to a psychiatrist and I’m already feeling dramatically better after less than a month. I’m not sure if this was an NP who was not qualified bc he was an NP or bc he was just really bad at it and inappropriate.

I slipped through the cracks after my old psychiatrist retired and have been essentially prescribing myself medication for 4 years, except for a few mania inpatients stays. I would have a 20min appt w my psych np every 6mo to 1yr and he would ask what I wanted, like ordering Taco Bell. One time I said “I feel like I’m my own psychiatrist” to which he responded “you’re good at it!”. Which at the time wasn’t reassuring but I felt sort of flattered which disarmed me. I’d always leave my appointments w him feeling utterly hopeless even if I entered the appointment with hope. My bipolar incapacitated me 6 mo out of the year and I was in my mid 20s only barely starting an undergraduate degree bc of this illness. I was having all kinds of terrifying side effects from APs and he would be like “that’s just how it is” and offer no alternatives. He said all kinds of things like calling lithium battery acid (already such a hard med to take) and Adderall meth. He seemed to hate all of my meds but view them as necessary, which is how I feel about them. Isn’t he supposed to tell me why it’s worthwhile or give me something else? It was so demoralizing. It took me a few years to realize what was happening and that he was under qualified and/or bad at his job.

I saw a psychiatrist recently from another clinic I’d been going to and she was so horrified by the fact that my np wasn’t ordering lithium levels, cholesterol panels for the APs or TSH (I’d asked him to a couple of times but wasn’t keeping up with it, my last lithium level was over a year and a half old)
I asked her about referring me to a psychiatrist for med management and she was like “I’ll do it, your case is so mismanaged”, she seemed so offended.

A month later I’m being treated for mild hypothyroid, coming off my AP safely which was causing dystonic tremor, weakness, this awful panic attack side effect because of some metabolite (no one i described this to recognized what was happening until this psychiatrist)

I have multiple other heavy mental health dx and I’ve always been called a complex case, when I agreed to see an NP years ago I didn’t know what it actually meant. Anyway I feel so much better already w the med adjustments and a lot safer in my new psychiatrists hands. I want other patients to be informed about this, especially if they’re already not doing well under the care of an NP.

Hello everyone. Before we start, yes I know what this subreddits opinion will likely be, but just the same I feel I should hear everything that will be in the comments out in full instead of relying on my assumptions. For context, I'm a mature student in Canada at a crossroads. For a long time I've wanted to work in healthcare, and have finally made the decision at 33 (after a solid career as a programmer, and many weekends over two years volunteering as a medical first responder) to return to school. I have two options.

One is going to a two year paramedic program at a local college. It's a well regarded program, and, at least at the minor level that I've experienced working at (which is to say I fully understand that my volunteering is a lower level of care/scope compared to true paramedic work), I enjoy the moment to moment pace, the detail oriented nature of the work, and the privilege of being trusted to help in dire circumstances. The amount of independence while still being under the overall direction/guidance of a physician that paramedics work with also appeals to me.

Two is returning to university and becoming a nurse. I would likely lean towards critical care environments, namely ED/ICU. As mentioned I am capable of working well within fast paced, detail oriented, and hectic environments. The execution of complex care plans, and being able to be there for patients in a longer term capacity than as a paramedic, all appeal to me.

As mentioned I like how paramedics tend to operate with some degree of independence while still being under the guidance/direction of a physician. Looking into it, I was very heavily considering going the NP route after attaining at minimum three years of experience in critical care environments so I could contribute in a more direct way to patient care. To be frank, this subreddit (and looking into it some more) has pumped the breaks there. My ideal work environment is operating with a degree of independence under a doctor's guidance, but if that entails putting patients at risk because of middling standards in certifications and education, then that's not something I'm willing to do. It's a privilege to be in a position of trust in healthcare, and I worry that in pursuing this I'd be listening to my ego over my brain, but just the same I can't fully discount that there might be environments where an NP, when properly utilized, can have a positive impact for patients. Not to replace a doctor (because they're not doctors) but to supplement them.

In any case, I'd love to hear your thoughts. Do you think there's any use case for NPs in an environment like critical care that doesn't compromise patient care? Are there any angles I haven't considered? Should I pack it all in and become a hobby farmer? For what it's worth, because of the state of Canadian medical education, I won't be able to pursue either PA or MD programs. Thanks for your time (and reading this novel).

How about yung dentista may personality disorder, manipulative, emotionally and physically abusive in her personal life diba delekado yun maka-affect sa Profession nya?

"Dr Karen Claire V Añonuevo"

Hi guys! I'm 27 and was born with a unicuspid aortic valve which I had replaced with a mechanical valve about 3 years ago, along with an aortic aneurysm repair. So, now I need yearly echocardiograms and cardiologist appointments to make sure everything is still working as it should be.

The Dr I've been seeing is leaving the practice, so I have to reschedule with one of the other adult congenital heart disease practitioners. I didn't realize that one of them is a CRNP, not a Dr, until after they scheduled my appointment with her.

Am I valid in being uncomfortable with seeing a CRNP instead of an actual Dr for something like this? I struggle with mild health anxiety anyways and the idea of having a nurse be the main person interpreting my echo results and managing my care for this makes me nervous, but I don't know if I'm overthinking it since obviously I'm not a medical professional of any kind myself.

Aside from the war between NPs and MDs, here are the things I think the NP and MD did well, and what could have been improved:

In my opinion, the NP really did well in communicating with the patient, and that little survey she sent every day was also nice.

Dr. Tufts is also a very knowledgeable professional. I think she did well based on how the US healthcare system works and how it’s taught here. I don’t necessarily blame her for some things she could have done better, but I do think she could have transferred the care to someone else, or at least communicated with the other NPs.

I’m basing my opinion on my experience as an MD who graduated internationally. The US has all the technology and medications you could possibly imagine, but it lacks that human connection — it lacks stepping outside the algorithm sometimes. My professor always said, “2+2 doesn’t always equal 4 in medicine.” I also understand that, unfortunately, this is how the system works here

Had a case where a child patient was being treated by an NP. No doctor supervision. Parent brought the child (13) in to NP because she was hitting at school. NP prescribed her Adderall, haldol and risperidone together and diagnosed her with autism. This NP had zero background in child psychology or neuroscience. The assessment was completed on the first appointment based on moms self report.

Mom said the child got worse. Came to ER and they requested psych consult. Myself (psych social work) and the psychiatrist came down, met with the family and admitted the child. The child didn't have autism and was taken off the unnecessary meds

I’m a psychiatry resident and I’ll say it plainly: I don’t think NPs should be diagnosing and prescribing independently. I’ll focus specifically on psychiatry in this post, although my opinion applies to every medical specialty being infiltrated by midlevels.

Physicians spend 4 years in pre-med, 4 years in medical school and another 4 years in psychiatry residency (add another 2 for fellowship) before practicing independently. Meanwhile, some PMHNP programs accept nurses with minimal experience and provide a fraction of the supervised clinical training. These are not equivalent paths, and pretending otherwise is ridiculous.

Psychiatry is medicine. It requires recognizing medical disease, managing complex medications, and understanding what you don’t know. It is not just matching symptoms to a diagnosis and prescribing an SSRI.

What bothers me even more is patients thinking they’re seeing a psychiatrist when they’re actually seeing an NP. If a patient calls you “doctor,” correct them. Getting a DNP and using “doctor” in a clinical setting only adds to the confusion and should be illegal.

I think we all know why healthcare organizations love independent midlevels. They can pay NPs far less than physicians while having them diagnose and prescribe independently. The organization saves money on doctors, while the patient gets someone with a fraction of the medical training.

Patients deserve physicians, transparency, and better than corporate healthcare cutting corners on their care.

And to all the NPs here who want to argue with me: if your loved one ever needed immediate, life-saving medical care, ask yourself who you’d want treating them, your NP colleague or an MD/DO?

Thoughts about PAs from physicians?

I know a lot of the discussion right now is focused on NPs and concerns about differences in clinical training, but I’m curious what people here actually think about PAs.

I’ve had the opportunity to spend a lot of time around MD/DOs and PAs through shadowing and now working in a hospital. From what I’ve personally seen, the PAs I work around seem pretty aware of their limitations and their role on the team.

At the hospital where I work, I mostly work directly with attending physicians. The PAs are technically allowed to see a pretty wide range of patients, including higher-acuity cases, strokes/traumas, and patients across all ESI levels. But most of them don’t seem interested in proving that they can handle everything independently. If something is outside their comfort level or they’re unsure about something, they involve the attending.

There are also PAs who actively want exposure to higher-acuity patients because they want to learn, and from what I’ve seen, the attendings actually encourage that when appropriate. It seems much more like, “I want to learn how to manage this with you,” rather than “I don’t need a physician.” There is this new PA who is always wanting to see the trauma level 1. He directly works with the SP and today the SP told him that he can see the trauma by himself. Once he was done he came back and told the SP "Everything went well." The SP nodded and replied with "Good Job"

Another thing I’ve noticed is that I’ve never heard any of them introduce themselves as anything other than a PA. Usually it’s simply, “Hi, I’m ___, I’m a PA and I’ll be taking care of you today.”

Obviously, this is just my experience at one hospital and I know it doesn’t represent the entire profession. That’s why I’m curious to hear from physicians here, especially those who have worked closely with both PAs and NPs.

What has your experience working with PAs been like? Do you generally feel comfortable working with them? Are there concerns you have about PA training or scope of practice? And do you see a meaningful difference between the PA and NP models in actual clinical practice (nursing model vs the medical model). Also, the PAs that work at my hospital had over 3-4 yrs of experience before actually applying to PA school. IDk I guess I am just curios (SORRY for the long text)

It took me an hour an a half of phone calls, and the appointment is 6 weeks out, but I found a PCP in my area that's an actual MD. This RN has spent too much time on this subreddit to have an NP as my PCP.

I have chronic intractable migraine, and I’ve been a patient at the best neurology/headache clinic in my state (WV) for several years. I saw an actual neurologist maybe twice way back at the beginning of my treatment, but ever since then the only person I’ve seen is an NP. She’s super nice and all, don’t get me wrong, but as far as treating me I feel like I’m a human dartboard, she’s just throwing drugs at me to see what sticks/works. I used to send MyChart messages once a month or so just to update her, let her know how things were going, but she never responded to me so I stopped, figured she didn’t care. I went from seeing her every 3 months to every 6 to once a year. I’d like to know if there’s any way to politely ask, without burning any bridges, that my care be switched to a neurologist or at least a PA, someone who sees me as a human and not a test tube, who takes my questions seriously. Thoughts/advice? Thanks much.

Normally I'm not a fan of Fox News but I noticed this video from Laura Ingraham's page and this is the first time I'm seeing cable news media acknowledging the role of midlevels in the Lindsay Clancy case.

Dr. Drew Pinsky pointed out the role of NPs in our healthcare system and compared it to a surgeon walking out in the middle of surgery and letting non-surgeons take over.

In the case of LC, I can't help but agree. Dr. Tufts started med management, patient left and saw 2 NPs who made several changes, and then LC returned to Dr Tufts and at that point she was picking up the pieces. Imagine a surgeon stepping away, lets midlevels take over and botch critical parts of the surgery, surgeon returns and is left to clean up a mess and close.

https://www.facebook.com/share/v/19DwCSinxV/

I know people here often say that physicians have 8 years of school plus residency and include undergraduate studies. However not all of undergraduate education is pertinent to being a physician. For example I was an engineering major and I can't honestly say my classes on semiconductor integrated circuit manufacturing or how to make a phased array antenna is pertinent for being a physician. Some of the prerequisites for medical school such as organic chemistry and biology should contribute to the physician's education though. Even calculus is needed to understand the area under the curve for drug dosing. A lot of K-12 education is also important for both being a physician and mid-level including how to read and do basic math.

The other thing is mid level education goes through much less material even for the same amount of time spent in the classroom (similar to calculus for engineers vs business major calculus) and I don't know how to correct for that.

What is the truly honest amount of specialized pertinent vocational education difference between mid-levels and physicians?

I don’t like the generalization in this subreddit about all NPs being bad and all doctors being great. I know I’m throwing myself to the wolves here but as a patient with chronic illnesses (Crohn’s disease, several mental health conditions), I’ve received better care from a great NP than from multiple different physicians, who either failed to diagnose me (mainly because they didn’t take the time to listen and dismissed my symptoms) or just didn’t seem knowledgeable about the disease despite being specialists. I am a NP myself now (after being an RN for 10 years) and never pretend to be a doctor, I seek help from my supervising physician and more experienced NPs when I don’t know the answer to something (or even refer patients somewhere else when I feel I can’t help them). I became an NP precisely to try to help people, listen to them, and do my best to give them the care they deserve. I hated that so many doctors( and yes some NPs too) would not take the time to listen, or take me seriously but it angers me that people think all NPs are incompetent, when I’ve been treated by an amazing NP who I’d trust my life with before many other doctors I’ve come across.

I’m so upset that I’m tempted to leave this program before it starts next week. I opted out of a few of the more “prestigious” schools because I DID NOT want to get my education online, instead choosing a state school located 20 minutes away from my house.

Today I find out that pretty much all of the coursework is online with the exception of a few days each semester. Apparently we’re going to be recording ourselves doing assessments remotely and hell, we can even use our own dog as a patient if we don’t have a person available.

I’m so mad right now. I could’ve been re-doing pre-reqs for PA school instead of focusing on this application. But now I’ve wasted time and feel stuck.

By a CRNA**"

Title says it all... And this was admitted to me by my entire care team, MD, CRNA, RN etc. 😭

I got toric lenses implanted in both of my eyes and you're supposed to be conscious during it to follow the directions the doctor is giving you-- look left, look right etc. Well, I was completely knocked out by the CRNA then jolted back to consciousness after the surgeon had already started cutting in my right eye. I guess nobody noticed until they realized I couldn't follow the directions given. He was able to finish implanting the lens, but I experienced complications in that eye immediately and they had to juice it like a grape. Also had a very prolonged and painful healing process that took months in this eye.

As a result of being jolted awake, I was overly conscious during the procedure with my left eye 😭. There was no pain, but I could feel every slice and pressure as he was cut into my eye and placed the lens in. Worst of all, I was experiencing this clockwork orange BS to 2016 pop music.

I'm under 5'0" and fairly slim so I wonder if that's why I was "over-anesthetized". Not sure if they'd ever use an Anesthesiologist at these sites, but I can't help but feel like if there was one there, it would have happened.

I have seen a large amount of hate for mid-levels lately and can say that I completely understand many concerns people have. That being said, I see an NP and a PA for 2 of my healthcare providers and actually like them very much, they have both been helpful and give me hope for other mid-levels. My question for all of the anti-noctor people out there: Do you guys see any value in mid-levels and do you think that there can be ethical and competent mid-levels who have a positive impact on the healthcare system? I am very curious about this and respect all opinions!

about it cut off my friends excess nipple length. dudes got like half an inch of straight swords coming from them pecks. we got a rubber band. kitchen shears. all tech super glue. a napkin and to sterilize we are using 100 proof Smirnoff.

i dont need advice i was just letting everyone know