 Provided by Clinician 1
I really, really love my job. So please don’t think that my blogs are “bitch-fests” galore. I have just recently had a plethora of defending my NP role. After defending my practice and stating that, NO, the DOCTOR would come to the SAME conclusion, it gets tiresome and irritating. Especially when, after all that is said and done, the patient ADMITS that he or she got the correct diagnosis and treatment by me, the “lowly” NP. I “get it” that I need to “prove” myself to those I haven’t seen before... or those not familiar with the NP role. However, it’s worse when I have previously appropriately treated patients... even better than a physician.
Case number one: a lovely older lady, never seen by yours-truly. She presented with a unilateral, itchy and painful vesicular rash along her left torso, stopping at the midline. Can you take ONE guess at the diagnosis? Yes, it was herpes zoster. I explained the epidemiology, course of the rash, treatment, and precautions to her.
Her next comment? “Wouldn’t it be better if the DOCTOR looked at it?”
Um... shingles is about the easiest rash to diagnose. (I growled to myself, on the inside.) I answered, “No,” I said, “it wouldn’t make any difference if the doctor saw it or not. Plus, he isn’t in the office right now. Here is the medicine that I will prescribe. Please call if it isn’t improving.”
Case number two: an older gentleman, age 60, seen previously by yours-truly 14 months ago. He also presented with herpes zoster. A particularly nasty-looking case, but very minimal pain... just itching. I outlined the same things as I had with the first patient.
His response? “What does it take to get an appointment with the DOCTOR for a sick visit?” I must have had a look on my face, because he quickly said, “well, all of the other providers here are great... like the one I saw last year. She took great care of me.”
I told him, “you saw me, sir.” Yes, I was the one who correctly diagnosed your pneumonia, which was misdiagnosed by a PHYSICIAN at the local urgent care center. The same PHYSICIAN who insisted that you needed a CT scan because you had an “abnormal” chest x-ray... showing an azygous lobe of the lung—a normal accessory lobe. The PHYSICIAN did not realize this was a normal variant, but I did.
I explained our office policy: a patient may see the provider of choice for routine visits, but for sick visits, he or she is scheduled with the first-available provider—given a choice if desired, of course.
Ultimately, both patients were satisfied with their care, but I had to take extra time to assuage the fears of the unknown.
I appraised my collaborating physician of these issues... and of course, as always, he supported me with my decisions. It’s just that some days, it gets really old. And I remind myself, I need to remember to “roll with it” and just take care of my patients. Hopefully, they will get it someday.
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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