Current Events > Its crazy how people genuinely think a NP or PA can replace an MD

(+) Yeah! (+)

I've heard so many stories from patients themselves about how they were more satisfied with the care they got form their NP or PA compared to their MD.

Honestly I think this has to do 2 things - 1 is that they always over-order tests and referrals - so it makes them seem like they are doing things for the patient even if the best course of action is to just wait and monitor. 2 - MDs often tend to use medical jargon and not explain things in laymans terms to patients, because they think of things in detailed pathophysiology. In the case of NPs, they mostly understand things in laymans terms so its easier for them to explain things to the patient.

Recent studies have come out showing how NPs and PAs waste significantly more resources than MDs. They order too many tests and consults. I think anyone who takes referrals like any specialist MD or even ER docs who see patients who have NPs or PAs as their primary care see how much wrong actually goes on. I can speak with first hand knowledge that I'm a lung specialist and I get referrals from NPs who have totally mismanaged a patients care. So often I've had to tell patients they don't actually have COPD or asthma or whatever their NP diagnosed them with improperly.

NPs/PAs having independent practice licenses is a newer thing. Wait until they start getting the same litigious pressure as MDs, the flood gates will open and things will change. Its honestly malpractice and harmful what so many of these guys are doing and it goes completely unnoticed. Just compare their education and training, its not even remotely close.

My rant is over. I know everyone here will hate, but this is the truth.

Doesnt matter why I like the nurse better than the doctor, I do because thats how theyre presented to me. If the doctor wants me to like him more maybe he should spend more than 5 minutes a year with me at my physical and not act like any questions I have are annoying because theyre delaying him moving on to the next patient. Maybe behind the scenes its not what it seems, but my perspective is what it is. The nurse is cool and interested and the doctor is a rich douche.

Doctors are assholes who talk down to you, bedside manner is a part of the care process.

Again, you guys can like or dislike people however you want, just know you are getting inferior care. Your labs may not be interpreted accurately, they may over order tests, they may not be able to put together 2 symptoms together and miss diagnoses.

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Data/evidence/studies don't often support doing things. Doing things can often lead to false positive findings which leads to more things. You could: A - listen to your doctors reassurance and things are fine now and just keep an eye on things every so often or B - do excessive tests leading to more excessive tests, and eventually invasive tests putting you in harms way for no benefit. B is bad medicine unless the data supports doing so. If a patient really wants to do all that, they have to understand the risks of doing that and tbh I doubt the NP understands these risks themselves.

There is no common scenario I can think of where good bedside manners + bad medicine = good for the patient. Its all a facade.

It's insurance companies' fault for incentivizing doctors to rush out patients and not provide the care they should.

YeahBecauseWow posted...

Doesnt matter why I like the nurse better than the doctor, I do because thats how theyre presented to me. If the doctor wants me to like him more maybe he should spend more than 5 minutes a year with me at my physical and not act like any questions I have are annoying because theyre delaying him moving on to the next patient. Maybe behind the scenes its not what it seems, but my perspective is what it is. The nurse is cool and interested and the doctor is a rich douche.

This is how I feel with most of my doctors.

NPs at least have manners.

But lately, I've had really bad experiences with DOs. I would definitely prefer an MD.

TC you can continue to toss all the studies and data you want, but if you keep acting like an unlikeable person people will continue to take less stock in what you have to say.

DanHaren2022 posted...

MDs often tend to use medical jargon and not explain things in laymans terms to patients, because they think of things in detailed pathophysiology. In the case of NPs, they mostly understand things in laymans terms so its easier for them to explain things to the patient.

This is dishonest. If an MD isn't explaining things to their patients appropriately, then they are failing their patients.

BuIIyMaguire posted...

TC you can continue to toss all the studies and data you want, but if you keep acting like an unlikeable person people will continue to take less stock in what you have to say.

I mean itd require TC to be an actual doctor and not full of shit.

BuIIyMaguire posted...

TC you can continue to toss all the studies and data you want, but if you keep acting like an unlikeable person people will continue to take less stock in what you have to say.

And it won't bother me in the slightest if people don't listen to what I have to say on an online message board.

People like nurses and PAs because they have better customer service skills, basically. Youre nuts if you think quality of care is at all relevant to the average person who doesnt know one medical condition from the next.

Nurses are gods these days, so good luck getting away with criticizing them.

Whats your goal here then?

Do you treat your actual patients like this?

COVxy posted...

This is dishonest. If an MD isn't explaining things to their patients appropriately, then they are failing their patients.

In all my experience I think MDs explain things more accurately. I think Non MDs make inaccurate analogies and bogus statements that sound like things you'd see out of a medical TV show.

DanHaren2022 posted...

In all my experience I think MDs explain things more accurately. I think Non MDs make inaccurate analogies and bogus statements that sound like things you'd see out of a medical TV show.

Again, if an MD is not explaining a patient's health in a way that the patient understands, they have failed that patient.

"Oh, they are just super smart and can't figure out how to dumb it down" is complete and utter bullshit.

Also I know some people here judge based on their personal experiences but how many doctors and NPs have you truly interacted with? If you have a bad experience with 2 or 3 MDs and a good experience with an NP, you absolutely can't generalize a whole profession based on that. Again, bad judgment on your guys part.

Ive interacted with plenty of MDs. Interestingly the only ones that currently sour my view on them all all post on CE. Imagine that.

I think there is some value in allowing it in undeserved areas. Okay care is usually better then no care.

But overall you are probably right.

COVxy posted...

Again, if an MD is not explaining a patient's health in a way that the patient understands, they have failed that patient.

"Oh, they are just super smart and can't figure out how to dumb it down" is complete and utter bullshit.

You didn't even read my reply. Saying doctors can't dumb things down for the layman to understand is a grossly inaccurate statement. Doesn't even need to be followed up with a counter argument. You have the right to be wrong.

Explaining things "more accurately" does not mean "ensuring accurate understanding".

You literally wrote in your OP:
DanHaren2022 posted...

MDs often tend to use medical jargon and not explain things in laymans terms to patients, because they think of things in detailed pathophysiology

That is bad communication, even if accurate.

No one is arguing that MDs don't give accurate and better quality medical care.

We are arguing that when compared to nurse, MDs are assholes.

I will always trust an MD more for medical advise, but there are plenty of reasons like the ones mentioned above to dislike drs.

Of the ones that dont communicate well that is usually the reason. So my bad I didn't type that out right.

And again assuming all doctors don't communicate well is just wrong and purely based on subjective personal experiences from a very few number of doctors. So I'm not even going to entertain that any longer as a valid argument unless you get me some proof or objective evidence.

Please explain why you guys think doctors are assholes?

I've only seen NPs misrepresent themselves as "doctor ____".

Patients love me and some nurses I've worked with believe in the most magical BS imaginable.

Ar0ge posted...

No one is arguing that MDs don't give accurate and better quality medical care.

We are arguing that when compared to nurse, MDs are assholes.

You should meet the nurse I used to work with.

"In here the mom doesn't make the calls, we do!" - That bitch

MDs are too busy dealing with legalese and being scardy cats to push the healthcare we deserve

The gold part is how people are trying to justify why inferior care, overdiagnosis, missed diagnosis, excessive testing, etc is better.

Do they not make MDs/DOs take motivational interviewing electives as part of the curriculum

I kind of assumed all healthcare related programs were doing that now

DanHaren2022 posted...

The gold part is how people are trying to justify why inferior care, overdiagnosis, missed diagnosis, excessive testing, etc is better.

I would argue if you know that your counseling/communication style is actively driving patients to inferior care then you should make an effort to fix that aspect

Theres going to be asshole everything and bad at their job everything, sure.

In my experience doctors act even worse if their patient actually has the slightest knowledge of medicine and anatomy.

I've had doctors basiclaly tell me " if you are so smart and know so much why are you bothering to come see me?"

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Lol

The problem with "wait and monitor" is that many people have waited long already. Most people do not like going to the doctor for obvious reasons (cost, scared, etc...)

People will wait to see if they might get better on their own and if the problem doesn't go away, then they will go as a last resort. I feel like most people know if something is seriously wrong with their body. An appointment might be weeks away. If the patient knows something is wrong and the doc doesn't run tests, the patient feels like they wasted time and money.

If the patient doesn't get better after being told to wait, they lost trust/faith in the doc and doesn't know if they should go back to the same doc or try a different one. The doc probably thinks, "oh my patient didn't come back, he must be fine."

I see a PA for primary care

rattlesnake30 posted...

The problem with "wait and monitor" is that many people have waited long already. Most people do not like going to the doctor for obvious reasons (cost, scared, etc...)

People will wait to see if they might get better on their own and if the problem doesn't go away, then they will go as a last resort. I feel like most people know if something is seriously wrong with their body. An appointment might be weeks away. If the patient knows something is wrong and the doc doesn't run tests, the patient feels like they wasted time and money.

If the patient doesn't get better after being told to wait, they lost trust/faith in the doc and doesn't know if they should go back to the same doc or try a different one. The doc probably thinks, "oh my patient didn't come back, he must be fine."

Wrong again. This is medical decision making we are debating and there is no 1 right answer. Every situation is completely different. It's the doctors job to dissect all the information you give them and determine what's the next best step and recommend that. We really can't talk in generics when it comes to medical decision making.

"Excessive tests" are unessesary that's inherent in the description. "Appropriate tests" are appropriate. Ordering a test isn't bad, it's ordering it when it's not indicated or not recommended is when it becomes bad.

Bridging the communication gap is a very marketable skill in the engineering world. A great portion of engineers apparently cannot communicate effectively with the layman. I know some people that make bank by literally translating engineering insights into language business people understand.

TCs "trust me bro I'm a dr" attitude sure is winning alot of people over lol

I'm a NP, and the issue that I see is that there is very little consideration to what the PATIENT wants. Patients do not like to wait-and-see. I'm not saying we should always order a bunch of unnecessary tests to pacify patients (it can be harmful in some cases like exposing patients to radiation for a CT that's not needed), but we need to listen to them and let them take a role in their own care. I always explain to my patients if the best method is to monitor, and I address any reservations they may have. I'm in psych, so I don't deal with it as much. What I hear from patients is that too many physicians resort to "Me smarter than you, so listen to me" tactics.

One of the biggest issues is that patients don't have the requisite knowledge to be able to distinguish between good and bad Medical practice. Patients gauge quality with metrics that ironically often suggest poor quality, including amount of tests and consults.

When you combine poor health literacy with biases, communication will always be poor.

The time of the big, bad, Im smarter than you doctor is over. Most med schools are graduating more female physicians and overall more well rounded human beings.

I saw a Mayo trained pediatrician berated by some trailer trash mom for reassuring and educating instead of prescribing antibiotics for her kids with the sniffles which were obviously viral. If she had gone to an urgent care Im sure some midlevel wouldve handed out a 10 day course of amoxicillin to fill some sort of quota.

At the end of the day Americans want McDonalds medicine and the hospital systems understand and profit off that. Why do you think so many pill mills are popping up online?

Shoulda been a dentist, bro

Hummer 2 posted...

When you combine poor health literacy with biases, communication will always be poor.

The time of the big, bad, Im smarter than you doctor is over. Most med schools are graduating more female physicians and overall more well rounded human beings.

I saw a Mayo trained pediatrician berated by some trailer trash mom for reassuring and educating instead of prescribing antibiotics for her kids with the sniffles which were obviously viral. If she had gone to an urgent care Im sure some midlevel wouldve handed out a 10 day course of amoxicillin to fill some sort of quota.

At the end of the day Americans want McDonalds medicine and the hospital systems understand and profit off that. Why do you think so many pill mills are popping up online?

The fact that you included "mayo trained" for the pediatrician and "trailer trash" for the mom just highlights the problem further in how some medical professionals view themselves or their status in contrast to patients.

I can understand this kind of thinking.

Ive seen some really shitty doctors before when I had to go in unexpectedly and only another physician in the practice was available.

DarkRoast posted...

One of the biggest issues is that patients don't have the requisite knowledge to be able to distinguish between good and bad Medical practice.

But it is your job to attempt to explain it to them in ways that best allow them to understand.

Lyrica posted...

The fact that you included "mayo trained" for the pediatrician and "trailer trash" for the mom just highlights the problem further in how some medical professionals view themselves or their status in contrast to patients.

frankly I find poor people to be repulsive