Nurse practitioner delusion / "Noctors" / "Midlevel staff" - Nurses get a 1 year degree and start thinking they are better than doctors

I hope you've had a great consult with your specialist by now and are all sorted out. Just wanted to note that hemochromatosis is genetically complex, you can have mild symptoms if you have part of the genetic combo for it, or severe if you have the whole compliment. I noticed you were concerned about your A1C- hemochromatosis is known to cause both an artificially high A1C and actual type 2 diabetes.

And as to the whole thread- excellent thread and excellent OP. NPs today are a menace, check out CNMs and related midlevel obstetrics providers, both in and out of hospital, for further lulz and horrors.

Ah, yes. I forgot about this thread! I did meet with the doctor and my blood work she ran in-house came back in the normal ranges.

So I've no idea what was happening. My A1c is now 5.2, mostly because of fasting and not eating as many carbs.

It's wierd and I'll probably never know why my blood work came back abnormal for a few months. The doctor said sleep apnea is the most frequent cause of this, and I do have a mild case. But I don't know why if it was sleep apnea why the values would be elevated only temporarily, but I guess that's because I'm not a doctor.
 
Ah, yes. I forgot about this thread! I did meet with the doctor and my blood work she ran in-house came back in the normal ranges.

So I've no idea what was happening. My A1c is now 5.2, mostly because of fasting and not eating as many carbs.

It's wierd and I'll probably never know why my blood work came back abnormal for a few months. The doctor said sleep apnea is the most frequent cause of this, and I do have a mild case. But I don't know why if it was sleep apnea why the values would be elevated only temporarily, but I guess that's because I'm not a doctor.
Most likely what he means is because of the interaction between blood gasses and hematocrit measurements. If you are chronically running low on oxygen your body will adapt by releasing more red cells- the main purpose of the red cells is to carry oxygen around your body where it needs to go. They figure ok a hct of 43% isn't cutting it anymore? Let's step up production. Same idea behind why your heart rate will shoot up if you are hypoxic. So you will see secondary polycythemia sometimes in COPD and some heart defects. And yes, sleep apnea.
 
Most likely what he means is because of the interaction between blood gasses and hematocrit measurements. If you are chronically running low on oxygen your body will adapt by releasing more red cells- the main purpose of the red cells is to carry oxygen around your body where it needs to go. They figure ok a hct of 43% isn't cutting it anymore? Let's step up production. Same idea behind why your heart rate will shoot up if you are hypoxic. So you will see secondary polycythemia sometimes in COPD and some heart defects. And yes, sleep apnea.

Makes sense. Could it cause secondary polycythemia for a short time like that? My watch I wear as long as it's not charging tells me a whole bunch of stuff and everything was in the normal range, according to Ye Olde Google Medical Degree. I know the watch isn't a diagnostic tool, I use it to keep a general eye on things.

If I'm understanding the Wikipedia article correctly, which is not a given, it doesn't look like I have the varients mentioned. 23andMe in their reports says I don't have the HFE variants.

In the end it doesn't matter what caused it, I suppose, since it was temporary. Just annoying.
 
Makes sense. Could it cause secondary polycythemia for a short time like that? My watch I wear as long as it's not charging tells me a whole bunch of stuff and everything was in the normal range, according to Ye Olde Google Medical Degree. I know the watch isn't a diagnostic tool, I use it to keep a general eye on things.

If I'm understanding the Wikipedia article correctly, which is not a given, it doesn't look like I have the varients mentioned. 23andMe in their reports says I don't have the HFE variants.

In the end it doesn't matter what caused it, I suppose, since it was temporary. Just annoying.
I don't know much about those watches but I doubt it adequately catches the desaturations you experience from sleep apnea. Your spO2 is probably not staying low enough long enough for it to register in most instances.
 
2022 reminder that these people are sharing intimate patient details on fucking Facebook and are crowdsourcing diagnoses and treatments as if they are sharing guacamole recipes or asking for coding advice on stack exchange.

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I'm sure this inspired a lot of confidence. 'Hold on hun! Let me take a real quick picture so I can ask my friends on facebook what they think'




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Stupid ~12 years of training psychiatrist knows nothing compared to a strong powerful 2 year NP Nubian queen. As if SSRIs aren't bad enough - no, lets get a 14 year old girl on 2 strong antiepileptic drugs at the same time! Why? Because risk factors due to family history are the only proof necessary! It's called a hunch, oldest of doctors, get ready for the new wave of medicine!
JESSUS FUCK MAN!

Doesn’t this dumb bitch realize that SSRIs are also prescribed for (and are quite effective against) anxiety?

But nah man! Let’s just stick the kid, who hasn’t shown any symptoms of manic behavior, on two powerful psych/epileptic drugs. Because you know he could be bipolar? Maybe?

In a sane world, everyone in her Facebook group would have told her that she’s about ten years and 200.000$ away from being qualified to have a “difference of opinion with psychiatrist”


For another sterling example of a no tor at work, here’s this story from Reddit.
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NP tells couple (rudely) to take some advil for post op pain. Man gets wheeled to the ER near unconscious from pain at midnight. Gets prescribed Dilaudid and antibiotics.

The NP CALLS THE NEXT DAY AND IS FURIOUS THAT THEY DIDNT FOLLOW
HIS ADVICE.

(Doctors suspects diversion, since he was supposed to get narcotics post op.)
 
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Doesn’t this dumb bitch realize that SSRIs are also prescribed for (and are quite effective against) anxiety?
SSRIs aren't effective with bipolar patients since the increase in serotonin can lead to mania. However, I really doubt a 14 year old meets the diagnostic criteria for bipolar, she's a depressed pubescent kid she doesn't need antipsychotics. Really weird overstepping of boundary there. Therapists and nurses love to argue diagnoses with psychiatrists while having like 1/3 the education.
 
SSRIs aren't effective with bipolar patients since the increase in serotonin can lead to mania. However, I really doubt a 14 year old meets the diagnostic criteria for bipolar, she's a depressed pubescent kid she doesn't need antipsychotics. Really weird overstepping of boundary there. Therapists and nurses love to argue diagnoses with psychiatrists while having like 1/3 the education.
Even if you had a solid reason for suspecting bipolar disorder other than "possible family history and it sounds like something fun to try" you would start lamotrigine OR lithium as a first line treatment. BOTH of those are extremely serious drugs that require close monitoring with careful eyes. With lithium you can go toxic very easily, you have to ease up the dose slowly and check blood levels. It's a salt and wants to replace other salts in your blood so you can have people get critically ill if they become dehydrated while taking it. It's not something to give lightly to anyone, especially a teen who may not have the best self-awareness and nutrition. Lamotrigine can cause a severe skin reaction and SJS and again, you have to ease it up slowly to make sure the patient is going to tolerate it. Oxcarbazepine is NOT first line and adding it to lamotrigine significantly increases adverse effects.
 
A tale of two subreddits:

Over on the Noctor subreddit, an actual doctor shares a horror story of how his dad now has to live in an assisted living facility, because a Noctor decided to shower his alcoholic father with Ativan instead of following protocol.


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Meanwhile on the NP subreddit:


“GUISE, HOW DO I ANTIBIOTIC?!?”

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Oh there’s an app for that! Well thank god!
 
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bit of powerleveling regarding NPs

I recently moved states and dealing with the gauntlet of noctors has been super frustrating. I was sent to a practice that's staffed with mainly NPs who are supposed to be evaluating and doing basic pain management.. I guess MDs are on scene on some days, but anyway.. I had my appointment to discuss ongoing treatment in this new state and instead of continuing the protocol I've been on for years now the arrogant NP decided it was time to exert her dominance by declaring she wanted to half my current regimen. For no other reason than she could. There was no room for discussion, it was that or nothing at all. I would've rather she simply pissed on my leg. All these NPs remind me of high school bullies, except now they have prescribing privileges. It's all about the power trip.

I decided to nope on out of there, but now I still need to find somebody who isn't insane for this pain management shit. The south is so backwards.

Fuck these assholes, man.


edited for clarity.
 
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Even if you had a solid reason for suspecting bipolar disorder other than "possible family history and it sounds like something fun to try" you would start lamotrigine OR lithium as a first line treatment.
You start neither. First-line in peds is risperidone.

Let me guess, you're a med student?
 
I recently moved states and dealing with the gauntlet of noctors has been super frustrating.
Yeah, what's that about? The last time I had to change doctors I ended up with two noctors in a row before I finally requested an actual M.D. directly and the place acted like I was inconveniencing them for doing so.
 
Yeah, what's that about? The last time I had to change doctors I ended up with two noctors in a row before I finally requested an actual M.D. directly and the place acted like I was inconveniencing them for doing so.
They're trendy right now cos they cost fraction of what hiring an actual doctor would. You can easily get 3 or 4 NPs for the same combined salary as one MD. The only people who really lose out are the patients who likely won't get adequate care. NPs are also practically malpractice-suit proof, hence their medcorporate appeal. Healthcare is a business now.. it's not really about practicing medicine....it's about squeezing as much money out of us and/or the insurance companies as they can. Woo capitalism.
 
nurses and nps are tards but i rather have an idiot who listens and actually tries to do something than some lazy god complex doctor who glances at you for two seconds diagnoses you with anxiety and bills you $500 (not for emergencies obv). All these examples of NP malpractice and cluelessness are just as common in actual doctors tbh except at least the nurses care to ask for second opinions rather than sending you out the door and telling you your problems arent real. If you see 5 different doctors you will probably get 5 different treatments. The whole American medical system needs a complete overhaul.
 
nurses and nps are tards but i rather have an idiot who listens and actually tries to do something than some lazy god complex doctor who glances at you for two seconds diagnoses you with anxiety and bills you $500 (not for emergencies obv). All these examples of NP malpractice and cluelessness are just as common in actual doctors tbh except at least the nurses care to ask for second opinions rather than sending you out the door and telling you your problems arent real. If you see 5 different doctors you will probably get 5 different treatments. The whole American medical system needs a complete overhaul.
Maybe next time you shouldn't waste the doctor's time with something stupid like "I feel bad" and save that appointment for someone with an actual problem.
 
Maybe next time you shouldn't waste the doctor's time with something stupid like "I feel bad" and save that appointment for someone with an actual problem.
On the one hand- yes. On the other hand, the media, parents, schools, so forth, do a terrible job of educating people about what is an actual medical concern you need to go to the doctor for, and what is just an annoying physical thing that will go away on its own. Thus we have vast swaths of the population doing the medical equivalent of calling 911 because McDonald's was out of nuggies. It's not even a class or race based thing, though the news will show the ER in the poor part of town full of Mexicans and blacks who go in for the sniffles or a twisted ankle instead of seeing a primary doctor. Neurotic upper middle class parents instill paranoia and a sense of duty to report every twitch to a physician too. You can really see the fruit of this insanity being harvested in the fallout from the coof. And why should hospital systems engage in better patient education when they can just keep raking in profits from morons?
 
nurses and nps are tards but i rather have an idiot who listens and actually tries to do something than some lazy god complex doctor who glances at you for two seconds diagnoses you with anxiety and bills you $500 (not for emergencies obv). All these examples of NP malpractice and cluelessness are just as common in actual doctors tbh except at least the nurses care to ask for second opinions rather than sending you out the door and telling you your problems arent real. If you see 5 different doctors you will probably get 5 different treatments. The whole American medical system needs a complete overhaul.
Would you rather have an MD with 10+ years of education and training looking at you for two seconds and diagnosing your health problems, or an NP who will look at you for two seconds and then leave the exam room so they can consult Reddit or their "girl boss NP" Facebook group?
 
It's amazing how much and yet how little regulation there is in the US medical system.

Monumental effort required to get insurance to cover reasonable treatment, but the provider responsible for writing the magic words can be a Dunning-Kruger NP who passed a "lol whatever" program.

If people were aware and honest about their scope, NPs would be the perfect adjunct to a packed ED. Triage peels off the UTIs and the "free pregnancy tests," all the should-have-been-a-PCP complaints to a fast-track with a midlevel, who knows when to kick something up the chain. But that would be adding staff, which costs money, so instead they just replace an MD/DO with an NP/PA, pocket the cash, and things are as slow as before but now less safe.

When you see articles about staff quitting due to "moral injury," it's not vaccine objectors. That odious buzzword is how they summarize "wanted to Help People, could no longer handle being a tiny moving part in a huge Kafkaesque blind and unconscious machine."
 
It's amazing how much and yet how little regulation there is in the US medical system.

Monumental effort required to get insurance to cover reasonable treatment, but the provider responsible for writing the magic words can be a Dunning-Kruger NP who passed a "lol whatever" program.

If people were aware and honest about their scope, NPs would be the perfect adjunct to a packed ED. Triage peels off the UTIs and the "free pregnancy tests," all the should-have-been-a-PCP complaints to a fast-track with a midlevel, who knows when to kick something up the chain. But that would be adding staff, which costs money, so instead they just replace an MD/DO with an NP/PA, pocket the cash, and things are as slow as before but now less safe.

When you see articles about staff quitting due to "moral injury," it's not vaccine objectors. That odious buzzword is how they summarize "wanted to Help People, could no longer handle being a tiny moving part in a huge Kafkaesque blind and unconscious machine."
A lot of it really comes down to a combination of politicians writing the laws to benefit their donors and interest groups and the fact that malpractice suits in the States can be both devastating to a hospital and also brought to bear for retarded reasons. Ever since the ACA was passed everyone was required to have insurance and the entire medical apparatus had to retool for that, the number of actual healthcare workers, doctors nurses specialists etc., has hardly increased at all over the last ten years or so while the number of financial and managerial support staff for hospitals has risen dramatically. Hospitals have essentially become cubicle farm insurance office workplaces with an oversized in house medical team tacked on. Combine this with the fact that medicine has been heavily politicized for at least a couple decades now and it's fallen victim to the classic case of spaghetti law that anything touched by the federal government in the USA falls victim to.
On the one hand- yes. On the other hand, the media, parents, schools, so forth, do a terrible job of educating people about what is an actual medical concern you need to go to the doctor for, and what is just an annoying physical thing that will go away on its own. Thus we have vast swaths of the population doing the medical equivalent of calling 911 because McDonald's was out of nuggies. It's not even a class or race based thing, though the news will show the ER in the poor part of town full of Mexicans and blacks who go in for the sniffles or a twisted ankle instead of seeing a primary doctor. Neurotic upper middle class parents instill paranoia and a sense of duty to report every twitch to a physician too. You can really see the fruit of this insanity being harvested in the fallout from the coof. And why should hospital systems engage in better patient education when they can just keep raking in profits from morons?
See the issue is that I've seen a lot of people IRL who are like this guy, where there isn't actually anything wrong with them or if there is they should see a therapist and not a physician, they get diagnosed with something along the lines of "anxiety" because there really isn't anything wrong with them and the doctor doesn't want to call them a munchie, and then the guy with no real problem completely disregards the doctor and says "NO THAT CAN'T BE IT! THE DOCTOR OBVIOUSLY DOESN'T KNOW ANYTHING I'M RIGHT AND THEY'RE WRONG!"

And then they usually bring up one of the more isolated incidents that get heavily publicized in the media where this person with a super weird one in ten thousand condition that appears to be any number of other more common conditions was misdiagnosed for months or years and nearly died until a specialist from far away properly diagnoses them.
 
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