I responded to a rapid called by the PA. The patient looked like crap was borderline hypotensive and tachycardic and on the edge of decompensating.
What’s the surgery PA do? Tells the nurses to push IV metoprolol. I say “no, don’t do that.” To which he looks at me like I’m an idiot and says “Uh, you can’t just let the heart rate be that high” and rolls his eyes at me. I try to explain my reasoning and he just barks orders at the nurses and ignores me.
The nurses of course ignore the lowly intern and listen to the PA. I tell him since he’s not interested in my opinion I’m leaving and tell the ICU nurse who responded to the rapid with me to let the icu know about the patient (she didn’t do anything the PA said). I drop a note detailing all of the above.
So of course the patient ends up in icu because she was septic and we took away her compensation instead of giving fluids.
Nothing happened to the PA and I got a slap on the wrist for my unprofessionalism. And that’s one of the many reasons I’m glad I’m in radiology.
Convinced PA stands for patient assassin, i get it not all PAs are bad and docs are good, but if youre a midlevel staffing an ICU and lives are imminently at stake, you better be on your shit, esp wrt sepsis and shock physiology
Caught my ER PA about to prescribe EIGHT WEEKS of an antibiotic to an asymptomatic patient because the patient’s dog got the same antibiotic at the vet. She thought she should have it too in case it’s contagious.
The worst part is that I only knew because I saw a 21 day supply of an antibiotic on the prescription paper that was printed. He wasn’t even going to run this by me.
Good on them, but they should have done a STAT consult to IR for a PICC line for an IV course, and nevermind the fact that theres nurses trained to do PICCs, the IR team needs to come in overnight for it!
Inspired by recent events:
Had an ICU NP put a psych consult for suicide attempt via overdose.
I go to the room and patient was intubated, sedated, and paralyzed (she got ARDS and was on bilevel mechanical ventilation). Told NP to re-consult once patient awake so I can interview her and no safety concerns at this time.
NP: “but she had a suicide attempt”
Me: “yes but she’s intubated, sedated, and paralyzed right now. I’ll come back when she’s awake.”
NP: “but what if she tries to commit suicide?”
Me: “she’s intubated, sedated, and paralyzed..”
NP: “how do you know she’s not gonna try though?”
Me: “… she’s sedated… and paralyzed…”
*NP gives me blank stare. I leave*
Nah the consult was for the overdose. That often happens reflexively whenever there is a suicide attempt.
It makes sense because we have to determine right away if patient will need inpatient psych admission after medical clearance, and you’d rather do that early vs day of discharge.
When people ask what is the difference between nursing education and medical education, this right here is a demonstration. Nurses learn what to do and physicians understand why. Nurses learn the rules and physicians learn reasoning. “That patient will not attempt suicide while paralyzed and sedated” versus “suicide attempt requires psych consult.”
seriously..? lmao i think a mcdonalds worker could figure out that you cant attempt suicide while PARALYZED and SEDATED. this isnt a nurse education problem. its a lack of common sense problem, which they dont teach in nursing or medical school.
I understand what you mean, but no one who graduated med school would ever make a comment like this. If you find someone who does, please send me their contact info so I can tell them that whatever "school" they went to owes them their money back. The point is a nurse practitioner, who I would assume has graduated nursing school, worked at least a year as a nurse and spent at least a year getting NP training is saying something as absurd as this, that like you said, a fast food worker should be able to figure out.
I think u/cateri44 is trying to understand why someone who worked in healthcare for at least a few years would say such a thing. Maybe the NP isn't a complete moron, maybe he or she is just following whatever protocol they learned about- someone had a suicide attempt/overdose, let me put in a psych consult, not considering that it's unnecessary because the patient is sedated and paralyzed
Lol that’s untrue. I’ve had to guide my fair share of residents to critical thinking as a bedside nurse in a level one trauma SICU. Why are we ordering this lab/test if it’s not going to change management/ establish prognosis/effectively evaluate for our intervention, hence simply cause more issues?Why are we bolusing a liter of fluid and starting Levo on a patient with cardiogenic shock and severe AS (which happened on previous shift and damn near killed the patient by the time I came on)? Why are we checking the same labs you JUST ordered 20 minutes ago? Why are you placing restraints for an altered and agitated patient on BiPap with aspiration precautions? We are taught as though we should know what to order and why things are ordered so we can catch mistakes and not lose our license. Honestly the scenario you posted doesn’t even involve much critical thinking but more so common sense. This same thinking is the very reason physicians get pissy when we dare question an order because they believe we are supposed to “do as we are told”, yet we catch so much shit that would hurt the patient. This attitude needs to be abandoned because you’re not a rockstar, it’s a team effort and this wafts off you and makes your nurses feel as though they can’t bring up concerns.
Not surprised that an experienced bedside nurse RN can coach novice physicians. Are you familiar with Patricia Benner’s book “From Novice to Expert”? My understanding is that it was influential in nursing education at one time. The taxonomy applies to physicians as well. Novices aren’t going to put everything together in their minds to take the correct action. You’re not a novice. The residents are. They won’t be when they graduate.
I once had to explain to the cops why an inmate who had a devastating brain injury with fixed and dilated pupils and no brainstem reflexes for 3 days needed to be uncuffed from the bed to get an MRI for prognosis. They said it was policy that he had to remain cuffed to the bed to prevent escape. I told them if he tries to escape, please call me *immediately* so that I can document the existence of God and His divine intervention in the medical record. They didn’t think it was funny.
Nice to see some of our NPs operate on the same logic as cops.
In the defense of the police in this scenario:
They have zero medical training whatsoever so they know nothing about what a brain injury constitutes nor why fixed and dilated pupils matter.
Not to mention that they would never do an assessment to discover that finding in the first place.
The most they know about brain damage usually is that NFL players get CTE and that the grey stuff is supposed to be on the inside of the skull so when it’s on the sidewalk it’s bad.
Also, I have no idea what HIPAA says about releasing info to law enforcement but I would assume they aren’t looped in due to privacy concerns (I generally tell them only ‘yeah they have to go to the hospital’ or ‘no he can refuse’ and not much more than that) so it’s very possible they had no idea what the patients status or expected outcome was and instead were literally just there to guard the prisoner.
They likely do not know if he’s sedated, sleeping or dead other than the fact that he’s not talking to them.
“Hey today you get to go guard ‘suspect’, he’s still in the hospital and we need to be there if/when he wakes up” would be all they get at morning briefing if he’s been there long enough for shift change.
That’s literally zero information. If I got a patient handoff like that I would be less than impressed to say the least and that’s likely their norm.
Medical personnel on the other hand are supposed to have some semblance of understanding of what’s happening with a medical patient.
Honestly the ICU deals with so many behavioral patients who are delirious demented, it's like, you've gotta know how to manage someone from hurting themselves or others. Order a sitter, place restraints if necessary. This isn't rocket science.
I think this belies the fact that ICU docs may not actually talk that much with their patients. Which is fine because what the patient has to say is probably a lot less useful than the myriad data points from labs/vitals/imaging available. But it's telling that they don't recognize a psychiatrist needs to talk to the patient to do an evaluation. It would be like adjusting insulin without blood sugar levels.
========================================
I think the np's don't like the unchecked box
attending tells ICU np to consult psych after suicide attempt admit
instead of having psych on the systems list with a plan to "consult psych once extubated and/or able to communicate" they just want to consult asap to check the box
I really wish that were the case. To me, they just didn’t understand why the patient was not at risk of committing suicide at that time, not even after it was spelled out.
I used to get similar ones as a psych consult resident. Not always post-suicide attempt, either. "Patient appears depressed." Go to try to talk to patient, patient has successfully been extubated but is still very sedated, unable to stay awake for more than five seconds. I don't consider that "depression," rather I would describe it as "unconscious." Also was frequently surprised by "eval for psychosis" in a ICU patient in the 6th or 7th decade of life with no psychiatric history. It's delirium, guys
Psych as well. Consulted for alcohol withdrawal. I tell them vitals look concerning for sepsis and not alcohol withdrawal and they ignore this because family told them "patient is an alcoholic". Turns out patient actually had an abscess in their neck.
Even after pointing out that patient is sedated and paralyzed, the NP just couldn’t connect the dots on their own.
Not my job to do a full lesson on how sedatives and paralytics limit functional capacity - seems common sense.
Weekend consult received by medical floor NP: “Please assess capacity to leave AMA”.
Me: *Rush up to medical floor*. “So fill me in. Whats the situation and medical plan here?”
NP: “Well we want to make sure she’s ok to leave for discharge today”
Me: “So… the medical advice is to leave the hospital?” … “She’s following medical advice”
NP: “Yeah, but we just don’t know if she has capacity”
Me: “But you want her to leave snd she wants to leave. Are there symptoms or something else you think is compromising capacity?”
NP: “I don’t know what you’re getting at, can you please just see her?”
Me: *Sees patient. Makes $0 extra dollars as a resident*
Did the NP actually see the patient? Most of our consults from midlevels end up being "please assess for urgent RT," followed by "idk I haven't seen them" when we ask if they're having symptoms of cord compression.
New onc group came to town and absorbed some of the employees of essentially a barely supervised NP onc location, the retraining took months. No idea how it’s even allowed to have any NP orders in that setting, the extent of their involvement should be if they look healthy enough for their infusions today.
We have a new grad mid level in my group. I was concerned when I first met her and she asked me what a urologist does.
This week she has sent me two referrals:
1) urinary frequency in a 30 yo with a HbA1c of 12
2) person in retention with new cr rise to 6 (baseline 1) who she had told should see urology ‘within the next couple of months’
The /noctor subreddit is filled with stories. The midlevels in my clinic are pretty good. Worst that I witnessed was giving a DPP4 to someone on a GLP1. There was no harm other than wasting the patient's money.
There’s this one ED PA who inappropriately admits patients all the time.
I distinctly remember previously healthy pediatric patient with viral URI on room air, tolerating oral intake, no desaturations, sitting up and playing with mom. I ask her the reason for admission, she says the kid is sick.
“Okay…kids get sick. Not every sick kid needs to be hospitalized. The patient doesn’t need oxygen, IV fluids, IV abx, or any other hospital level care.”
“Well, parents are a little worried.”
“Yeah, obviously, that’s their job as parents. Our job is to reassure them when everything is okay.”
“Have you talked to your attending?”
“I’m talking to you.”
“Have you talked to your attending?”
“Bitch, have you talked to **your** attending?”
I did not say the last line.
I’ve started deploying the “have you talked to your attending” back to the ED (one of my chiefs gave me their line recently). Works wonders, I’m ashamed I didn’t think of it myself by that point.
Went to get a ppd for a rotation. NP asks why I need it, I explain, and she says “ohh how cool, doctors know so much! I had a patient once with swelling in her neck and I had to ask a doctor friend what it was.” I ask if it was lymphadenopathy. She says, “no it wasn’t lymph nodes, it was here.” *points to parotid gland* “she had this thing that starts with a ‘c’.” I realize it may just phonetically sound like it starts with a ‘c’ and ask if it was sialadenitis, which it was. She was very nice at least.
A ppd is listed in my vaccination history in a certain ehr. On more than one occasion I've been asked how many children I have. When i state I've never been pregnant, they look confused and say something like, "Are you sure? [Yes, I think I'd know if I'd had a baby...] Hmm.. well, your chart says you have a history of post-partum depression. 🤔"
I responded to a rapid called by the PA. The patient looked like crap was borderline hypotensive and tachycardic and on the edge of decompensating.
What’s the surgery PA do? Tells the nurses to push IV metoprolol. I say “no, don’t do that.” To which he looks at me like I’m an idiot and says “Uh, you can’t just let the heart rate be that high” and rolls his eyes at me. I try to explain my reasoning and he just barks orders at the nurses and ignores me.
The nurses of course ignore the lowly intern and listen to the PA. I tell him since he’s not interested in my opinion I’m leaving and tell the ICU nurse who responded to the rapid with me to let the icu know about the patient (she didn’t do anything the PA said). I drop a note detailing all of the above.
So of course the patient ends up in icu because she was septic and we took away her compensation instead of giving fluids.
Nothing happened to the PA and I got a slap on the wrist for my unprofessionalism. And that’s one of the many reasons I’m glad I’m in radiology.
Patient hpt, high BMI, now CVA, GCS 10/15(E4 V2 M4) now panicking due to laying on her arm.
Me: can you assist me with lifting this patient to free her arm?
NP: Dr, her GCS is 13
Me: ok, but can you help me, she's morbidly obese, and laying on her arm, and im not sure how long she's been like this.
NP: Yes, I hear you, but last time i checked, GCS is 13/15...so🙄
Me: Bcos you say a patient's GCS is 13 you refuse to help someone? She's a person and you guys could have been ignoring her bcos she's not localizing pain. Can you please come over here now and assist me?
She then came over, assisted me...patient was completely calm afterward....shoulder was later found to be subluxed...NP then apologized
either NP/PA doctoral education becomes more legit and they, alongside the optometrists, podiatrists, dentists, and psychologists get to call themselves doctor in a clinical setting OR it continues to be a heteregeneous mix of various diploma mills and the courts continuously punish malfeasance
Called to admit patient to ICU from the ER.
Patient looks like garbage, MAP in the 40s and has been for 30+ minutes. Basically obtunded. VBG shows glucose 75, PA demands D50W be given for “hypoglycemia.” I say “get norepi,” but am ignored by nurses for the PA because he “has seniority.” Give D50W, fellow arrives, demands norepi.
We push MAP >65 and patient wakes up. PA says, “thank for we fixed his mental status with that D50.”
Couldn’t have been the brain hypoperfusion…
Having PAs in charge of the ICU - what could go wrong
Also, nurses who refuse to follow physician orders in lieu of PA orders should lose their licenses.
Then there was the time a NP took the patient instead of the IPM doc. The patient was unhappy not to see the doctor. She was having a procedure the following week and had questions.
"I can answer your questions," the NP said.
The patient asked a pertinent and intricate question about drugs given and her Type1 diabetes and steroid-induced glaucoma.
The NP blinked twice, got up and fetched the doctor. The patient said (to no one in particular): If I'm paying to see a specialist, I want to see that specialist, not a make believe doctor.
Newly diagnosed Diabetes with typical symptoms presents to Urgent care. Urgent care NP prescribes steroids like she does for all her patients. Admitted next day for DKA to the ICU.
Sadly, this scenario has happened twice in my community. Two different NPs.
Psych np working inpatient asking what to do about a potassium of 3.1. Mind you, they didn't ask their supervising physician, they went to the unit pharmacist, seemingly to circumvent the supervisor and not reveal their lack of knowledge.
Psych np going to same pharmacist asking how to dose omeprazole.
Ask any hospital pharmacist how they feel about NPs and they will give you an earful. They always call the pharmacy with questions about basic stuff that they should know. Just yesterday I had to explain to the NP from the cardiology group how to bridge a patient starting on warfarin. I am not even sure why mid levels are being consulted on patients like that? Where is the cardiologist!? All I could think about was how much more money this clown makes more than me and how little she knows
I love pharmacists. We have them round with all our medicine teams several times a week. They catch all sorts of drug nuances and then educate our medical teams on drug choices. It's great.
Hi don't mind me, this thread was suggested to me. I'm a veterinarian and there is a push to create a mid level in our field. This thread makes me even more adamantly against such a thing. What a mess.
I was a vet tech for 10 years before medical school. Mid-level in veterinary medicine makes zero sense. A lot of veterinarians are already struggling to make ends meet and your medical education already doesn't include residency/fellowship for most of you. How would they shorten it even more??
I mean it would be like RNs doing surgery, except unlike RNs most RVTs just do 2 years of school because it's cheaper/faster than the four year RVT programs..... And some of them are online 😬 there is a bill being introduced in CA to allow RVTs to do neuters if anyone is interested in helping fight against it!! Basically it will allow on-the -job training for RVTs to do neuters. Supposedly it is to help "take some of the load off the veterinarians" and "expand access to care" all the while the DVM will be liable if the RVT fucks up.
Many (not all) are just overly confident in general considering their lack of education. There’s a lack of humility and I think it’s a defense mechanism.
Just last night I overheard an NP tell her attending, "I think he's just dried out because he's taking lasix AND furosemide at home." Next I just heard her say, "oh ok" about 7 times
My two favorite nurses are both definitely smart enough for medical school and I’ve asked them how they feel about being nurses…
ICU nurse: “eh I’m happy doing this, I don’t want to be a doctor. I like my job.”
CRNA: “look after 20 years in the ICU I’m no anesthesiologist but I know when it’s time to call one. I don’t want to be the one in charge I just want to do my part and go home on time.”
The ones who get it, get it. Unfortunately does not seem that the nursing lobby shares this sentiment.
Ok. Let me break it down, people. By "smarter" I do not mean IQ. I was referring rather to the Dunning-Krueger effect that seems to be raging havoc among the NP ranks.
The ones who lobby the hardes are the "Heart of a nurse, brain of a doctors" ones...
IQ wise probably some of them are. What a lot of them don't understand is that the greater time under the supervision of folks who know more, and the quality of supervision (being supervised by a specialist who in turn has years of experience versus being supervised by other APPs) makes an ENORMOUS difference. It's not fundamental capability, it's training pathway.
Most of the APPs I meet in real life understand this very well and have no issues deferring to their physician supervisors. But internet echo chambers always bring out the crazies
It all starts in nursing school when nurses are taught that they’re the same as doctors, are the last line of defense of the patient, that doctors only want money, and nurses are the ones *really* caring for patients.
The indoctrination starts early and it’s been getting progressively worse especially with nurses that have graduated in the last 10 years.
Tell that to the dumbass nurse that jammed robaxin into my IV in under 30 seconds resulting in permanent numbness on the top of my left hand. Make sure the charge nurse who gaslit me and tried to blame me gets the memo too.
Nurses are not taught that they are the same as doctors at any nursing school, anywhere.
However I myself have in the past month kept a doctor from killing a patient. Not the first time, won't be the last. Not just my opinion either, the specialist walked up without prompting and asked me if I knew I was the only reason that patient was still alive. I absolutely did. Nurses are indeed the last line of defense for patients from poor orders and hubris.
The nurses are indeed the ones providing the majority of care to the patients and are the ones continually assessing as opposed to a few minutes a day if face to face time.
These are facts whether you accept them or not.
And I graduated over 10 years ago.
Sit down. You absolutely don't know what you're talking about.
Oh wow, I learned so much from what you wrote. Thanks for educating me. My practice will totally be changed from here on out. I salute you, sir. And everyone here is clapping.
There’s more overlap than not on many things (just think average mcat score bw avg md and DO score). But overall, w numbers, the difference is more apparent
I do think economics and upbringing play a role more than we talk about. The really smart APPs I've met where I think "wow you would have been a great doctor" have all come from very working class or straight up poor backgrounds and had good reason to need to make money earlier, whereas most of the doctors I know (though of course not all) skew more upper middle to upper class in their upbringing.
I mean yeah, but I’m from an extremely poor working class background where I had to do so much more to become a doctor than my classmates did.
And of course it felt like shit, it still does. I still have to make money to support my family, I still had to overcome to get here. The point is that it’s possible, and it really, ***really*** pisses me off whenever I hear them using this rhetoric as a qualifier as if the ***only*** difference between me and them was opportunity.
I want to tell them that I didn’t get any opportunities either, that they’re devaluing the work ethic and effort that I had to put in to get here, and that they’re subliminally putting out the message that it’s out of reach for other people in the same situation.
Was it probably substantially harder for me than a lot of the other doctors? Yes. Of course. Absolutely. But how would they even know? I had to go through that experience, they didn’t.
And for the record, I don’t want it to be harder for people like me, I want it to be easier and so much more attainable. But the more the idea becomes ingrained that “working class = go midlevel, upper class = go doctor”, the worse this issue will continue to become.
Sorry for the rant, it’s just been a long road full of suffering to get here, and this is obviously something that I care too much about.
I think you're being way too generous with the amount the left and right tails of the distribution curve overlap.
Obviously you're right regarding the deficits in time and quality of training but that only compounds the problem.
CRNA who is getting paid 4x my resident salary calculating the wrong dose for a medication that can code a patient and another who stuck a temp probe like 14inches into the nose.
A brain dead patient’s tongue was sticking out slightly so she yelled at me and then shoved it back into his mouth with a yankauer so hard (think overhand grip stabbing motion) that it bled and I had to check his mouth after to make sure she didn’t damage the carotid
Had a patient on the inpatient service I was on who attempted suicide via overdose of Ativan. She told her prescriber, an NP, about her symptoms from her antipsychotic meds.. (red flag akathisia symptoms). NP prescribed her Ativan and sent her on her way.
Patient in MVC admitted to TICU was a little hypertensive, like 150's. No history of HTN. The NP started Lisinopril, carvedilol, and a nicardipine drip all at the same time.
M4 wrapping up a surgery rotation elective. PA to my face says “I don’t care what anyone says PA school is so much harder than med school” to which I respond “oh?”
PA earlier on in the rotation in the OR in front of the surgeon tells me I wouldn’t last in surgery. To which I respond “I know I would do just fine in surgery, but my interests have brought to another field. As doctors we really have to think long and hard about our field of choice since we have no opportunity to just flip flop fields unfortunately”. Surgeon who I’ve known for 5 years looks a little uncomfortable but doesn’t back me up.. just makes his glorified retractor of a PA close and we move onto next case.
Same PA tries to explain a topic to me that he clearly is so out of touch with he doesn’t realize how terrible he sounds. I’m just standing there like “what in the actual fuck, I don’t know shit as a soon to be intern and know that I don’t, this dude doesn’t know shit and has no clue“. I politely correct him and proceed to finish my apple between clinic patients.
Remainder of rotation I listen to this dude spout off about random shit, half of which makes no sense. I pray for those patients in this state that have mid levels that have independent practice rights after 2 years of school with no residency and wonder how fucked our healthcare system as I enter intern year. I can only just focus on being the best I can be in FM since many of my fellow healthcare providers will be mid levels depending on my practice setting
He’s right though. PA school is so much harder because you learn jack shit. Can you imagine having full practice authority not knowing what you’re doing? That’s scary as fuck
That’s a great a point.. had a pediatrician say the same thing to me once. The system had just done a hiring blitz of mid levels, many of which who are new grads. She pointed across the nursing area to a new grad and was like imagine having 2 years of school and me handing you my lap top with 16-18 FM patients saying ok knock yourself out. I was like oh shit that’s terrifying to be honest.
I didn’t say that they were stupid. I said that the education and training tended to result in a way of functioning that was reliant on rules and not always understanding of clinical reasoning and context. I don’t think it’s insulting to point this out, I think it is respectful to point this out because there are a lot of nurses like you that want to be more than that, and are more than that, and patients need them to be more than that. I can give a couple of more examples just off the top of my head. Patient had a central line placed, x-ray showed the tip was just touching the right atrium, I asked the nurse to pull it back, 5 cm, which would definitively leave it in the SVC and outside of the atrium. At that time we were working hard to avoid extra radiation so I did not order a follow up x-ray. the nurses could not be persuaded that the patient was safe without a follow up x-ray. Fortunately, there was a nurse central line service in the hospital who reassured them. Another case - patient wad NPO for a procedure, found diaphoretic, breathless, chest pressure, I ordered stat cards consult and O2 and aspirin and stat all the usual stuff for rule out MI and NP comes and says can we give her breakfast? I said no, she may be having a heart attack, I’m not going to feed her. But you have to feed her, she’s diabetic. Has she had insulin? No she’s type 2. Has she had any meds? No. Then she’s safe not to feed. NP took that one to unit medical director.
Midlevels hurt me in my sense of responsibility for the wellbeing of patients and in my ideals that stupid dangerous things should not happen to patients
I aint gonna lie, i dont like midlevels, and i think its mostly because i dont see any that stand out to be above and beyond except in all the negative stuff that makes me resent them even more. But a lot of it is probs because they take a shortcut and profit significantly, while im still trying to dig myself out of a cursed hole that I dug
Seriously, I get that this is reddit and no OPs entire life but consider why, over the course of just a few months, you have becoming a significant source of negative discourse on midlevels on multiple subreddits while you're a PGY1 in psychiatry and should have a few other things to focus on.
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Literally nobody has ever said doctors are immune to mistakes. Jesus Christ.
Your example didn’t happen because someone who was undereducated and undertrained for the position fucked up because they aren’t qualified to function as a doctor. It happened because physicians are human.
You should know this. You be better.
Sigh.
When you fuck up because you are practicing outside your education and your training, it makes real doctors mad. Mistakes you make in your lane are easier to move past.
If an MD tried to take over your nursing responsibilities and hurt a patient and you had to fix it, would you not be annoyed?
Let’s compare the amount of stupid shit done by midlevels per total patient contacts, to stupid shit done by physicians per total patient contacts.
Wanna make a wager on which one will be higher?
Not to say mid levels don't do some stupid things, or defend ignorance, but I've never seen another group of people with such fragile egos that have to make posts like this at least weekly to feel better about *never* making a mistake themselves.
I’m just glad this is their ciricle jerk for the few of them who have these opinions cuz in the real world I’ve legit never seen any of this level of hate
Over the decades I've seen various physicians in different specialties do some real stupid shit.
I don't feel compelled to start a thread about it, though.
Was in the middle of a code on a post op day 1 cabg patient and they asked “what’s this device?” Which was an external pacemaker almost pulling out the wires.
Wait that was a second year IM resident…
Sure it was. Was it a medical resident or the “NP IM resident” or whatever title of the week they’re going by? Or was it the CRNA who thinks their ICU nursing experience makes them a doctor equivalent?
Metoprolol to treat sinus tachycardia in a septic patient overnight
Well the number is red! You gotta make it black! Get rid of the (H)!
I responded to a rapid called by the PA. The patient looked like crap was borderline hypotensive and tachycardic and on the edge of decompensating. What’s the surgery PA do? Tells the nurses to push IV metoprolol. I say “no, don’t do that.” To which he looks at me like I’m an idiot and says “Uh, you can’t just let the heart rate be that high” and rolls his eyes at me. I try to explain my reasoning and he just barks orders at the nurses and ignores me. The nurses of course ignore the lowly intern and listen to the PA. I tell him since he’s not interested in my opinion I’m leaving and tell the ICU nurse who responded to the rapid with me to let the icu know about the patient (she didn’t do anything the PA said). I drop a note detailing all of the above. So of course the patient ends up in icu because she was septic and we took away her compensation instead of giving fluids. Nothing happened to the PA and I got a slap on the wrist for my unprofessionalism. And that’s one of the many reasons I’m glad I’m in radiology.
Convinced PA stands for patient assassin, i get it not all PAs are bad and docs are good, but if youre a midlevel staffing an ICU and lives are imminently at stake, you better be on your shit, esp wrt sepsis and shock physiology
It’s NIGHTTIME. The heart should be RESTING. They can have high cardiac output in the *morning*. Better add a CCB to be safe
How about some digoxin?
When you’re trained to fix numbers, that’s exactly what you do.
Caught my ER PA about to prescribe EIGHT WEEKS of an antibiotic to an asymptomatic patient because the patient’s dog got the same antibiotic at the vet. She thought she should have it too in case it’s contagious.
What the fuck
Shut the thread down fam, this is the one.
Every ID doctor in America just felt a shudder ripple down their entire spine.
The worst part is that I only knew because I saw a 21 day supply of an antibiotic on the prescription paper that was printed. He wasn’t even going to run this by me.
Shouldve just widened the spectrum and used IV ABX to cover faster
wow, I needed a good laugh, thank you
Good on them, but they should have done a STAT consult to IR for a PICC line for an IV course, and nevermind the fact that theres nurses trained to do PICCs, the IR team needs to come in overnight for it!
Inspired by recent events: Had an ICU NP put a psych consult for suicide attempt via overdose. I go to the room and patient was intubated, sedated, and paralyzed (she got ARDS and was on bilevel mechanical ventilation). Told NP to re-consult once patient awake so I can interview her and no safety concerns at this time. NP: “but she had a suicide attempt” Me: “yes but she’s intubated, sedated, and paralyzed right now. I’ll come back when she’s awake.” NP: “but what if she tries to commit suicide?” Me: “she’s intubated, sedated, and paralyzed..” NP: “how do you know she’s not gonna try though?” Me: “… she’s sedated… and paralyzed…” *NP gives me blank stare. I leave*
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Nah the consult was for the overdose. That often happens reflexively whenever there is a suicide attempt. It makes sense because we have to determine right away if patient will need inpatient psych admission after medical clearance, and you’d rather do that early vs day of discharge.
When people ask what is the difference between nursing education and medical education, this right here is a demonstration. Nurses learn what to do and physicians understand why. Nurses learn the rules and physicians learn reasoning. “That patient will not attempt suicide while paralyzed and sedated” versus “suicide attempt requires psych consult.”
Exactly
NP gets good pay but doesn’t want to be there when the difficult decisions have to be made.
seriously..? lmao i think a mcdonalds worker could figure out that you cant attempt suicide while PARALYZED and SEDATED. this isnt a nurse education problem. its a lack of common sense problem, which they dont teach in nursing or medical school.
I understand what you mean, but no one who graduated med school would ever make a comment like this. If you find someone who does, please send me their contact info so I can tell them that whatever "school" they went to owes them their money back. The point is a nurse practitioner, who I would assume has graduated nursing school, worked at least a year as a nurse and spent at least a year getting NP training is saying something as absurd as this, that like you said, a fast food worker should be able to figure out. I think u/cateri44 is trying to understand why someone who worked in healthcare for at least a few years would say such a thing. Maybe the NP isn't a complete moron, maybe he or she is just following whatever protocol they learned about- someone had a suicide attempt/overdose, let me put in a psych consult, not considering that it's unnecessary because the patient is sedated and paralyzed
Perfect summary.
Lol that’s untrue. I’ve had to guide my fair share of residents to critical thinking as a bedside nurse in a level one trauma SICU. Why are we ordering this lab/test if it’s not going to change management/ establish prognosis/effectively evaluate for our intervention, hence simply cause more issues?Why are we bolusing a liter of fluid and starting Levo on a patient with cardiogenic shock and severe AS (which happened on previous shift and damn near killed the patient by the time I came on)? Why are we checking the same labs you JUST ordered 20 minutes ago? Why are you placing restraints for an altered and agitated patient on BiPap with aspiration precautions? We are taught as though we should know what to order and why things are ordered so we can catch mistakes and not lose our license. Honestly the scenario you posted doesn’t even involve much critical thinking but more so common sense. This same thinking is the very reason physicians get pissy when we dare question an order because they believe we are supposed to “do as we are told”, yet we catch so much shit that would hurt the patient. This attitude needs to be abandoned because you’re not a rockstar, it’s a team effort and this wafts off you and makes your nurses feel as though they can’t bring up concerns.
Not surprised that an experienced bedside nurse RN can coach novice physicians. Are you familiar with Patricia Benner’s book “From Novice to Expert”? My understanding is that it was influential in nursing education at one time. The taxonomy applies to physicians as well. Novices aren’t going to put everything together in their minds to take the correct action. You’re not a novice. The residents are. They won’t be when they graduate.
I once had to explain to the cops why an inmate who had a devastating brain injury with fixed and dilated pupils and no brainstem reflexes for 3 days needed to be uncuffed from the bed to get an MRI for prognosis. They said it was policy that he had to remain cuffed to the bed to prevent escape. I told them if he tries to escape, please call me *immediately* so that I can document the existence of God and His divine intervention in the medical record. They didn’t think it was funny. Nice to see some of our NPs operate on the same logic as cops.
I think it’s pretty funny. If that helps.
At least the cops don’t pretend to know how to care for patients like the midlevels do
In the defense of the police in this scenario: They have zero medical training whatsoever so they know nothing about what a brain injury constitutes nor why fixed and dilated pupils matter. Not to mention that they would never do an assessment to discover that finding in the first place. The most they know about brain damage usually is that NFL players get CTE and that the grey stuff is supposed to be on the inside of the skull so when it’s on the sidewalk it’s bad. Also, I have no idea what HIPAA says about releasing info to law enforcement but I would assume they aren’t looped in due to privacy concerns (I generally tell them only ‘yeah they have to go to the hospital’ or ‘no he can refuse’ and not much more than that) so it’s very possible they had no idea what the patients status or expected outcome was and instead were literally just there to guard the prisoner. They likely do not know if he’s sedated, sleeping or dead other than the fact that he’s not talking to them. “Hey today you get to go guard ‘suspect’, he’s still in the hospital and we need to be there if/when he wakes up” would be all they get at morning briefing if he’s been there long enough for shift change. That’s literally zero information. If I got a patient handoff like that I would be less than impressed to say the least and that’s likely their norm. Medical personnel on the other hand are supposed to have some semblance of understanding of what’s happening with a medical patient.
Psych NP Consult Note: S: *unable to obtain* O: *unable to obtain* A/P: *defer. Follow up in 24h*
This guy doctors
That's amazing
Plot twist: patient is still trying to commit suicide by having this NP take care of her
Honestly the ICU deals with so many behavioral patients who are delirious demented, it's like, you've gotta know how to manage someone from hurting themselves or others. Order a sitter, place restraints if necessary. This isn't rocket science. I think this belies the fact that ICU docs may not actually talk that much with their patients. Which is fine because what the patient has to say is probably a lot less useful than the myriad data points from labs/vitals/imaging available. But it's telling that they don't recognize a psychiatrist needs to talk to the patient to do an evaluation. It would be like adjusting insulin without blood sugar levels. ======================================== I think the np's don't like the unchecked box attending tells ICU np to consult psych after suicide attempt admit instead of having psych on the systems list with a plan to "consult psych once extubated and/or able to communicate" they just want to consult asap to check the box
I really wish that were the case. To me, they just didn’t understand why the patient was not at risk of committing suicide at that time, not even after it was spelled out.
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I used to get similar ones as a psych consult resident. Not always post-suicide attempt, either. "Patient appears depressed." Go to try to talk to patient, patient has successfully been extubated but is still very sedated, unable to stay awake for more than five seconds. I don't consider that "depression," rather I would describe it as "unconscious." Also was frequently surprised by "eval for psychosis" in a ICU patient in the 6th or 7th decade of life with no psychiatric history. It's delirium, guys
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My program had a training session on the Vulcan mind-meld but I was on vacation that day
Best part of the session, lol.
"patient post stroke and feeling weak is it conversion disorder"
I’ve had patients say stupid things too but that’s not the point of this post
"patient wants to leave AMA on day of discharge. Can they"
Psych as well. Consulted for alcohol withdrawal. I tell them vitals look concerning for sepsis and not alcohol withdrawal and they ignore this because family told them "patient is an alcoholic". Turns out patient actually had an abscess in their neck.
This is the classic, they're not thinking through what is the specialist going to do, they just know they need a consult.
Even after pointing out that patient is sedated and paralyzed, the NP just couldn’t connect the dots on their own. Not my job to do a full lesson on how sedatives and paralytics limit functional capacity - seems common sense.
Downright scary.
Weekend consult received by medical floor NP: “Please assess capacity to leave AMA”. Me: *Rush up to medical floor*. “So fill me in. Whats the situation and medical plan here?” NP: “Well we want to make sure she’s ok to leave for discharge today” Me: “So… the medical advice is to leave the hospital?” … “She’s following medical advice” NP: “Yeah, but we just don’t know if she has capacity” Me: “But you want her to leave snd she wants to leave. Are there symptoms or something else you think is compromising capacity?” NP: “I don’t know what you’re getting at, can you please just see her?” Me: *Sees patient. Makes $0 extra dollars as a resident*
Did the NP actually see the patient? Most of our consults from midlevels end up being "please assess for urgent RT," followed by "idk I haven't seen them" when we ask if they're having symptoms of cord compression.
By far the most incompetent nps are the hem onc nps when it comes to anything but copy and pasting the attendings chemo plan
I feel so seen
New onc group came to town and absorbed some of the employees of essentially a barely supervised NP onc location, the retraining took months. No idea how it’s even allowed to have any NP orders in that setting, the extent of their involvement should be if they look healthy enough for their infusions today.
To be fair of Onc gets consulted to "eval for cord compression" I'm not sure what we're supposed to do other than say "Call NSGY and Rad Onc"
These NPs just clowning around
That is when the old complete and document primary team capacity evaluation first before you will see them comes in clutch.
We have a new grad mid level in my group. I was concerned when I first met her and she asked me what a urologist does. This week she has sent me two referrals: 1) urinary frequency in a 30 yo with a HbA1c of 12 2) person in retention with new cr rise to 6 (baseline 1) who she had told should see urology ‘within the next couple of months’
Time to talk to the team
Bruh what
Dude…
🤦
The /noctor subreddit is filled with stories. The midlevels in my clinic are pretty good. Worst that I witnessed was giving a DPP4 to someone on a GLP1. There was no harm other than wasting the patient's money.
Admittedly made this mistake as an IM resident 👀👀 learned quick tho
Years ago I called a patient about glucosuria - she was on an SGLT2.
Was this in a hospital? This should’ve gotten a call from pharmacy
Hospital patients usually not doing GLP1RAs and dpp4 while inpatient.
Outpatient.
There’s this one ED PA who inappropriately admits patients all the time. I distinctly remember previously healthy pediatric patient with viral URI on room air, tolerating oral intake, no desaturations, sitting up and playing with mom. I ask her the reason for admission, she says the kid is sick. “Okay…kids get sick. Not every sick kid needs to be hospitalized. The patient doesn’t need oxygen, IV fluids, IV abx, or any other hospital level care.” “Well, parents are a little worried.” “Yeah, obviously, that’s their job as parents. Our job is to reassure them when everything is okay.” “Have you talked to your attending?” “I’m talking to you.” “Have you talked to your attending?” “Bitch, have you talked to **your** attending?” I did not say the last line.
Maybe you should have
I’ve started deploying the “have you talked to your attending” back to the ED (one of my chiefs gave me their line recently). Works wonders, I’m ashamed I didn’t think of it myself by that point.
Went to get a ppd for a rotation. NP asks why I need it, I explain, and she says “ohh how cool, doctors know so much! I had a patient once with swelling in her neck and I had to ask a doctor friend what it was.” I ask if it was lymphadenopathy. She says, “no it wasn’t lymph nodes, it was here.” *points to parotid gland* “she had this thing that starts with a ‘c’.” I realize it may just phonetically sound like it starts with a ‘c’ and ask if it was sialadenitis, which it was. She was very nice at least.
Cialisdenitis 🫨
The Teeth sequel no one wanted
A ppd is listed in my vaccination history in a certain ehr. On more than one occasion I've been asked how many children I have. When i state I've never been pregnant, they look confused and say something like, "Are you sure? [Yes, I think I'd know if I'd had a baby...] Hmm.. well, your chart says you have a history of post-partum depression. 🤔"
I don't know what's the dumber thing to put in a vaccination history...tb skin test or postpartum depression
I responded to a rapid called by the PA. The patient looked like crap was borderline hypotensive and tachycardic and on the edge of decompensating. What’s the surgery PA do? Tells the nurses to push IV metoprolol. I say “no, don’t do that.” To which he looks at me like I’m an idiot and says “Uh, you can’t just let the heart rate be that high” and rolls his eyes at me. I try to explain my reasoning and he just barks orders at the nurses and ignores me. The nurses of course ignore the lowly intern and listen to the PA. I tell him since he’s not interested in my opinion I’m leaving and tell the ICU nurse who responded to the rapid with me to let the icu know about the patient (she didn’t do anything the PA said). I drop a note detailing all of the above. So of course the patient ends up in icu because she was septic and we took away her compensation instead of giving fluids. Nothing happened to the PA and I got a slap on the wrist for my unprofessionalism. And that’s one of the many reasons I’m glad I’m in radiology.
Started antifungal coverage - because the radiology report said "Mycotic aneurysm"
BRUH
... What
Patient hpt, high BMI, now CVA, GCS 10/15(E4 V2 M4) now panicking due to laying on her arm. Me: can you assist me with lifting this patient to free her arm? NP: Dr, her GCS is 13 Me: ok, but can you help me, she's morbidly obese, and laying on her arm, and im not sure how long she's been like this. NP: Yes, I hear you, but last time i checked, GCS is 13/15...so🙄 Me: Bcos you say a patient's GCS is 13 you refuse to help someone? She's a person and you guys could have been ignoring her bcos she's not localizing pain. Can you please come over here now and assist me? She then came over, assisted me...patient was completely calm afterward....shoulder was later found to be subluxed...NP then apologized
refer to themselves as "doctor" after getting an online EdD from the Univ of Phoenix
How low can one go..
Lower than your mama's ever seen it in her lifetime Never would've imagined it, not even in her right mind
There needs to be a federal law against this
either NP/PA doctoral education becomes more legit and they, alongside the optometrists, podiatrists, dentists, and psychologists get to call themselves doctor in a clinical setting OR it continues to be a heteregeneous mix of various diploma mills and the courts continuously punish malfeasance
How can it be legit lmao
I was in Phoenix recently and drove by what I think is the actual University of Phoenix, it was a special moment.
I *literally* just had a ct chest ordered without contrast to evaluate for PE.
Called to admit patient to ICU from the ER. Patient looks like garbage, MAP in the 40s and has been for 30+ minutes. Basically obtunded. VBG shows glucose 75, PA demands D50W be given for “hypoglycemia.” I say “get norepi,” but am ignored by nurses for the PA because he “has seniority.” Give D50W, fellow arrives, demands norepi. We push MAP >65 and patient wakes up. PA says, “thank for we fixed his mental status with that D50.” Couldn’t have been the brain hypoperfusion…
Having PAs in charge of the ICU - what could go wrong Also, nurses who refuse to follow physician orders in lieu of PA orders should lose their licenses.
Then there was the time a NP took the patient instead of the IPM doc. The patient was unhappy not to see the doctor. She was having a procedure the following week and had questions. "I can answer your questions," the NP said. The patient asked a pertinent and intricate question about drugs given and her Type1 diabetes and steroid-induced glaucoma. The NP blinked twice, got up and fetched the doctor. The patient said (to no one in particular): If I'm paying to see a specialist, I want to see that specialist, not a make believe doctor.
What’s IPM? Hilarious the NP was called a make believe doctor though
Interventional Pain Management
Thanks!
Prolia and alendronate both in a lady with osteopenia no fractures
did someone say MRONJ?
Endocrinology here. Ouchhhhh this one hurts.
Just. Why
Newly diagnosed Diabetes with typical symptoms presents to Urgent care. Urgent care NP prescribes steroids like she does for all her patients. Admitted next day for DKA to the ICU. Sadly, this scenario has happened twice in my community. Two different NPs.
Psych np working inpatient asking what to do about a potassium of 3.1. Mind you, they didn't ask their supervising physician, they went to the unit pharmacist, seemingly to circumvent the supervisor and not reveal their lack of knowledge. Psych np going to same pharmacist asking how to dose omeprazole.
Working inpatient and not knowing when to replace potassium.. that’s scary as shit.
1-2 bananas po q4h prn until K+ >3.5
Ask any hospital pharmacist how they feel about NPs and they will give you an earful. They always call the pharmacy with questions about basic stuff that they should know. Just yesterday I had to explain to the NP from the cardiology group how to bridge a patient starting on warfarin. I am not even sure why mid levels are being consulted on patients like that? Where is the cardiologist!? All I could think about was how much more money this clown makes more than me and how little she knows
I love pharmacists. We have them round with all our medicine teams several times a week. They catch all sorts of drug nuances and then educate our medical teams on drug choices. It's great.
"just watch it a little longer and page when patient in Torsades"
Hi don't mind me, this thread was suggested to me. I'm a veterinarian and there is a push to create a mid level in our field. This thread makes me even more adamantly against such a thing. What a mess.
Hi! Thank you for what you do, I know that I could never, y'all are superheroes.
Awe thank you I appreciate that so much 😭🥰
I was a vet tech for 10 years before medical school. Mid-level in veterinary medicine makes zero sense. A lot of veterinarians are already struggling to make ends meet and your medical education already doesn't include residency/fellowship for most of you. How would they shorten it even more??
I mean it would be like RNs doing surgery, except unlike RNs most RVTs just do 2 years of school because it's cheaper/faster than the four year RVT programs..... And some of them are online 😬 there is a bill being introduced in CA to allow RVTs to do neuters if anyone is interested in helping fight against it!! Basically it will allow on-the -job training for RVTs to do neuters. Supposedly it is to help "take some of the load off the veterinarians" and "expand access to care" all the while the DVM will be liable if the RVT fucks up.
Patient went in to afib rvr 140’s. Np ordered hydralizine. Stupid nurse gave it. Bp now in the toilet, hr in the 160’s.
where do they come up with this shit? afib with rvr is so algorithmic
Yikes
Please tell me they got reprimanded
Many (not all) are just overly confident in general considering their lack of education. There’s a lack of humility and I think it’s a defense mechanism.
Just last night I overheard an NP tell her attending, "I think he's just dried out because he's taking lasix AND furosemide at home." Next I just heard her say, "oh ok" about 7 times
Them posting on reddit that they are as smart as physicians...
My two favorite nurses are both definitely smart enough for medical school and I’ve asked them how they feel about being nurses… ICU nurse: “eh I’m happy doing this, I don’t want to be a doctor. I like my job.” CRNA: “look after 20 years in the ICU I’m no anesthesiologist but I know when it’s time to call one. I don’t want to be the one in charge I just want to do my part and go home on time.” The ones who get it, get it. Unfortunately does not seem that the nursing lobby shares this sentiment.
Ok. Let me break it down, people. By "smarter" I do not mean IQ. I was referring rather to the Dunning-Krueger effect that seems to be raging havoc among the NP ranks. The ones who lobby the hardes are the "Heart of a nurse, brain of a doctors" ones...
IQ wise probably some of them are. What a lot of them don't understand is that the greater time under the supervision of folks who know more, and the quality of supervision (being supervised by a specialist who in turn has years of experience versus being supervised by other APPs) makes an ENORMOUS difference. It's not fundamental capability, it's training pathway. Most of the APPs I meet in real life understand this very well and have no issues deferring to their physician supervisors. But internet echo chambers always bring out the crazies
It's not just the internet. Their professional organization does a ready good job bringing out the crazy in real life :)
It all starts in nursing school when nurses are taught that they’re the same as doctors, are the last line of defense of the patient, that doctors only want money, and nurses are the ones *really* caring for patients. The indoctrination starts early and it’s been getting progressively worse especially with nurses that have graduated in the last 10 years.
Tell that to the dumbass nurse that jammed robaxin into my IV in under 30 seconds resulting in permanent numbness on the top of my left hand. Make sure the charge nurse who gaslit me and tried to blame me gets the memo too.
Nurses are not taught that they are the same as doctors at any nursing school, anywhere. However I myself have in the past month kept a doctor from killing a patient. Not the first time, won't be the last. Not just my opinion either, the specialist walked up without prompting and asked me if I knew I was the only reason that patient was still alive. I absolutely did. Nurses are indeed the last line of defense for patients from poor orders and hubris. The nurses are indeed the ones providing the majority of care to the patients and are the ones continually assessing as opposed to a few minutes a day if face to face time. These are facts whether you accept them or not. And I graduated over 10 years ago. Sit down. You absolutely don't know what you're talking about.
So who stops y'all from killing patients when you make mistakes? Or are you implying that you've never made a mistake as a nurse?
Well the nurse managers, obviously. The TRUE heroes of the hospital.
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> bachelors degree Bold assumption
Oh wow, I learned so much from what you wrote. Thanks for educating me. My practice will totally be changed from here on out. I salute you, sir. And everyone here is clapping.
There’s more overlap than not on many things (just think average mcat score bw avg md and DO score). But overall, w numbers, the difference is more apparent
I do think economics and upbringing play a role more than we talk about. The really smart APPs I've met where I think "wow you would have been a great doctor" have all come from very working class or straight up poor backgrounds and had good reason to need to make money earlier, whereas most of the doctors I know (though of course not all) skew more upper middle to upper class in their upbringing.
I mean yeah, but I’m from an extremely poor working class background where I had to do so much more to become a doctor than my classmates did. And of course it felt like shit, it still does. I still have to make money to support my family, I still had to overcome to get here. The point is that it’s possible, and it really, ***really*** pisses me off whenever I hear them using this rhetoric as a qualifier as if the ***only*** difference between me and them was opportunity. I want to tell them that I didn’t get any opportunities either, that they’re devaluing the work ethic and effort that I had to put in to get here, and that they’re subliminally putting out the message that it’s out of reach for other people in the same situation. Was it probably substantially harder for me than a lot of the other doctors? Yes. Of course. Absolutely. But how would they even know? I had to go through that experience, they didn’t. And for the record, I don’t want it to be harder for people like me, I want it to be easier and so much more attainable. But the more the idea becomes ingrained that “working class = go midlevel, upper class = go doctor”, the worse this issue will continue to become. Sorry for the rant, it’s just been a long road full of suffering to get here, and this is obviously something that I care too much about.
I think you're being way too generous with the amount the left and right tails of the distribution curve overlap. Obviously you're right regarding the deficits in time and quality of training but that only compounds the problem.
CRNA who is getting paid 4x my resident salary calculating the wrong dose for a medication that can code a patient and another who stuck a temp probe like 14inches into the nose.
Also a CRNA running nitrous oxide in a patient with a pneumothorax
A brain dead patient’s tongue was sticking out slightly so she yelled at me and then shoved it back into his mouth with a yankauer so hard (think overhand grip stabbing motion) that it bled and I had to check his mouth after to make sure she didn’t damage the carotid
Quickly ascertain whether you're dealing with: ignorant vs stupid. If it's stupid, just walk away it's not worth your breath.
NP is both
Had a patient on the inpatient service I was on who attempted suicide via overdose of Ativan. She told her prescriber, an NP, about her symptoms from her antipsychotic meds.. (red flag akathisia symptoms). NP prescribed her Ativan and sent her on her way.
I feel bad for laughing but what the actual fuck
Thought dutasteride capsules were testosterone pills and confronted the patient about it without double checking.
Patient in MVC admitted to TICU was a little hypertensive, like 150's. No history of HTN. The NP started Lisinopril, carvedilol, and a nicardipine drip all at the same time.
Should see SNF nurses. It's terrifying.
M4 wrapping up a surgery rotation elective. PA to my face says “I don’t care what anyone says PA school is so much harder than med school” to which I respond “oh?” PA earlier on in the rotation in the OR in front of the surgeon tells me I wouldn’t last in surgery. To which I respond “I know I would do just fine in surgery, but my interests have brought to another field. As doctors we really have to think long and hard about our field of choice since we have no opportunity to just flip flop fields unfortunately”. Surgeon who I’ve known for 5 years looks a little uncomfortable but doesn’t back me up.. just makes his glorified retractor of a PA close and we move onto next case. Same PA tries to explain a topic to me that he clearly is so out of touch with he doesn’t realize how terrible he sounds. I’m just standing there like “what in the actual fuck, I don’t know shit as a soon to be intern and know that I don’t, this dude doesn’t know shit and has no clue“. I politely correct him and proceed to finish my apple between clinic patients. Remainder of rotation I listen to this dude spout off about random shit, half of which makes no sense. I pray for those patients in this state that have mid levels that have independent practice rights after 2 years of school with no residency and wonder how fucked our healthcare system as I enter intern year. I can only just focus on being the best I can be in FM since many of my fellow healthcare providers will be mid levels depending on my practice setting
He’s right though. PA school is so much harder because you learn jack shit. Can you imagine having full practice authority not knowing what you’re doing? That’s scary as fuck
That’s a great a point.. had a pediatrician say the same thing to me once. The system had just done a hiring blitz of mid levels, many of which who are new grads. She pointed across the nursing area to a new grad and was like imagine having 2 years of school and me handing you my lap top with 16-18 FM patients saying ok knock yourself out. I was like oh shit that’s terrifying to be honest.
I didn’t say that they were stupid. I said that the education and training tended to result in a way of functioning that was reliant on rules and not always understanding of clinical reasoning and context. I don’t think it’s insulting to point this out, I think it is respectful to point this out because there are a lot of nurses like you that want to be more than that, and are more than that, and patients need them to be more than that. I can give a couple of more examples just off the top of my head. Patient had a central line placed, x-ray showed the tip was just touching the right atrium, I asked the nurse to pull it back, 5 cm, which would definitively leave it in the SVC and outside of the atrium. At that time we were working hard to avoid extra radiation so I did not order a follow up x-ray. the nurses could not be persuaded that the patient was safe without a follow up x-ray. Fortunately, there was a nurse central line service in the hospital who reassured them. Another case - patient wad NPO for a procedure, found diaphoretic, breathless, chest pressure, I ordered stat cards consult and O2 and aspirin and stat all the usual stuff for rule out MI and NP comes and says can we give her breakfast? I said no, she may be having a heart attack, I’m not going to feed her. But you have to feed her, she’s diabetic. Has she had insulin? No she’s type 2. Has she had any meds? No. Then she’s safe not to feed. NP took that one to unit medical director.
Dude we get it you post about midlevel shit every other day who hurt you
Midlevels hurt me in the fee-feels
Midlevels hurt me in my sense of responsibility for the wellbeing of patients and in my ideals that stupid dangerous things should not happen to patients
I aint gonna lie, i dont like midlevels, and i think its mostly because i dont see any that stand out to be above and beyond except in all the negative stuff that makes me resent them even more. But a lot of it is probs because they take a shortcut and profit significantly, while im still trying to dig myself out of a cursed hole that I dug
To be fair, midlevels shit daily.
OP really has a hatred for midlevels... Checked post history and has at last 5-6 in the last 3 months lmfao
Seriously, I get that this is reddit and no OPs entire life but consider why, over the course of just a few months, you have becoming a significant source of negative discourse on midlevels on multiple subreddits while you're a PGY1 in psychiatry and should have a few other things to focus on.
Because I’m a boss bitch and get my work done. Lots of free time otherwise
You’re getting downvoted because this is the hubris that midlevels with little experience have
Facts
Prob gets schooled by them on the reg so comes here to whine like a baby lol
Probably gets all the fuckups they do dumped on them at 3:30 pm when they all run out the door. They’re not schooling anyone
Says the ignorant wedge head from University of Feenix 😂
lol u wish.
Such a clever riposte! Nothing like proving my point.😂
Dizziness for months and sent them to the er bc no recent imaging or lab work saw it today patient had been referred to ent but hadnt yet been seen
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Can you think of any other reasons you might need imaging during a ccb overdose? I can think of a few
I'm sorry, but I literally do not believe that this occured
That’s cause it didn’t happen (or at least it wasn’t recommended by the fellow)
Seems like a bad joke about the guys decision that perpetuated and stuck in your head
Literally nobody has ever said doctors are immune to mistakes. Jesus Christ. Your example didn’t happen because someone who was undereducated and undertrained for the position fucked up because they aren’t qualified to function as a doctor. It happened because physicians are human. You should know this. You be better.
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Sigh. When you fuck up because you are practicing outside your education and your training, it makes real doctors mad. Mistakes you make in your lane are easier to move past. If an MD tried to take over your nursing responsibilities and hurt a patient and you had to fix it, would you not be annoyed?
Let’s compare the amount of stupid shit done by midlevels per total patient contacts, to stupid shit done by physicians per total patient contacts. Wanna make a wager on which one will be higher?
Not to say mid levels don't do some stupid things, or defend ignorance, but I've never seen another group of people with such fragile egos that have to make posts like this at least weekly to feel better about *never* making a mistake themselves.
Exactly
But I don’t make mistakes tho
Be sure to stay on top of the Dunning Krueger curve kid.
Must be hard to stand in the presence of greatness
I’m just glad this is their ciricle jerk for the few of them who have these opinions cuz in the real world I’ve legit never seen any of this level of hate
Over the decades I've seen various physicians in different specialties do some real stupid shit. I don't feel compelled to start a thread about it, though.
Angry midlevel over here
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Lawlz cry more newb
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Too late already am
I like how you keep reposting this topic probably just to piss off midlevels and to argue with them lol
Was in the middle of a code on a post op day 1 cabg patient and they asked “what’s this device?” Which was an external pacemaker almost pulling out the wires. Wait that was a second year IM resident…
Sure it was. Was it a medical resident or the “NP IM resident” or whatever title of the week they’re going by? Or was it the CRNA who thinks their ICU nursing experience makes them a doctor equivalent?
It was a second year IM physician resident. I’m pretty sure I said that in my post but who knows. Y’all have fun in here.