Nurse Practitioners In The UK Are Having The Same Issues

Over at Advanced Practitioner UK, they are having the same issues as we are in regards to prescribing practice rights and dealing with patients who ask for antibiotics for colds and flus. Here's my response to the link. Enjoy!

I diagnose and treat medical conditions in my office on a daily basis. My collaborating MD often praises me for not jumping to conclusions and diagnosing something as the most the obvious. It is a learned skill that new MDs have to learn as well. Just because someone has a degree of MD behind their name does not make them a better health care provider or prescriber. I had a recent teenaged female in my office that had been treated by her regular MD as a sore throat. With no response, she came to me and after taking the time to do a complete history and physical. I figured out pretty quickly that she had Mono. Did the test to confirm right there in the office and she and Mom were so impressed that they will be seeing me for their primary care from now on. It's just that fast to lose a patient if you don't listen to them.

Please Stop Asking Me For Antibiotics For A Cold!

It is the start of the flu season and we have had a large number of patients coming in the a sore throat, sinus pressure, hacking cough, and stuffy ears. This is usually a cold or allergy flare. IT DOES NOT REQUIRE AN ANTIBIOTIC FOLKS. I try so hard not to give antibiotics for upper respiratory symptoms, but most patients get upset when they pay for your evaluation and don’t walk out with an RX.

Most patients come in the very first day of symptoms. I cannot tell whether it is bacterial or viral ESPECIALLY this early in the game. Most say that they have not had a fever (which doesn’t mean it’s a bacterial as well) and don’t appear to be toxic feeling. I know it sucks that have a stuffy nose, scratchy throat, stuffy ears and a cough. This shall pass if you just hang in there. Most virals wrap up in 7–10 days though some still leave a residual cough from reactive airway response.

Most say “I’m going somewhere and I don’t want this to get out of hand”, or it’s Friday and I know you are closed for the weekend and I don’t want to not be able to feel better, and such.

I live in a hotbed of allergy triggers with almost no airflow. We are surrounded by oaks, pines, hay fields, and ragweed. 90% of you are allergic to these things. Do I tell you to take your allergy meds on a DAILY basis and you do not? YES. Do you take your nasal sprays? Most do not. If you don’t block these triggers, they will start the symptoms that MAY develop into bacterial infections if left too long.

Symptoms that do not require antibiotics:

Fever (low grade < 102.5)

Dry or “rattling if not productive” cough

Stuffy or runny nose (even if it’s green)

Ear pressure or muffling or facial pressure

Headache that is relieved with OTC Tylenol or Motrin

Symptoms that do require antibotics:

High fever (>102) on a consistent basis (more than one day)

Productive cough with shortness of breath or extreme chest pain

Facial pain on palpation that is intense (means that you almost jump back when touched)

Ear pain with bulging, red tympanics or exudate

Sore throat that is so bad that you cannot swallow regular foods or swollen with white pustules (you need to be tested for Strep)

Plan of action will be to test for the flu in the season if you are appearing appropriately ill. Strep testing as needed for sore throat. Otherwise, watch, wait, take the over the counter meds for comfort, drink lots of fluids and get plenty of rest. Take your allergy meds as prescribed. I will call in an antibiotic if these symptoms don’t resolve in 10 days or you get worse enough to miss school or work and can’t get out of bed.

I have written a post over at one of my other sites regarding how I treat MRSA infections. It is a monetized post so if you would like you can read it here.

Template Question From The Nurse Practitioner's Place

Hello to my regular readers and to you who just stopped by. I am taking suggestions regarding the background color on the blog. Is the darker background distracting or hard on the eyes? I tried a lighter one, but didn't think that it looked as good.
Please leave a comment regarding this change!

Things at the office are going really well! We are getting busier by the day and now one of the other doctors from the other branch will be coming up on Tuesdays and Thursdays full days and half days Wednesdays starting at the end of the month. This will be an interesting scenario due to the limited space in the office. My nurse is drawing labs, setting up patients, and doing some of my call backs once I approve them. She also pulls the labs each day and puts them on the appropriate charts for my to review. Now she will be doing double the work. We think that it's time for a new addition (CNA) to help out. We'll see what transpires in the next few weeks.

Our patient satisfaction surveys are coming in with great reviews. (Pat! Pat!) I am blessed to have a pretty diverse set of patients and we are seeing more children. That's becoming more enjoyable than I thought. I also gave a presentation at the local Rotary Club about MRSA infections that went over very well. Unfortunately, that subject is a whole other post.

On the home front, my grandson William is getting so big! He's almost 6 months now and has cut his first teeth. My son is getting ready to go into the Navy in Feb. and is up in South Carolina seeing his friend graduate from Army boot camp. We are proud of both of them. They've known each other since 3rd grade.

I am getting ready to submit myself to the local colleges for nurse practitioner precepting. I think I'm ready to give some pointers now. I miss teaching the nursing students at the hospital and I always looked forward to seeing the light come on when a concept really sank in.

Gonna run for now!

My Husband Is A Photojournalist

I am so proud of my husband. He has been taking pictures as a hobby for a long time and has recently been submitting them to the local newspaper. They were impressed and have given him his photojournalist badge. Now he can actually get closer to scenes and interview witnesses. While the majority of his pictures have been crashes, he hopes to start covering local events as well.
Pop over to his other site and leave him a nice comment if you like his pics. He also has another site as well that he is putting individual pictures onto. Enjoy!

Here's the picture that was on the front page today.

Are You Happy Being A NP?

I was checking out my sitemeter and usually research what brings people to my site. One of the most common entries is "Are you happy being a NP?"
Well...let me think about it for a minute...Sure am!! I love my job! I can't say enough about it. It is one of the greatest things that has EVER happened to me. Here's the top reasons why I love being a NP.

1. I can actually make patients better! I have the ability to interview patients and get to the root of their health problems and show them ways to feel like they have some control over their lives.


2. Patients trust me with their lives. What an awesome and humbling responsibility.


3. I love the way the kids smile when they see me on each visit, even if I have to be “mean to them” when they are really sick. This usually entails that really terrible stick that I have to get into their mouths to visualize their tonsils while in a headlock. YUCK!


4. The nice letters that my bosses sometime receive when my patients write in to say what a great job we do for them. Pat! Pat! Many thanks to you for those unsolicited notes!


5. I very seldom have to work on the weekends. I only work rotating half day Saturdays with the other providers in the practice. Not too bad.


6. I’m home by 6pm every night. This means that I actually get to see my kids while they are awake. Nice!
   

What are some of the reasons that you like being what you are?

I'm A Featured Nurse Practitioner Guest Blogger on Nurse Connect.com

Nurse Connect is one of the places that I guest blog. Please pop over and read my latest entry and sign up so you can comment on it. They are nice enough to support my blogging efforts.

Nurse Practitioner's Opinion Regarding Gardasil Vaccines

As a primary care provider, I see many cases of abnormal Pap smears. Often, patients are young women who do not use protected sex and are at high risk for the HPV virus. I am asked on an almost daily basis what my opinion is regarding this vaccine. Wanna know more? Click here.