NURSE PRACTITIONER VS MD

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Test Flyer
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 3/4/2009 7:56 PM (GMT -6)   
I have an appointment tomorrow with a new GI practice and I was told I would first see one of the staff NP's.  They also asked me for procedures, which of the Docs I would lile to use.  I have a list of questions prepared to address to the NP so I'm prepared but what has been the experience from you folks who have worked with NP's with thise disease?  What can I expect from this first visit?  I'm told NP's can be more caring than many MD's.
 
Is NP care becoming more common these days?
Left side UC
diagnosed 1990
Azulfidine medicated
 


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 3/4/2009 9:59 PM (GMT -6)   
NP care is becoming more common. I've had 50/50 luck with NPs. I do know many people (non-UCers) who see NPs regularly and like it because they are able to get in faster. NPs are usually able to spend more time with you than an MD. So that is a definite plus.

I would approach the appointment the same way you would approach it with a new MD. Perhaps (out of curiosity) ask what the difference is.

Good luck tomorrow :)
Pan-colitis and GERD diagnosed May 2003
Osteopenia (hip and spine) diagnosed Feb 2006
Status:  Remission???
Asacol 12 per day,  Azathioprine 50mg, Aciphex, Effexor XR, Forvia, Fibercon, and Culturelle
Remicade: 1st infusion 06/17/08:  Next infusion: April 1
Last Prednisone dose:  7/15/08
 
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kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 3/4/2009 11:33 PM (GMT -6)   

I have a primary care NP young man and now I have a NP I see at the gastro doc office.  I love them both.  I can request seeing the doctor but probably take longer.  My gastro NP, a young woman, very caring and takes time with this senior to answer all questions or get the answers for me.  I understand she sees most of the patients unless the doctor is requested after the first visit while things are doing ok.  She has a weekly conference (more if necessary) with the doctor going over all his cases and test results, recommendations, etc.  I love it and I can call her with questions and she will return my call usually same day.

My husband goes to VA hospital and has several NP and PA who follow his various health problems always consulting with his specialists, etc.  Works great!

ElaineNY


 
Senior - New diagnosed with proctosigmoiditis - 6/2008
Tried all mesalamines and enemas, Canasa, etc.  Colonoscopy 10/28 showed only few cm. left to heal -hydrocortisone enemas 12 days - much worse. Cannot tolerate mesalamine!
2/3/2009 - sigmoidoscopy showed about 30 cm. involved but mild - starting on prednisone only 40 mg. taper on 2/7/2009.
 Feb. 21 - down to 20 mg. - no blood, no pain, no bad side effects so far. Starting 6-MP Feb. 28 along with 20 mg. prednisone.
Probiotic Align, Prilosec for GERD
 
 
 


Red_34
Elite Member


Date Joined Apr 2004
Total Posts : 23551
   Posted 3/5/2009 8:31 AM (GMT -6)   
I've never seen a NP but I have PA and I will never ever again see a PA. She was a general medicine PA and she was extremely arrogant and assumed she knew more about my UC then me. She prescribed me an antibiotic for a UTI and after I called her several times because I was almost close to going to the ER in pain she kept trying to tell me that it was normal to feel that way. Turned out the antibiotic I was taking contained sulfa and I'm highly allergic to sulfa. But that is just my experience. I've heard great things about NP's though. My MIL see's one and she loves her to pieces.
 @--->--SHERRY--<---@
Moderator for Allergies/Asthma and Co-moderator for UC
~Left sided Uc-'92-Colazal(9 daily),6mp(50-100mgs),Bentyl, Prilosec,Biotin,Forvia,Pro-Bio**Unable to tolerate Asacol, Rowasa or Canasa**~Year-round allergies-Singulair, Zyrtec~Secondary Reynauds Syndrome-'04-Norvasc~Sacroiliitis-epidural injections~bulging and herniated discs C5/C6 & C6/C7~3 epidural injections-second series starts 2/17, OA in my fingers -Celebrex, Tylonel Arthritis and Voltaren Gel
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Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 3/5/2009 4:48 PM (GMT -6)   
Good grief. That PA needs to get out of medicine.

My doc's office is small and I don't think she uses an NP. But generally I believe they know as much as many docs.
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, trying 15/20 mg. Appt 3/6 to discuss Humira, etc.   


Test Flyer
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 3/5/2009 5:28 PM (GMT -6)   
UPDATE:  I went to my appointment and the NP spent nearly 1.5 hours with me - in all the years with this disease I've never had anyone spend that much time with me.  I found myself to be more relaxed with her than I have been with MD's for some reason so I'm pleased so far.  One of the MD's in the practice will be performing the next colonoscopy, of course, but for office visits and maintenance advice it seems the NP is more than qualified.

Left side UC
diagnosed 1990
Azulfidine medicated
 


notsosicklygirl
Forum Moderator


Date Joined Dec 2008
Total Posts : 16728
   Posted 3/5/2009 6:05 PM (GMT -6)   
I don't want to see a NP unless they are discounting the cost.
Diagnosed with proctitis in March 2007 - Treated with Canasa 2x Daily
Diagnosed with UC December 08 but had symptoms months ago - Treating with Asacol 400mg (9 a day)


Test Flyer
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 3/5/2009 6:33 PM (GMT -6)   
not likely - the way they see it, an office visit is an office visit for specialized service regardless of who offers the care.  I was charged the usual 'specialist' insurance copay.
Left side UC
diagnosed 1990
Azulfidine medicated
 


notsosicklygirl
Forum Moderator


Date Joined Dec 2008
Total Posts : 16728
   Posted 3/5/2009 6:47 PM (GMT -6)   
I don't have insurance, I pay out of pocket. Even if I had insurance I would still expect a reduced bill if I am seeing an NP. The NP isn't getting as much for their time - why should you pay the same amount?

Diagnosed with proctitis in March 2007 - Treated with Canasa 2x Daily
Diagnosed with UC December 08 but had symptoms months ago - Treating with Asacol 400mg (9 a day)


Test Flyer
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 3/5/2009 6:53 PM (GMT -6)   
good point, but frankly I could care less what the NP is making for a salary.  if the care they provide keeps me from running to a  bloody toilet 15 times per day, I'll pay their office visit.

Left side UC
diagnosed 1990
Azulfidine medicated
 


notsosicklygirl
Forum Moderator


Date Joined Dec 2008
Total Posts : 16728
   Posted 3/5/2009 7:12 PM (GMT -6)   

As long as the doctors office is up front about it when I make the appointment - I don't care.

Sometimes cost isn't an issue, especially if you're in the midst of a terrible flare. I would inquire about the price difference between a GI and a NP, I am always trying to cut corners. If they said it was the same cost, my preference would be to see the GI. Of course, if I were in pain, I would see the NP and hope for a good experience. It sounds like it worked out well for you.


Diagnosed with proctitis in March 2007 - Treated with Canasa 2x Daily
Diagnosed with UC December 08 but had symptoms months ago - Treating with Asacol 400mg (9 a day)


kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 3/5/2009 7:14 PM (GMT -6)   

You know it really depends on whom you trust and have a good rapport with.  I have been going to all kinds of doctors - Army, etc. around the world for over 50 years.  If I don't like the person (don't care whether they are doctors, NP, PA, nurses), I just have a problem dealing with them - a personality conflict sometimes.  We just can't "get along" with everyone.  Some think I am funny that I can't "get along" with a good doctor no matter what their personality is - just don't trust them, I guess.  I went to three knee surgeons before I found would I could "get along with".  Either NO personality or sense they really didn't care about ME!

Right now I have a great, experienced gastro doctor who is also an internist.  I trust his opinions, treatments, etc.  BUT - first time I saw the NP I knew I would see her as much as possible.  She is caring, listens better to me and takes her time (no matter how far behind she may get).  I am on Medicare and supplement insurance so they really do try to limit the time since Medicare is so "cheap".  I do see the doctor anytime I request (although may have to wait a week or so longer) AND this next appointment is with the doctor because he put me on 6MP to see how I am progressing.

You have to trust and believe in your health care provider - no matter for what conditions, etc.  If you don't - try to move on to one you do!!

ElaineNY


 
Senior - New diagnosed with proctosigmoiditis - 6/2008
Tried all mesalamines and enemas, Canasa, etc.  Colonoscopy 10/28 showed only few cm. left to heal -hydrocortisone enemas 12 days - much worse. Cannot tolerate mesalamine!
2/3/2009 - sigmoidoscopy showed about 30 cm. involved but mild - starting on prednisone only 40 mg. taper on 2/7/2009.
 Feb. 21 - down to 20 mg. - no blood, no pain, no bad side effects so far. Starting 6-MP Feb. 28 along with 20 mg. prednisone.
Probiotic Align, Prilosec for GERD
 
 
 


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 3/5/2009 8:41 PM (GMT -6)   
Test Flyer - I am so glad you had such a great experience with the NP. 1.5 hours! My goodness - that's absolutely unheard of with an MD.

Best of luck with your scope next week!
Pan-colitis and GERD diagnosed May 2003
Osteopenia (hip and spine) diagnosed Feb 2006
Status:  Remission???
Asacol 12 per day,  Azathioprine 50mg, Aciphex, Effexor XR, Forvia, Fibercon, and Culturelle
Remicade: 1st infusion 06/17/08:  Next infusion: April 1
Last Prednisone dose:  7/15/08
 
Co-Moderator UC forum:  Keep HealingWell running smoothly:  www.healingwell.com/donate


subdued
Veteran Member


Date Joined Dec 2008
Total Posts : 3231
   Posted 3/6/2009 12:40 AM (GMT -6)   
My GI spends time with me.
Joy - 47 yrs and counting
Diagnosed w/ UC Dec 06 (also have IBS)
Currently in remission

Lexapro (for stress)
Probiotics and Vitamins (a whole bunch of them)
Anti-inflammatory foods: turmeric, seaweed, garlic...
Avoid: anything with high-fructose corn syrup, foods high in fructose, artificial sweeteners
Previous treatments: Fecal transplantation (worked), Prednisone (stopped working), Colazal (stopped working), Asacol (stopped working)


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5975
   Posted 3/7/2009 4:28 PM (GMT -6)   
     This modern method in many doctors offices cracks me up.  I worked for an Internist/Endocrinologist as his lab tech for many years.  He had his own practice and was very picky about who would treat his patients when he was on vacation.  I bet he is just turning over in his grave with this physician assistant and nurse practioner business.
     I was going to a family physician but he decided to open a larger practice and hired a nurse practitioner, physician assistant, two MD's and two DO's.  The physician assistant prescribed Paxil for me when I first started with symptoms of UC.  It gave me severe headaches.  Needless to say, from then on I insist on being seen by the MD's.
62 yr old granny. South Jersey
Diagnosed with ulcerative proctitis in 1998 in hospital
Hospitalized (2nd time) in May 2008
Update 11/03/08...finally in remission!!  Hope I don't jinx myself.  Off the prednisone since 11/01/08...now see if I can stay off for longer than two weeks.  Other meds: 6MP (75 mgm), colazal (6 per day), Benicar and Toprol (high blood pressure meds), Probiotic (2 per day), fish oil capsule and multi-vitamin and calcium with vitamin D.


kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 3/7/2009 4:44 PM (GMT -6)   

I have had the best treatments from NP not the PAs!  My gastro NP never prescribes anything for me unless approved - recommended by the GI doc BUT her imput seems very important as she really knows ME better - not my insides, not my UC maybe - BUT ME!!  She takes time to ask about other aspects of my health and my life.  She knows my stress level and my anxieties, etc.  Doctor has never ask me why I fear or don't like something.  I have written on my chart - NO MORPHINE.  Doc never even ask if I was allergic or anything.  BUT - Rachael, my NP, ask me about it and I told her because I saw what it did to my husband and Mother and preferred to leave it for the day when NOTHING else worked for the pain!  I am happy she has at least weekly consulations with him for all aspects of my care and the other patients.

ElaineNY


 
Senior - New diagnosed with proctosigmoiditis - 6/2008
Tried all mesalamines and enemas, Canasa, etc.  Colonoscopy 10/28 showed only few cm. left to heal -hydrocortisone enemas 12 days - much worse. Cannot tolerate mesalamine!
2/3/2009 - sigmoidoscopy showed about 30 cm. involved but mild - starting on prednisone only 40 mg. taper on 2/7/2009.
 Feb. 21 - down to 20 mg. - no blood, no pain, no bad side effects so far. Starting 6-MP Feb. 28 along with 20 mg. prednisone.
Probiotic Align, Prilosec for GERD
 
 
 


potty girl
Veteran Member


Date Joined Dec 2006
Total Posts : 835
   Posted 3/7/2009 6:01 PM (GMT -6)   
I see PA at my regular doctors office and at my cardiolagist office I actually prefer them they take a lot more time to listen to what I have to say. and they are both cheaper. And a lot easier to get into in a hurry. Mine listens to everything I suggest when talking about my UC when it comes to antibiotics. I just fine them more caring then some doctors. Dont get me wrong I like my doctors alot if I didnt I would find a new one. But at my regular doctor I save 10 bucks a visit and about 48 bucks at the cardio which helps when u dont have insurance.
Rona

synthroid .088 mg, lowpressor 50 mg x 2, cozaar 25mg x2, imdur 30 mg
nitroquick, proventol, plavix 75 mg, protonix 40 mg x 2, asacal 400mg x 9
carafate 1 gm x 4, zyrtec 10 mg, rhinocort aqua nose spray, fish oil,
potassium.


bap06
Regular Member


Date Joined Jun 2008
Total Posts : 57
   Posted 3/7/2009 8:49 PM (GMT -6)   
Love, love, love my NP. Like my doctor, too, but my NP is really great. If things are really bad (after I'm out of the hospital, etc.), I'll insist on the doc, but typically I'm just as happy with my NP.
-USA
*Diagnosed pancolitis 10/07 (6 months pregnant w/ 2nd baby)
*Currently in remission
*6 MP (50 mg at night)
*Lialda (3 x a day)
*Calcium, multivitamin, Metamucil, iron, fish oil, probiotics


ticklengiggle
Regular Member


Date Joined Nov 2008
Total Posts : 23
   Posted 3/8/2009 12:44 AM (GMT -6)   
My experience with the GI office NP has been positive overall, better than with the PA in the same office but I think this was as much a personality thing as it was a philosophical difference (as a general rule PA's are trained under the medical model (disease-centered), NP's are trained under the nursing model (patient-centered)).
I think mid-level practitioners (NP, PA) are great once you are in the maintenance stage or if you have an uncomplicated course, but it's also good idea to check in with the dr. from time to time to keep a good rapport with the person that does the invasive stuff (colonoscopy, etc...).
I was kind of disappointed on my last visit to the NP though because he said that I've taken longer than most of his patients to get the UC under control. He recommended a visit with the GI doc in a few months. At least he knew when to send me back to the dr. I do like him though. He's warm, caring, listens and teaches.
I've made an appointment with a different GI doc for a second opinion.
Distal UC (25cm), Nov 2008
Colonoscopy Nov. 2 08: Pathology showed inflammatory changes throughout colon, but ulcerations, friable tissue, etc. last 25cm of colon
Lialda  3.6g (Nov 08);  4.8g/daily (Dec 08)
Canasa supp. 1g (for 3 weeks, from Nov. 5),
Prednisone 40 mg/daily 4 week taper (Nov. 17 ‘08), Back up to 15mg Dec. 20, taper 2.5mg/wk. Off Pred Jan 27…knock on wood.
Rowasa: 4g/bedtime Dec. 20 ‘08, 4g/bed time Jan 19 ‘09
Procotofoam: 1 application/bedtime, Jan 20 ‘09
Prednisone: 30mg taper, started Feb 10, 09.
Prilosec OTC generic: 1 pill every night (the pred upsets my stomach).
Other current meds/supplements: Sertraline, Yasmin, Vit E, Omega 3 FA, Krill Oil, Mupirocin (bacterial rhinitis), Maxalt MLT (migraine), phenergan (nausea).
 
My mother (UC for 20+ years) has been in remission for quite some time (at least a few years). :)
One of my cousins has Chron's dz. :(

I love Cottonelle moist flushable wipes!

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