Nurse practitioners, midwives the future of medical care?

I realized today that I can’t remember the last time I’ve personally been seen by a doctor.

I went to a midwife for my annual exam in January. I had a routine surgical procedure done by a nurse practitioner also in January.

Two weeks ago when I thought I had strep I saw the nurse practitioner at my doctor’s office and yesterday I saw a nurse practitioner at the Walgreens Take Care clinic. (I went to the Take Care clinic because they have rapid strep tests and my doctor’s office sends the test out for several days.)

The closest I am getting to an actual doctor these days is our dentist.

I haven’t seen an ob/gyn in seven years. I’ve seen only the midwives (other than one specialist with each baby) since I was pregnant with Walsh. I love the midwives. They take time with you. They listen. They are very reassuring. (One friend recently said she would stay pregnant all the time if she could hang out with midwife at our practice.)

The nurse practitioner who did my procedure was excellent — very on the ball and lots of experience. She answered all my questions and even took the time to call and check on me two days later.

The nurse practitioner I saw yesterday was very thorough. She did a history, a full exam, and did the strep test.  Since nurse practitioners can write prescriptions, she then electronically forwarded it to the pharmacy to have it filled and I was in and out in 45 minutes. (That rocked!)

I know that in small towns or out of the way places nurse practitioners are used a lot but they definitely seem to be more common place here now.

I asked the nurse practitioner her thoughts on it yesterday and she said people are definitely realizing there are some things they don’t need to see a doctor for and there are many things the nurse practitioners can handle less expensively and efficiently.

I think everyone would agree sometimes you just have to see a doctor: something you have no clue what you have, something very serious or life threatening, and maybe even for children, especially babies. I do like seeing my pediatrician. I have confidence when I leave that my children have been diagnosed correctly.

But I am wondering what your comfort level is with nurse practitioners, midwives and other medical professionals other than doctors?

Are you noticing that you are seeing nurse practitioners more often – maybe even at your doctor’s office? Do you trust them? What level of care do you trust them with – strep throat, gall stones? Do you think this is the future of medical care, where patients only see doctors if the nurse practitioners can’t figure it out or think it’s too serious for them to handle? Would you trust them with your children? What about babies?

113 comments Add your comment

FCM

February 12th, 2010
7:16 am

We have seen the NP at our Ped office a couple of times. Routine check up for one. Usually we see the Dr though. I have not seen my Gen Prac in um….a long time. I went to the Dr when I had stomach flux. I went to a Walgreens NP when I had a “sinus infection” it was bronchitis and a sinus infection. She was the first one to suggest an inhaler. My Dr told me a couple of times “I think you may have asthma aggravated by the sinus, but let’s hold off on an inhaler.” Then my youngest had to use a nebulizer (sp) for her asthma on a very frequent basis. I would have to hold her in my lap to get her to keep the mask on. Of course I could breathe the stuff coming off her. I found that I could see a difference. When I told the NP she said, well then you probably need something! OMG what a difference it made in being able deal with the whole thing. I didn’t feel like an elephant was sitting on my chest. Anyway it certainly makes me question the Dr I had used for 20 years.

Tamika

February 12th, 2010
7:21 am

Today is a great Day for my Canada– Go Team USA and Team Canada may the Olympics be the best ever!!!!

Jane

February 12th, 2010
7:21 am

You really might want to see your OB/GYN once in a while. To go seven years without is just a bad idea. A midwife doesn’t have nearly enough knowledge in that area to justify not seeing the doctor.

Midwife for delivering a baby – okay. Midwife for your annual exam – no.

mom2alex&max

February 12th, 2010
7:35 am

I love midwives and NPs. They take a MUCH more personal approach, they take the time to answer your questions, they are much more caring.

Doctors only care about getting you out the door in the allotted 15 minutes.

Wayne

February 12th, 2010
7:41 am

We’ve requested that when we make an appointment, we don’t see an NP at our pediatrician’s office – had it put right in our kids charts. The doctors have been (and are) great. NP’s, not so much. Even at a major Boston hospital, we requested that we only work with doctors when we were there. The NP’s just didn’t have the depth of knowledge the docs did.

Now, for me, seeing an NP is fine – for the most part – because you can get in quicker that way.

lakerat

February 12th, 2010
7:49 am

You do know that the “rapid strep test” is not 100% accurate, don’t you? That is why MD’s send the culture out for “sure” results, and the NP probably did, too.

Several years ago we were getting ready to go on a winter vacation when my then 10 – 11 year old son came down with a “sore throat”. We went to a Children’s Healthcare office where we saw the NP who did the rapid test. It came back negative, so off we went for the vacation. The office also sent the culture out for the “sure” result verification. Lo and behold it came back 2 days later positive for strep – they tried to call us to give a prescription antibiotic, but, of course, we were out in Utah skiing! The son’s throat hurt but he was a real trooper – imagine how we felt when we got home to have the voice mail about the positive strep – we were child abusers and did not even know it!!!!!

So, be careful…..nothing against the NP, as they warned us that the rapid test “most likely” was accurate – we just happened to be the one that was not one of the “most likely”…

RJ

February 12th, 2010
7:54 am

I’ve never seen a nurse practitioner but I have seen a physician’s assistant. I refuse to ever do that again. I was bitten by a spider, she told me to take penicillin for a week. She had no idea what kind of spider bite it was. I was in excruciating pain and it didn’t end in just one week. I went back and insisted on seeing the doctor. Thank God because I had been bitten by a brown recluse. He prescribed meds for a month along with a follow up visit. Now I only see the doctor.

I used a midwife with my son and LOVED the experience. She was awesome. I will say that my doctor is not like most. He will sit down and talk to you. He asks questions and is genuinely concerned. He’s the first one I’ve had do that in many, many years. The rest seem to come in, take a look, make out a prescription and move on to the next patient.

motherjanegoose

February 12th, 2010
7:55 am

WOW…I do not think I have ever seen a nurse practitioner and I am certain I have not been to a midwife, so I will lurk and read what others have to say.

I do think the convenience of the corner clinic is awesome for parents of young children who do not want to sit and wait in the emergency room!

mom2alex&max

February 12th, 2010
7:55 am

RJ: u are indeed lucky to have a doctor like that.

motherjanegoose

February 12th, 2010
8:01 am

@lakerat….I just shared this story with friends the other day.

I typically took my kids for their annual check up in the beginning of the summer, right around their birthdays. We went in on a Friday for a full check up. On Saturday, we left for the beach.
My son had a fever and sore throat on Sunday night. I called back to Atlanta to speak with the Pediatrician on Monday. I laughed and told her that she was supposed to check them out before we left for our vacation. She asked the name of a Pharmacy nearby and called in an antibiotic. She then told me that if he was not any better in 24 hours, to have him seen by a Doctor.

Yes, these kinds of things can happen and the clinics would come in handy. Not so sure I would do it on a regular basis though.

We too have awesome Doctors.

Theresa Walsh Giarrusso

February 12th, 2010
8:02 am

My regular doctor’s office says the rapid strep can give false negatives but I really needed to know if it was strep and it came up immediately — It would have been no help to send it off for four days and I would have had no other info —- Our pediatrician when I was little used to do both to double verify it — quick so mommy has answers and then slow just to be certain —- now they just do the rapid too — did on both my kids in the last two weeks

I think if the midwives didn’t feel qualified to do anything but deliver babies they would send me back to a gyn in their office — I cannot say enough about my midwife. I think she is one of the smartest most caring people in the world. I feel very confident in their work — also think about this in the last seven years I’ve given birth to two babies and nursed three years of that time.

lakerat

February 12th, 2010
8:15 am

That was the point, Theresa – if you get a “positive” to the rapid test they go ahead and give you the script for the antibiotic – it is the “negative’ results with which you must be concerned, because, as in our case, they said “no can do” to the antibiotic in light of the negative read, initially. So in your case, all turned out well…

Kathy

February 12th, 2010
8:17 am

We have always taken Little E to see the NP at the peds office. She was AMAZING and was the most popular in the practice. She has recently moved so we are going to have to see someone new. When I need to go to the doctor (which is usually only once a year for my physical) I only see the doctor. He has been my doc now for about 10 years and he is wonderful. Listens, never rushes me out the door, genuinely seems concerned about me. I drive all the way from Lawrenceville to Johnson Ferry Rd. to see him, he is that good. I just made my gyn appt. the other day and for the first time I will see a NP. My regular doc is booked until April and I am overdue. If I had some serious issues I would wait to see the doc, but since this is just a routine Pap, I am fine with the NP.

motherjanegoose

February 12th, 2010
8:19 am

@mom2alex&max…both my regular MD and my GYN, ( whose name I shared) take time with me.

Our family all goes to the same general practice and the MD we like to use always asks me about everyone else ( in our family) . When we were waiting to hear about college for our daughter, he asked about that ( the nurses too) and he recently also told me that if our son needed any Pharmacy experience in a Pharmacy connected to a Doctor’s office, to let him know and he would set him up in the building. ( they do rotations like a student teacher). We have seen him for about 10 years.

Even our chiropractor takes time with us . Guess we are very lucky!

motherjanegoose

February 12th, 2010
8:21 am

@ Kathy…hey, I was thinking about you this week…give me a call! I have not seen you on the blog lately.

motherjanegoose

February 12th, 2010
8:22 am

LOL…I said I would lurk and have not kept my promise…so now I will…outta here!

JJ

February 12th, 2010
8:25 am

Streph cultures are done immediately. In less than 10 minutes. Why does your doctor send them out for DAYS?

lakerat

February 12th, 2010
8:29 am

JJ – please re-read the initial comments…

Theresa Walsh Giarrusso

February 12th, 2010
8:29 am

the grow them — and that is more accurate like lakerat is saying –

Becky

February 12th, 2010
8:37 am

Well, my primary care Dr. retired, as did one of my og-gyns and the other one left to be a Congress man..I have seen one of the ob’s assistants, but have yet to get a new ob..I don’t know anything about midwives, I’ll try to learn sonething today..

hopefully, Becky...

February 12th, 2010
8:38 am

…you won’t need a mid-wife?!?!?!?!?!

hopefully, Becky...

February 12th, 2010
8:39 am

…or an OB…

JJ

February 12th, 2010
9:00 am

I see my internist about three times a year, and she does the OB/GYN exams also. I have elevated calcium levels, and have had two surgeries to remove thyroid glands. I get my bloodwork done twice a year.

She is THE BEST doctor. She actually calls me herself when she needs to talk to me. Anytime I call and leave a message for her, she calls me back within an hour. She has the nicest staff. Thank you Comprehensive Internal Medicine in Johns Creek…..

Dave

February 12th, 2010
9:07 am

For those of you that say your doctor only wants to get you in and out as quickly as possible – GET ANOTHER DOCTOR!

I didn’t like a doctor I went to see, so I switched and now have one that I’m very happy with. Just like anything – you don’t like the service you get, go somewhere else!

Katie

February 12th, 2010
9:11 am

I only saw my dr. at the first visit for my pregnancies, and then the midwife for all other visits, including delivery! Dr’s dont do anything anymore … LOL..seriously though, they must not be as busy!?

We have also gone to Walgreens on several occasions when I know it is probably strep or ear infection or something along that line – the nurses are more thorough there than most dr’s ever have been, in my opinion!

One time the nurse at Walgreens told me that she always did the majority of the work for her patients at the practice she worked at, so she felt that her position at Walgreens actually showed that she can do it alone!

Michelle

February 12th, 2010
9:15 am

JJ-a strep “culture” does indeed take 24-48 hours. However, a strep “screen” only takes about 10 minutes!

NP’s in general are an EXCELLENT option to seeing a physician (IMO). I think as you get more specialized (i.e. OB, cardiology, etc.) they are even better! I say this for a few reasons:

They are trained to assess ALL the needs (medical, physical, phsycological, etc.), not just the medical problem to treat with medication. They are trained to teach prevention as well as educate about the diseases.

They do not just give prescriptions for symptoms (as many physicians will do).

They are educators! They TEACH you about what is going on with you, your child, etc.

About 10% of all of their patient visits HAVE to be reviewed by the primary MD (the MD’s don’t have anyone review their work!)

OK, with all that being said, you get some bad ones just like bad doctors! Some of them have great book smarts but poor clinical skills and vice versa!

Personally, I am a nurse and I would see either one. The benefit I have versus the “average” Joe is that I can usually tell if the NP is understanding all the signs and symptoms! If I get an NP that I don’t like, I request not to see them again.

I think that the best thing to keep in mind is this: Be sure you are ABSOLUTELY comfortable with the person you are seeing. If you are not comfortable, change! It is YOUR health and body, not theirs! It is your RIGHT to choose whom to see (granted, you may have to wait longer for an MD vs. NP)!

I hope I’m not rambling, and I hope this makes sense!

Also, NP’s MUST have a master’s degree or higher (since the 90’s I believe). They (just like physician’s) go through a rigorous training. Many NP’s (not all) started out as nurses and have a very good “base” knowledge to build from before ever going back to school for the advanced degrees! So, they have seen MANY of the illnesses and diseases from all stages (early detection, beginning signs, complications, late stages, etc.)

I, myself, would be more leary of a NP who had just graduated from school with less than 1 year of experience in the “real world” and no prior nursing experience! THAT would make me nervous! :o)

Theresa Walsh Giarrusso

February 12th, 2010
9:16 am

Just FYI — if you haven’t seen our Better Health blog, you might be interested to check it out — here’s the link —

http://blogs.ajc.com/better-health/2010/02/09/ask-dr-h-disease-causes-weak-muscles/?cxntfid=blogs_better_health

Theresa Walsh Giarrusso

February 12th, 2010
9:19 am

Michelle – the NP I saw yesterday had also been an ICU nurse and those nurses have very high levels of training — I was amazed by the ICU nurses that took of my brother at Emory —- He bled through his lungs and it was the nurses that were on it at because they are the ones in there all the time with him — I am convinced the nurses saved him a couple of times. They were truly amazing. (Don’t get me wrong the doctors were amazing too but the family had most of their contact day in and day out with the ICU nurses.)

SRH

February 12th, 2010
9:20 am

I have seen both NP and doctors. I get asked when I make an appointment as to whom I want to see. I have been real happy with NPs and feel as if they provide me more time for Q and A than would my regular doctor. Still, I have seen my Dr. when requested, but the wait (for an appointment and in the waiting room) seem to be longer when I choose that option. I agree with the other posters in that maybe you should change your Dr, unless you are fine with not seeing him for 7 years. I have also frequented the care clinics and the docs-in-the-box in a pinch. They were okay as well, but I really have grown to like and respect the NP at the doctors’ office.

Lisa

February 12th, 2010
9:22 am

NPs are good for most things. However, not every problem/illness that pops up is routine. If you have something a little unusual, your NP won’t have a clue as to what it is – whereas your Doctor will (that’s why s/he went to school all those years and continues to get updates).

I had a friend (forgot the name of her illness) who went to an NP and the NP basically just B.S.’d her about what it was and told her what to take. A few days later when it got worse, my friend went to a doctor and discovered the B.S. the NP had been telling her. Fortunately she saw the Doctor in time!

JJ

February 12th, 2010
9:29 am

Theresa, how is your brother? You haven’t updated us in awhile. Is he still in the hospital?

Michelle

February 12th, 2010
9:36 am

Lisa, trust me, there are MANY MD’s who are in such a hurry that they miss plenty of important things as well! Like I said, in both fields, you have the good ones and the bad ones!

My sister’s OB was in such a hurry that when my sister was pregnant with her first child and called the MD with concerns, they told her to just lay down and put her feet up. When the problems continued they finally told her to come in. The MD did NOT do an exam, but gave her medication for a urinary tract infection (even though she was bleeding and cramping). When they asked if they should call if it continued to get worse, they said, no, just go to ER, they’ll know what to do! Well, within a few hours, she did indeed get worse and ended up in the ER. When she vomited, she pushed the baby out because she had an incompetent cervix! The baby lived for about 8 hours. If her MD had taken ANY time or concern with her (i.e. and exam) they would have noticed that her cervix had begun to dilate and taken appropriate steps.

So…NP’s aren’t the only ones to miss things! For every NP horror story, I’m sure will have a similar one for an MD!

Becky

February 12th, 2010
9:48 am

@hopefully Becky..Gee, glad that you woke up on the wrong side of the bed this morning and that you are so concerned about someones health..

motherjanegoose

February 12th, 2010
9:57 am

Popped back in….this may be a silly question but is the Becky who has posted today about the OB the same Becky who usually posts ( has been around here quite a while) and is in her late 40″s? I am confused too but just chalked it up to not knowing everything…as some think I act like I do….LOL.

Maybe the assumption has been made that if you are heading to 50, you should not need an OB?

Theresa Walsh Giarrusso

February 12th, 2010
10:00 am

JJ — thanks for asking — he’s doing very well!!! He was in ICU for 10 weeks this summer got out on Labor Day but then has been back in a couple of times since. Sometimes with rejection,. sometimes with sickness —- He just had a biopsy on Tuesday and the rejection was 0!!! We were so happy. His 41 birthday was yesterday!! We feel very lucky and blessed that he made it to that next birthday. So many of the people that were in the hospital at the same time as him died. So we definitely feel blessed he’s doing so well. He’s back working about once a week with my folks and doing a little exercise. It is amazing!! His third-grade daughter wrote the most amazing story for a school contest about his surgery and how she was feeling through it. She was so in tune with what all was going on and wrote in incredible detail. My mom zeroxed it for all the doctors to see. We’re supposed to be celebrating his birthday tonight but with the snow and my strep I’m not sure it will happen. He said yesterday “you could kill me!”

Becky

February 12th, 2010
10:09 am

@MJG..Yes,I’m one and the same..Guess it was my fault that I just put ob, not gyn..

@Theresa..Was wondering about something you said on the other blog..You said that you woulnd’t give the kids diet 7 up? Is there any reason why? My little one (7) will only drink diet coke or sprite when she drinks sodas..So should I be making her drink something else? Thanks..Glad to hear the update on your brother..

motherjanegoose

February 12th, 2010
10:20 am

LOL…good Becky…glad you are here and do not need an OB ( unless you want one) …hugs to you. Has anyone seen any snow yet in metro Atlanta? I just called my sister and we are going to try to meet for lunch…we’ll see!

s

February 12th, 2010
10:29 am

I haven’t taken an antibiotic in over 15 years.

Theresa Walsh Giarrusso

February 12th, 2010
10:29 am

Hey Becky — I’m more afraid of artificial sweeteners than I am of sugar. Every now and then Rose will get some because I have coke zero in the house most of the time. I try to keep cans of Sprite or ginger ale or regular coke for them when they have it —- With that said, all three of my kids are tiny and not heavy at all. If my kids had weight issues then I might be more afraid of the extra sugar than the artificial sweeteners.

JJ

February 12th, 2010
10:35 am

Theresa, they should be drinking water, not sodas!!!! Sorry, but I’m anti-soda. That crap is SO bad for you, and your little ones SHOULD NOT be drinking it. Healthy eating/drinking habits should start at an early age.

I sure hope the baby isn’t drinking sodas……

JATL

February 12th, 2010
10:47 am

I like seeing NPs at my OB and my kid’s pediatrician when it’s all routine or for something minor. For yearly exams or if my children are really sick and I’m not sure what’s going on -I want to speak to the doctor. I’ve been lucky to find exceptional doctors as my OB-GYN, GP and pediatrician who all take time to sit down and speak with me. My OB/GYN is the same as MJGs -wonderful doctor! I have been really impressed with the NPs at the gyno’s office and the one now at the pediatrician -very knowledgeable! I have no experience with midwives although I support people using them and think they’re providing a great service out there. I wouldn’t see a midwife for my annual gyno exam though.

JJ

February 12th, 2010
10:55 am

Thanks for the update Theresa. I am VERY happy your brother is doing so well……

Erin

February 12th, 2010
11:23 am

I wasn’t aware a NP could do the full Gyn Exam – I’ve never been allowed to get a prescription without a yearly exam from a Dr, and never had an office suggest a NP (even after some moves, two insurance companies and 6-7 ob/gyn offices).

Becky

February 12th, 2010
11:29 am

Thanks Theresa..They do drink a lot of stuff other than sodas..She of course (as I tell her) isn’t a true southerner, cause she can’t stand sweet tea..When I was growing up, sodas are about all we drank and to lok at any of us, you would of thought that my Mother starved us to death, we were so skinny..

@MJG..Thanks..I forget that some on here take things so literal, so next time, I’ll try to spell everything out..As for the snow, haven’t seen any in Cobb County yet..Have a really good friend in MD. that sent me pictures of the more than 50″ that they have..

Erin

February 12th, 2010
11:37 am

On the soda thing – HFCS seems to be just as scary as most of the artificial sweeteners. Even outside of the conflicting health studies, it just trains young taste buds towards things that aren’t good for them. There are a few specialty cane sugar varieties – but I would not assume that any regular soda in the US is more natural than the zero/diet varieties without a VERY thorough label reading. Of course, ‘bug juice’ and milk used to be kid staples… seems they aren’t anymore. The PUR filters that add flavor to water might be convenient and family friendly? – haven’t tried them yet myself.

JATL

February 12th, 2010
11:47 am

@ Erin -I know at my GYN practice, NPs can do the full pelvic exam/pap smear. They also do a lot of routine pregnancy check ups. I think it really varies from practice to practice as to how much they use NPs. I’ve had exams from NPs during pregnancy, but for that annual exam, I still like to see the actual doctor. The practice I go to asks you and gives you the choice.

TechMom

February 12th, 2010
12:00 pm

I usually see a PA at our family practice. Want to see a doctor for an immediate need? Forget it. Usually those appointments are booked 2-4 weeks in advance. I can usually get in to see a PA that day or soon thereafter which suits me just find. I don’t have any chronic conditions and when I feel like crud, usually all I want is someone who can write a prescription. Plus, the doctors are there in the building if the PA has a question or something so it’s not like they don’t have anyone to go to. Taken my son to the Walgreens Minute Clinic clinic twice and seen a NP there without any issue. One was just to get a school sports physical done; didn’t realize my son’s had expired and couldn’t wait 2 weeks for it and the other time we suspected the flu and it was after hours so I would have waited longer and still not seen his doctor at the local pediatric clinic which charges twice as much as MinuteClinic. I usually see a NP at my Gyn office (it’s a team, one Gyn Dr. and one NP). I like the NP and again, I have no issues, I just need someone to write a perscription so quite frankly, if it saves money and time, then I’m all for it.

Valstake

February 12th, 2010
12:03 pm

If there was a cost difference for me between seeing: 1. a physician, 2. a nurse practitioner, 3. a physician’s asst. that would influence my choice. But if I’m paying “full price,” then I want to have a physician treat me. I have no idea where the future of health care is headed, but personally have no reason to think PAs or NAs are not competent to fulfill many of the routine duties undertaken by physicians. If this PA/NA “trend” were to help lower health care costs, then I’d be very supportive of the practice.

RJ

February 12th, 2010
12:35 pm

@Valstake, amen!

RA

February 12th, 2010
12:47 pm

I have been going to the same doctor’s office for 10 years now and the first time I met my doctor was in a social setting. He introduced himself, and I paused confused for a second knowing I recognized that name from somewhere and then blurted out, “you’re my doctor!” Sad. Still, I have nothing but good things to say about all my interactions with NPs and PAs.