Seniors

PAs and NPs are not the equivalent of MDs unless you need a band-aid. I work with people with disabilities. Many of them are in the bad shape they are because they’ve been treated by PAs and NPs for years, exclusively or nearly so. Their diabetes is crap. Their treatable musculoskeletal issues aren’t left untreated as they’re told they just need to “live with it.” Seizure disorders are uncontrolled as patients are told “Oh, try one more month on these meds...” rather than being sent to the neurologist to try something else because the regimen simply isn’t working. It goes on and on. The only - and I do mean the ONLY - time I’ve seen PAs work well is in extremely specialized settings, for visits that are purely for cardiac, pulmonary, etc. retests. They can be just fine for scheduled testing and going over therapies.

I made the mistake a handful of times in my life of letting them set me up with an NP or PA in an emergency. Every one was a laughable failure.

- I fell off 7 inch heels in the ice at a club and hurt my elbow badly. The NP was available to order an x-ray. She called me back to tell me my arm was broken. It was complete fiction, and NOT the findings on the x-ray. An orthopedist let me know that it was a bruised nerve, several days later.

- I had an exposure to very active TB at work and needed a Mantoux test. NP did fine administering it, but another one had no clue how to read the result several days later, and hemmed and hawed until a doc came to sort it out.

- I finally said no more, and refused to sign the agreement at my clinic to allow any NP or PA to treat me. My doc had put me on blood pressure meds for the first time in my life, during a period of gruesome stress when I started having bad BP spikes when emotionally triggered, like my mother developed late in life. Months later, with stressors resolved and BPs always low or normal, I developed a known but less common side effect to the PM dose. I took myself off the bedtime dose for a week, the side effects vanished immediately, and my BPs were rock solid. So I called my doc to make it official that I would still be on the AM dose, but drop the PM. (The plan had been to get me off completely in a few months, BTW.) The NP did everything she could to avoid giving my message to the doc. She finally suggested the stupidity of “Why don’t you take your ‘whole’ dose in the AM instead?” Excuse me, but my BP was perfect on this dose - no need to double it! I told her to butt out, and got to my doc, who said it was great, so let’s kill the PM dose and just keep monitoring for a month before we call it permanent.

Just don’t do it to yourself. Get a doc, and insist on that doc. Especially if you’ve been out of medical care a few years, do ONLY an MD. If, in the course of working with that doc, you discover that the doc has a fabulous NP or PA, and all the diagnostics and treatment tweaks are done so you only need occasional monitoring checks, then maybe occasionally see THAT fabulous NP or PA but don’t let them switch you to any others. Medical personnel are not fungible. You find the one that’s good, and you keep that one.