Nov 7, 2019 06:16PM sbelizabeth wrote:
Mavericksmom, when you make the appointment, can you specifically state you want to be seen by your oncologist? Not the nurse practitioner?
Posted on: Nov 7, 2019 05:35PM
Who else is getting handed off to a nurse practitioner for follow up care?
My Medical Oncologist told me she wants to see me in 3 months, however, I was introduced to her NP today. This is how all care at the cancer hospital I go to is headed. All appointments are listed as being with a doctor, but I never know who I will see if I will actually see a doctor. I thought I could count on seeing her, I trusted her and I don’t trust many doctors. I don’t trust her NP.
I decided today that I am not going back for follow ups. My co-pay is for a specialist.While Nurse Practitioners do have a place in medicine, they ARE NOT doctors and definitely not specialist! It took me awhile to trust my MO, I am not wasting my tim trying to trust someone else. If “anyone” will do, I will just see my PCP for follow ups. At least he is a doctor who I trust! I also have a great gynecologist who will be able to provide care.
Posts 1 - 30 (39 total)
Nov 7, 2019 06:16PM sbelizabeth wrote:
Mavericksmom, when you make the appointment, can you specifically state you want to be seen by your oncologist? Not the nurse practitioner?
Nov 7, 2019 06:53PM Mavericksmom wrote:
I can't request to see the doctor. Who I see depends on how busy the doctor is. They prioritize patients and those like me are left seeing nurses. I get it, I do, patients going through treatment, especially chemo, and those who are stage 3/4 have more of a need to see the oncologist.
That said, I was passed off to a PA by my plastic surgeon and I had a really difficult time healing from my DIEP surgery. It is just how they do things.
I put up with it with the plastic surgeon because I was on disability and his office was the one who filled out the forms. When I went back to work it was annoying to take off from work only to be seen by someone other than a doctor. It puts a patient at a disadvantage because you don't know who you are seeing. I would have a list of questions for the doctor, then a stranger would come in (PA or NP) and I no longer felt comfortable asking questions.
I am curious to know if this is the trend. I wouldn't mind seeing a NP for cold or minor illness, but I am uneasy when it comes to specialists. If I am not worth being seen by the oncologist, then why bother going at all?
Nov 7, 2019 08:02PM MinusTwo wrote:
I think it depends on the NP. So far I've found most of the NPs I've seen are more attentive than the docs, appear to have or at least to take more time, and probably just a competent on day to day matters. They've always has the answers to my questions.
I would however not appreciate having a different one every time.
Nov 7, 2019 08:21PM Scrafgal wrote:
I see my MO everytime. The physican assistant or NP might see me first (to take vitals etc.), but I see my MO every time.
Nov 7, 2019 08:25PM MinusTwo wrote:
Scarf - I should have added, I too see my MO every time. And my cardiologist & my dermatologist & my PCP. I do often see an NP first now instead of a nurse and have found then knowledgible.
Nov 7, 2019 10:08PM Scrafgal wrote:
I also have found the oncology NPs and PAs very knowledgeable...much more than my PCP, when it comes to all things breast cancer. They have additional training for oncology. At my annual physical with my PCP, I found myself educating her on some of the details about my diagnosis! This doesn't mean that my PCP is not a good doctor. She just doesn't specialize in oncology. So, her knowledge of some of things is limited. She is very good about documenting things and making sure that she is doing her part in helping me manage my health, in the context of understanding my total health history.
Come to think of it, I do see my cardiologist, dermatologist and other doctors, too! They usually have a young ResidentFellow tagging along which, as a teacher, I don't mind at all!
Nov 8, 2019 03:02AM Pessa wrote:
I have told all my physicians that I will not see an NP or PA (except for information gathering at the beginning of an app’t). They have all respected my request.
Nov 8, 2019 08:30AM flashlight wrote:
I see an oncologist NP now when I go in for my 4-month check ups. The last time I scheduled with the MO he saw me 2 hours late. I am now seen on time and any questions I have are answered. My NP works very closely with my MO and they discuss each patient who is to be seen that day. I feel very comfortable with her and she isn't as rushed as he is. Also, it helped to learn that she had been with my MO for 12 years. I know they have a working relationship.
Nov 8, 2019 08:43AM edj3 wrote:
For my MO, I will see his PA unless I specifically schedule the appointment with him. I met her last week, she seems great so no issues for me there.
Mavericksmom do you have any thoughts on what you need to feel OK with seeing the NP or PA? From what you've posted, that will be your reality and I hate for you to be so uncomfortable or not ask the questions you need to ask.
Nov 8, 2019 08:55AM SummerAngel wrote:
I've seen both my MO and his PA. I can specifically ask to see my MO if I want to.
This is a trend, and there is a reason: There is a shortage of doctors, and Oncology is being hit especially hard. Many medical school students don't want to go into Oncology because, let's face it, it's a pretty depressing specialty.
Nov 8, 2019 10:27AM SimoneRC wrote:
I am a relative newbie as I was diagnosed Feb 2018. So far, my oncology visits have been only with my MO. The first visit was 2 hours. Subsequent visits have been 45 minutes. He does a thorough verbal medical assessment. Answers and discusses any questions or concerns I have. Finally, he does a thorough physical exam.
I never thought too much of it until this spring. I had a pre op visit with my PCP. While there, she did a thorough physical exam including feeling my breasts and axilla. Literally one week later I had my 6 month MO visit. When he did my physical exam, he found a suspicious lymph node in my axilla. I went for my ultrasound thinking nothing of it. Was BIRADS 4 and I had to have a biopsy. Thank goodness it was benign, but it gave me a whole new appreciation for my MO’s experience and exam!
Nov 8, 2019 11:36AM Scrafgal wrote:
SimoneRC...I found my own tumor not that long after a visit with my PCP where she didn't feel it. Grant it, it wasn't noticeable while laying back on an exam table...only when leaning forward and facing the floor. I do think that it takes experience with touching breasts of cancer patients to know what you are feeling for! I touch my breasts a lot more than my PCP....and my MO touches more breast that my PCP...
Nov 8, 2019 12:00PM bcincolorado wrote:
At cancer doc office I see the Dr. At neurologist I saw doc and now will follow with NP. Hubby has a transplant for routine care when he needs to get in for something if Doc is booked the NP treats. They can write RX and have a LOT of medical training. For complicated cases they go get the doc anyway even if they are booked.
Nov 8, 2019 02:03PM Spookiesmom wrote:
An ARNP took out a squamous lump from my arm years ago. While she was doing it, I asked her what was the difference between her degrees, and a PA. She said the PA was equivalent to a Masters degree. She could do anything the doc could, except write narcotics scripts.
She got clean margins. Nursing school is tough to get through. I’d rather see an ARNP than a PA any day, but doc is always around if needed.
Nov 8, 2019 02:05PM Dani444 wrote:
At my BS office I have seen both the MD and NP. I have been happy with both providers. I don’t think my PS has a mid-level provider as I have only seen her. I have not seen the NP at my MO’s office, just him. I can see where you might feel more comfortable getting questions answered from your physician. That is disappointing that you can’t request to see the MD.
SimoneRC- That’s good your MO does a thorough exam. Mine has never done a physical exam on me. I always thought that was odd
Nov 8, 2019 02:08PM edj3 wrote:
Dani444 my MO has done the physical exams and I always, always SHRIEK because his hands are slabs of ice!
Nov 8, 2019 03:14PM - edited Nov 8, 2019 03:24PM by ctmbsikia
True story. One time my MO only examined my right breast. So odd! I didn't have the heart to ask wtf are you doing? I'm too forgiving I guess.
I think this is a trend everywhere. My husband was recently in the hospital and he had an internal med Doc that acted like a primary would, the specialist did come in, but the daily checks were done by their PAs. So, this goes on even when you're admitted.
I met the NP at my MOs office once when MO was out of the country. This was after the true story incident. They actually called well ahead of time to ask if I wanted to reschedule. I will be OK with getting handed off. I don't think it will happen this year, maybe toward the end of next? I trust I will always be granted access to the MO if I request it. You're still the patient of the MO I believe. They will still be tracking you.
At the larger centers, I would not like not knowing who I would be seeing on appt. day. They must have a rotating schedule. If you could figure out which day (?) the MO you would like to see is on seeing patients in the office duty, I would make the appt. for that day.
Nov 8, 2019 03:18PM flashlight wrote:
One difference I have seen is my GYN does the breast exam while I am laying down. The MO, RO, and NP all do the breast exam while I'm sitting on the exam table. My BS did both sitting and then laying down. Before my mammogram I could only feel the lump while standing in the shower.
Nov 8, 2019 03:44PM - edited Nov 8, 2019 03:46PM by wrenn
I got rid of my GP and got an NP and love her. She calls to ask what I thought of the results of bloodwork (she knows I check online after draw). She takes her time with me and is aware of all things going on and refers to a specialist when needed. She will also ask physicians in her clinic when she isn't sure about something. I am 72 and have had great primary physicians and specialists but to date she is by far the best. She is very competent and knows many areas of medicine well but respects any input I have and is not afraid to say she doesn't know but will find out when she is unsure.
ETA that many NPs have been nurses for years and were exposed to many different medical issues and are used to managing the personal aspects or how to relate. Some physicians have not been in practice that long and although the education is more extensive they have not all had a lot of experience.
Nov 8, 2019 03:54PM AliceBastable wrote:
My ex-PCP* did a breast exam and found nothing. The next week I had the mammogram that started this whole trip. When my MO does a physical exam, which she does at every 3-month appointment, it's like a deep-tissue wrestling demonstration, and has me squirming and yelping. If there's ANYTHING in there, she'll find it.
*Not the reason she's my ex-PCP. The idiot didn't open emails from my other doctors last year and didn't know about any of my fun 2018 until I saw her in January. I fired her right after that crazy visit.
Nov 8, 2019 04:25PM Mavericksmom wrote:
I do understand why PAs and NPs are being used, but my issue is more with the fact that I never know who I will see.
I was a veterinary technician. I examined animals, took blood samples, ran the bloodwork, took x-rays, prepared animals for surgery, gave the anesthesia, assisted in surgery, performed dentistries on dogs and cats, gave injections and did everything but diagnose and write prescriptions. All that, but I wasn't a veterinarian, although I had a degree and on several occasions I found breast cancer and other problems that the veterinarians missed. Again, I wasn't a doctor. While I was highly qualified, the veterinarians had far more knowledge and experience than I had.
I wouldn't object to seeing a NP or PA if I knew ahead of time who I was going to see. I wish that when I made an appointment, it would be for the person whose name is on the appointment.
It is however, like a slap in the face when a doctor says they want to see me every so many months and then I end up seeing a NP. I mean no disrespect for NPs or PAs but I want to know who I am seeing!
I am still living with intermittent pain that I think is from a surgical hernia, but the plastic surgery PA examined me and said he didn’t think it was. No other doctor I see will even look at that because it isn’t their specialty. They tell me to make an appointment with the plastic surgeon. I can’t know for sure I will even see the surgeon, most likely it would be with the same PA and what is he going to say to me, “I already told you it isn’t a hernia?” So I am just living with a huge bulge at the DIEP surgical site and hope nothing gets twisted or causes an infection. My surgery was in January so there is some scar tissue there too.
Trying to advocate for our health and navigate the system isn’t easy! I am more inclined now to just avoid making appointments, especially since I decided not to continue to take the AI.
Nov 8, 2019 05:20PM Scrafgal wrote:
Exactly...my PCP always does a breast exam laying down and my tumor was almost impossible to feel that way...until I felt it when I bent down to face the floor...then when I knew where it was located, I could sort of find it on my back. They should actually tell general practitioners about this issue with examinations laying on your back! Until I got breast cancer, I didn't know the difference either....and my MO also does a clinical exam while I am sitting up and then while I am laying back.
Nov 8, 2019 06:47PM MinusTwo wrote:
Mavrick - do you have access to My Chart or a patient portal? I've found my docs very responsive when I ask non-emergency questions that way. As an aside, I schedule imaging/scanning procedures only on the days that the particular radiologist I trust is reading the films, and is there to talk to me if I need. I do have to ask when scheduling & not accept anything else.
Nov 8, 2019 07:57PM Mavericksmom wrote:
Hi MinusTwo, yes I do have a patient portal and I do use it. Unfortunately the one I have at the cancer center doesn't always get answered. I have 7 other patient portals and they are all efficient. Questions are answered fairly quickly by doctors or office staff. The cancer hospital is a hit or miss. If it is something semi-important, they will call me. I was actually told not to use it for some things I asked, apparently they thought I should have used the nurse triage line, but I didn't think they were important. When I have used the nurse triage line, they refer me to my PCP, go figure?
Nov 8, 2019 09:36PM Mavericksmom wrote:
I wanted to add that from responses here, I guess NPs and PAs are here to stay.
My doctors want me to see them every three months for now. I guess since my treatment is over, follow up care really isn’t such a big deal and it doesn’t matter who I see, as long as I am seen by someone at the cancer hospital I go to. I know consistency is important, my records are all at one place and if I go with questions, as long as someone can answer them, it doesn’t matter who that someone is, doctor or NP.
I decided not to continue taking the AI, because the side effects were not worth the small benefit for me,so I don’t want to blow off appointments. That would be so easy to do now that I feel a lot like my pre-second Dx self.
Reading others experiences with NPs makes me less apprehensive and opened my eyes to new perspectives. Thank you to all who posted here!
Nov 8, 2019 10:02PM ElaineTherese wrote:
I see a NP at my OB-GYN. In fact, I have never actually met my OB-GYN, as I recently started going to this practice after my old OB-GYN retired. It's the same NP every year, but I don't consider my OB-GYN a crucial part of my medical team so I don't mind. The NP is perfectly qualified to do an annual exam and to do a pap smear every other year.
For the first five years after diagnosis, I saw my MO every three months. Now that I'm five years out, I see her every six months. She's the one who arranges for my monthly shots (Zoladex), bone density shots (Prolia), annual mammogram, biennial dexa scans, and port flushes. She also renews my AI prescription. She has no NP; if she's on vacation, I just see one of her partners. They're fine.
I see my PCP for high blood pressure every six months. And that's it.
Frankly, I'm relieved to have reduced my medical team to just those three. I never see my surgeon, and I didn't really have any complications from radiation so just stopped visiting my RO. It's all good.
Nov 9, 2019 09:09AM flashlight wrote:
Mavericksmom, for your hernia repair did they use mesh? My girlfriend had a repair done with mesh and it caused irritation and pain. She had to have it removed. I think you should go for a second opinion with a general surgeon. Good luck to you.
Nov 9, 2019 09:34AM DogMomRunner wrote:
I see both my MO and NP for my ongoing Herceptin infusions. Saw both of them during chemo. I have no problem with my NP, she is very knowledgeable about cancer. Most of the time I know which one I am seeing for a particular appointment.
Also former licensed vet tech here. The third no no is surgery. I worked at a vet school in the anesthesia department and taught vet students as part of the job
Nov 9, 2019 11:42AM JRNJ wrote:
I agree, I'm at the end of my rope with PAs for my surgeons. BS PA was working for her two months and out of school. Many mistakes and inappropriate comments. My PS has several PAs and nurses working for him most very young. I like the ones with more experience, but I hate one of them and I never know who I am seeing. After surgery, both BS and PS sent PAs to hospital I didn't see either surgeon. And I was distraught finding out I had a positive node and was in a lot of pain that wasn't managed properly. BS wouldn't talk to me for 2 weeks until final pathology back, that is her policy. I'm never going back to her. Most of my appointment with PS are with him though. Especially with the pseudomonas infection and just had TEs removed. Funny, he did two procedures since surgery under local and I had plenty of time to talk to him while I was on the table, lol. So far my MO and RO appointments are just with Drs. But that is because I don't have a treatment plan yet. We'll see what the future holds there. Looking back, I've been seeing NPs for years for annual exam, pap, mammo. Now I think I made a mistake. My friend has a Dr. who sent her to MRIs occastionally for dense breasts. It could have been caught sooner. Also, I did see a new young doctor in July for annual. She said, do you want hormone replacement for menopause? right before DX. That's crazy. She didn't even consider the risks of that? I said no, went for mammo, and guess what...…...
Nov 9, 2019 01:04PM edj3 wrote:
flashlight I had an incisional hernia repaired in 2006 (lower left quadrant of my abdomin, from the previous six major abdominal surgeries). The surgeon used mesh and it's been fine. I did grow some adhesions to the mesh and tore them doing yoga one time--that was incredibly painful as in throwing up painful. Otherwise I never notice it.