PEEK!!! QUICK QUESTION!!

[Michele, Katy, TX]

Hi Peek,

I was wondering if you might know the answer to a question I am having.  I was wondering if you know the difference between a doctor, physician's assistant, and a nurse practitioner???

I have taken my kids to the Take Care Clinic at Walgreens a few times.  2 of my kids were misdiagnosed last week.  One of those had to go back and the other ended up in ER on Saturday.  I feel like both could have easily been avoided if properly diagnosed and I know that these people are not actually MDs, but Nurse Practitioners (sp??).  I just want to know the difference.  I do plan on complaining.  It's ashame too.  I think these clinics are a great idea and alternative if you just need to be seen for non emergencies.  They also have extended and weekend hours which help us working moms/parents, but at the same time, they need to be qualified.  Otherwise they are only putting people at risk.  My 2 daughters simply needed anti-biotics.  They both almost ended up in the hospital because they weren't given anti-biotics.  It was Bronchitis, which as you know, can easily and quickly turn into Pneumonia.  If you could have seen and heard my kids.  It would have just broken your heart.  I know it did mine to see them suffering the way they were.  

Why didn't I take them to my Pediatrican???  Well, because she wouldn't see them that day and they needed to be seen that day.  I had a great Ped at one time.  Then my insurance changed and I had to get a new one (Ped).  I am not very happy with her for obvious reasons.  I see no reason to have a doctor if you can't see them when you are sick and this is the 3rd time I have been told my kids couldn't be seen that day.  I have never been told that before.  Any ped I had in the past would see your sick child that day no matter what.  You may have to do some waiting but they never turned away a sick child!!!  My insurance is changing again on May 1st.  I can't wait.  I will get to have my old Ped again!!!  Yay!!!

Sorry to get so OT, but I needed to vent in addition to asking my question :)  

Thanks,
Michele

[April1113]

I googled it and this is what I got, hope it helps a bit

A doctor has a degree from medical school (4 years, either an MD or a DO) and has gone through residency (anywhere from 3 to 10 additional years of training). They are licensed to practice medicine or surgery (or both) independently, write prescriptions, etc. They are board-certified, if qualified, on the national level and must obtain a state license where they practice.

The requirements for a PA vary a bit from state to state, but it's usually at least a two year program and many already have a bachelor's degree, but I don't think it's always required. They work in close relationships with supervising doctors and they don't perform surgery, but they may do almost any other aspect of medicine. They may write their own prescriptions under the doctor's license but are not independently licensed to practice on their own, although they are boarded nationally.

A nurse-practitioner is a nurse with an advanced degree beyond the RN, usually a masters but sometimes a PhD. Whether they practice completely independently or not varies by state, but in many states they do. They usually are highly specialized, like doctors who specialize, and prescribe under their own DEA number. They are also nationally certified and licensed by the state.

[peekawho]

You've gotten a good description above.

The thing is, the push is on, and has been for quite a while, is not to treat respiratory infections automatically with antibiotics.  Most of the time, these are viral infections, and all the antibiotics in the world won't help.

Good practitioners won't simply hand out antibiotics to every child they see with bronchitis or a URI.   Parents often want the antibiotic, and the pressure is often unbearable for practitioners NOT to give them.  

Most times, the child will improve with simple supportive and comfort care, with or without antibiotics.  Sometimes bronchitis will worsen, as you point out, and become a secondary pneumonia.  But this is not the norm.

I hear where you're coming from, but antibiotics are not usually handed out for children with URI's or bronchitis, unless the clinical picture and xrays support the need.  Xrays are not usually done unless the clinical picture is very worrisome or the child has been acutely ill for quite some time.

[GNicole]

My daughter's pediatrician practice rarely gives out antibiotics (and they are all MD's). Over Christmas I took her in 3 times to be seen and never left with an antibiotic. She had a fever of 103-104 and a horrible cough. Finally she got so bad after we left the the office for the third time that we took her to the ER. She had pneumonia and  bilateral ear infections. Needless to say I wasn't suprised, we knew she was very sick but the doc just brushed us off. I understand not wanting to over use antibiotics but this was ridiculous! The doc called me 2 days later wanting to know why Avery went to the ER because she didn't have the report back yet. I think she almost dropped the phone when I told her. I was so mad. Needless to say, we are looking for a new pediatrician.

[AndiJ78]

Our clinic is also tight with antibiotics and I am happy they are that way. Numerous times they have had simple viral infections and recovered without the use of antibiotics. I saved them the inevitable yeast flare-up and the burning loose stools, not to mention saved the risk of propagating super-bugs that are antibiotic resistant.

Now when they need antibiotics as demonstrated by a complete workup, including chest x-rays as indicated, they most certainly will prescribe them. Not once have I had to return to the urgent care or ER or pedi for meds due to not being given them on the initial visit.

Not every URI needs them, nor does every ear infection. In certain age groups, generally above 18 mos, they would prefer to wait to give antibiotics as the ear infections normally resolve on their own.

Sometimes, bad stuff happens and obviously it is okay to be upset. However, more often than not, they simply are not indicated and the doctor or PA is simply following the recommended guidelines for prescribing these medications.

I hope your kids feel better soon. My oldest had pneumonia this time last year and he felt awful. Ironically, it was bilaterally lower lobe viral and upper lobe bacterial and even though we were given antibiotics, he felt 100% better the next day, before the antibiotics even had a chance to work. So he was on the mend before the meds were even on board.

[Michele, Katy, TX]

Wow!  Thanks to all for your information.  I understand where everyone is coming from w/ the antibiotic thing, but at the same time, if you could have seen my kids.....well, they were just getting worse and worse.  Their fevers were so high, I could hardly break them no matter what I did.  My youngest (20 months old) that I took to the ER was given 2 shots there.  They also gave me a script for an antibiotic and a script for a breathing machine.  She looked to be on death's door when I took her to ER.  Her fever being 104.  She was so weak, she could hardly cry.  She had no voice left when she tried to wine.She could hardly call for her mommy.  And her diaper was dry after 7 hours because I couldn't get her to drink anything.  I was very concerned about dehydration.  This was all Friday night and Saturday morning, but after the shots and meds, by last night, she was returning back to my child again.  She was smiling and trying her best to get you to smile too.  She loves to make others laugh.  She is such a character.  I know, without a doubt, that in her case, the meds helped her.

I have chronic bronchitis as an adult.  I usally get it about once a year and I know it long before it gets into my lungs.  You never forget the feeling of a weight being placed on your chest.  I have always gotten an antibiotic for it.  I have been diagnosed by 3 different docs at various times, and they have all given me antibiotics and I was only
x-rayed once.  I don't know.....It is just very difficult to see your children like that and to feel so helpless.  

I guess I just don't understand how they would know what is viral and what is bacterial without taking blood, x-rays, etc.  They don't do those things at those clinics.  About all they do is take blood pressure, look at ears and throats and take a temp.  Then they diagnose you.

After all was said and done, I am glad I made the decision to go to ER.  Pneumonia can happen really quickly and is not something to play with.  I have a co-worker whose daughter (only about 3 weeks older than mine) was misdiagnosed about a month ago.  She was then hospitalized for Pneumonia and then quarantined for 2 weeks.  The same thing happened to my brother when he was a baby.  He almost died.  

I know doctors aren't perfect, but again, thanks to all of you for your responses.

Thanks April for your research on my behalf.  I really appreciate it!

[tiredbuthappy]

how many days were there between your visit at the clinic with the nurse practitioner and when you had to go to the er?

my ped is also very cautious in giving out antibiotics. DD (almost 20 months) has been sick plenty of times, but has only been on antibiotics once in her life. And that was when 10 days of rsv congestion finally led to a mild ear infection at 5 months. No matter what else I have taken her in for, they advise me to wait and sure enough, she always recovers quickly without antibiotics. Colds, congestion, fevers (even a fever of 104-105 for 4 days) all seem to resolve themselves. However, my ped is wonderful about seeing patients. They provide clear instructions on when to bring the kid back, and would always accept her immediately if i felt she was getting worse. I think that is a very important component of the wait and see approach. Most cases do resolve without antibiotics, but it is crucial to have follow-ups if symptoms persist or get worse. The nurse practitioner you saw should have clearly informed you of this, and I am surprised she didn't recommend you follow up in a day or 2 with your own ped.

i'm glad to hear you'll be getting your old ped back! Hopefully you won't have to worry about this in the future.

By the way, chronic conditions that require antibiotics such as your chronic bronchitis is one of the main reasons why so many medical practioners are getting so conservative in prescribing antibiotics. My grandfather was on and off antibiotics all his life. unfortunately, he wasn't good about taking the full prescription, and he had a doctor friend who would prescribe him antibiotics for anything and everything. In the end, he had several antibiotic resistant infections. He was on the last line of defense antibiotics several times (ones that had to be reported to the CDC). He was a perfect example of why doctors need to be more cautious! Not to say that your conditions and reasons aren't valid- it's those who are taking antibiotics for everything and not finishing courses that are causing some of these crazy resistant strains.