Can nurse practitioner diagnose MS

Went to see new "doctor" or so i thought.  Got there and appt was with nurse practitioner.  I don't mind who i see but she was a little wacky.  Talked really fast, strangely dressed, purple streaks in hair.  Does anyone think that is strange?  I guess the way we look does not count for what we know.

Either way, she looked at all my notes and did a neuro exam which she said was abnormal.  Second abnormal neuro exam in two months.  How come other medical people find my neuro exams abnormal and the neurologist doesn't?  Well at least the neurologist in the ER.  i also had a negative rhomberg.  Whatever that means.

She said she has treated people with MS and thinks what is going on with me definitely looks like MS but the neuro has to diagnose.  Which leads to my original question, can APRN diagnose MS.

Hopefully the MS Specialist will agree.

Thanks for the feedback.
Kerri

[essdipity]

Well, I agree that it is the neuro who should be doing the diagnosis. That's officially the way things go.

However, NPs can be very knowledgeable. My own certainly is. She's been an MS nurse since 1988, has published in major journals, continues to participate in research, is a member of the boards of important MS groups, etc.

She gave me the most thorough physical exam I've ever had, and is generally great in every way. But she doesn't have purple hair or any other off-putting characteristics, so it's easy to be her patient. I can see why you might be skeptical about the one you saw, yet it's good that she seems tuned in to you and your symptoms.

What you need is for the MD to buy into this, and to prescribe not only symptom management but also one of the DMDs. Personally, I'm convinced you have MS, but my opinion doesn't count. You need an MD on board.

Hope this happens soon,
ess

[LisaJF]

Hi Kerri,

I wonder why they would make you think you were going to see a doctor and instead you see a Nurse Practioner? Did they state that the doctor was in an emergency or something?  Was this your first visit with the "new" doctor?  I find it odd to make an appointment with a "new" doctor and end up seeing someone entirely different.  Almost feels like a "bait and switch" deal doesn't it?

Not that I'm saying the NP could not do a proper physical examination, but I think when you are expecting to see the "doctor" you called to make an appointment with, I would say I'd be a bit confused as to why "he" wasn't there?  

I have never met any medical professional with purple streaks in their hair.  There is a strict code as to how one presents oneself in any place I've worked at. However, perhaps that office is a bit lax about that sort of thing?  I wouldnt put any stock in what a person wears as much as their performance of assessment, taking the time to explain things while they are asking you to perform them.  Depends on how you felt how "thorough" she was?  I would call the office and ask why the doctor you were expecting to see that day wasn't the one who was there.  It's a start.

A negative Rhomberg means that you can stand with your feet close together, extend arms out and stand with eyes closed and not fall. It is natural to waver a little but not fall over.  First they have you do this position with your eyes opened, then ask you to close them.  You must of been able to maintain your posture without falling over with your eyes closed.

I can't tell you if a NP can diagnose MS or not -- I do not think that is standard practice to diagnose in a specialty that is left up to the doctors who specialize in this area.  I know for myself, I would want a MS Specialist to diagnose me, the expert, the one who will take their time needed to thoroughly investigate, rule out any other mimics possible before giving me a diagnosis of MS which is the way it should be, since it is a diagnosis of exclusion.

I'm sorry if Im not of any more help.

Lisa

[kerrtelli]

Thanks.  I did think i was seeing a doctor but now that I think back to the phone conversation they said a womans name and I just assumed it was a doctor.  My fault.  This is a community health association that took my medicare.  So in terms of dress code, they are probably lax.  I would be very leery if she didn't say that the neuro had to diagnose me and luckily i am seeing the specialist on June 1.  

I am ging to find an md though.  I told her I thought I was seeing a doctor and she made it very clear that she could do all the things a docTor could do.

Like I said before, no diagnosis, no mess.  No one seems to want to give me any medications even though i am walking arou nd with a cane.  That was another weird thing, she said she thought the cane, with the flowers on it, was my husband.

I guess better luck next time.  By the way, I found out today the the specialist I am seeing actually has MS himself.  What do you think, pro or con?

[essdipity]

That NP is out of it, even if she knows about MS. Her statement about your cane is weird. She may be high on something.

When do you see the MS specialist again? I would push for that, given the circumstances.

ess

[LisaJF]

I would have to agree with ess on that statement regarding the cane. LOL.  Psychedelic!!!

I would say there could be a two sided coin to that situation, but to me, a pro for he may have a bit more empathy and an attentive listening skill that would surpass many others.

When do you get to go see him?!!!?

[LisaJF]

Oops you said it "June 1st".  My bad. LOL

(you can whack me with the cane now to pay attention) :D

[twopack]

The hair isn't very professional but I love a free spirit.  Apparently CT isn't the conservative place I always thought it was.  I've seen a few stray color streaks in RN hair here in OH as well.  I'm ROFL that NY Lisa is the one who is most surprised.  hehehehehe

The stupid cane comment might have been a lame attempt at humor (you know, a "someone to lean on" type of thing).  The exam and feedback she gave you made sense.  She shared her opinion but was upfront that she doesn't have diagnostic priviledge.  All diagnosing is reserved for physicians.  Even most PCPs will bow to the neuro or MS Specialist for a definitive MS diagnosis.

The part that most bothers me is her statement that she can do everything the doctor does.  That is arogant and just not true.  Otherwise, why bother with all the education and training to become a physicain?  Nurse practitioners (and Physician Assistants) may seem to work independently but they are always under the supervision of the physician who employs them.  Most times they provide an excellent service.  Sometimes they get a little full of themselves.

Was this kind of a pre-visit visit?  A fact finding mission that she will use to prep the doc for your next visit?  It does seem a little strange but if I think back to my first visit to the MS Clinic, I spent time with the MSRN first.  When the doc came in he was already prepped with the info I had given her.  Maybe that's what was happening here but for you it's happening on two different days?

As far as the doc having MS himself, I'm with Lisa.  It can go either way especially since MS has so many different faces and graces.  Several of the employees at the MS clinic I go to have MS.  One nurse is usually in her power chair.  The OT who teaches a yoga class "looks good" but shares her challenges with us.  I do always feel like PwMS "get it" a little better than Pw/oMS.

I'm thinking this doc must be a little quicker on the uptake than many of us around here.  Then again, he probably gets to dictate rather than keyboard.  (Reminds me, I've got to get that voice recognition program installed!)

Hope your answers come soon but it does take more than cane use to get what you need.  All too often you have to ask directly for prescriptions you think might help control symptoms.  You'll soon learn the subtle approach (sadly) required.

Mary