lealea1005
Senior Member
NPs in Idaho don't need MD collaboration or supervision for writing scripts Tink.
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Medicating without a doctor seeing the kids
- Thread starter JoLo0808
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TinkerBelleLuvr
Senior Member
When my daughter had the flu, the NP gave her TamiFlu. Now she ask who all is in the house with her. It was myself and the BF. She gave me a prescription, but could NOT do one for the BF because the BF was NOT a patient of hers. (I am a patient)
On a side note, it's really unwise to take prescriptions of antibiotics when it is unwarranted; that can be setting the children up for serious problems when they get older and there are fewer ones that they can take.
On a side note, it's really unwise to take prescriptions of antibiotics when it is unwarranted; that can be setting the children up for serious problems when they get older and there are fewer ones that they can take.
lealea1005
Senior Member
Honestly...no offense to you or your NP, but giving a parent a prescription for anything because the parent states they "pretty much know they have it" is sloppy medicine. As a mom/RN, myself, I understand that you know your children better than anyone...BUT...I have seen 2 children die because they were prescribed antibiotics without an examination. Both were thought to have strep ( the parents "pretty much knew" the symptoms). One died of pneumonia 4 days later and the other died of acute epiglottitis. I'll never forget the faces.
IF there was a prescription written. Since step-mom is an RN it is quite possible her friend just stocked her up on samples and there is no record of anything.
lealea1005
Senior Member
It's that time of year! Just wait until school's been in session about 3 weeks....just long enough for the kids to infect eachother. Good luck with your stepson.
Just wanted to give some perspective; I am a research biologist at a hospital, and I also spent several years as a licensed medical assistant. This is a tricky question, but I think shedding some light on certain aspects of this situation may ease some tension.
Many people are unaware of the actual reason we now suggest prescribing antibiotics less frequently. With frequent use, it is not the child’s immune system or tolerance level that will change. Rather, the bugs themselves which cause infections will, in time, mutate to become more antibiotic resistant. In theory, this will cause there to be more infectious bugs “out there” which can’t be treated as well with modern day medicine… overall, a negative consequence. But just because a super-bug exists doesn’t mean that a child with recurrent infections and antibiotic use will automatically start contracting the stronger strains—for the most part, everyone in a community is equally vulnerable, give or take a few factors. Therefore, limiting antibiotic use is more of a public service for future children than a personal safety issue for the currently infected child.
In certain situations, it is common practice, not negligence, for an on-call medical professional (not necessarily a child’s regular doctor) to call in medications without an examination. We consider this to be appropriate if the medical practitioner can attest to the fact that the caregiver has correctly identified signs of infection in the past, and verbally attests to the fact that the child has a history of either infections that require antibiotics to resolve in a reasonable time frame, or if the child is experiencing a great deal of discomfort. It is up to the discretion of the prescriber as to whether or not they will give preventative scripts to other family members. This tends to be based on previous history provided by the caregiver on whether illness tends to stay contained or spread throughout a family. If the prescriber has witnessed the RN stepmother regularly being a person of good character, then they may be helping the family save money on co-pays, lost wages, or other reasons that families list as reasons to avoid medical care. They may be seen as realistic and cost-efficient, not sloppy. Every provider has the ethical responsibility to recommend a check-up if a problem is recurring and worsening, or reaches beyond the scope of the original complaint. A concerned parent who didn’t notice that their child was continually worsening with an illness such as pneumonia or swelling to the point of respiratory failure is more likely to be at fault for negligence than overprotecting, and it doesn’t seem like the kids in question here are at death’s door with uninformed parents. A provider is usually obligated to offer services to a patient in need help, regardless of whether he/she is their regular provider.
It can be reasonably assumed that the RN step-mother can be trusted to identify a likely case of strep throat. Even if it turns out not to be strep throat per se, any sore throat with infectious indications would be treated with the same antibiotics as used for strep throat, if antibiotics are to be used at all. Certainly, the medication of a child should be discussed between parents. Heck, if it were up to my ex, our daughter would have had a root canal without any pain reliever, and I would have been furious. Being overly cautious swings on both sides of the spectrum. Before the claws come out, it would be wise to consider the step-mother’s motives for administering antibiotics. Unless she is mentally ill, it is highly unlikely that she is trying to be lazy or pull a fast one. It would be reasonable to assume that she is trying to protect the child from an infection that he or she is likely to contract, thereby sparing the child intense pain, loss of sleep, and inability to participate in school or fun activities. Augmentin is a safe drug; when side effects do arise, they generally present as nausea. If your child has an allergic reaction or severe vomiting or diarrhea, these would be reasons to protest.
As for the ex-husband, it seems to be common knowledge that Augmentin is a penicillin-type drug—it seems unlikely then, if not impossible, that an RN wouldn’t know this. Again, unless she is mentally ill, it is unlikely that she would give this to him out of spite or laziness. It’s quite common for people to grow out of their penicillin allergies, or for a penicillin allergy to be misdiagnosed. Is it possible that this is the case? If he’s already been taking it, it can be safely assumed that there is nothing to worry about. Besides, what he decides to take (as long as it does not impair his judgment while parenting alone) is up to him—he is a grown man, and he is capable of bypassing his current wife and taking himself to a doctor if he chooses to do so.
Many people are unaware of the actual reason we now suggest prescribing antibiotics less frequently. With frequent use, it is not the child’s immune system or tolerance level that will change. Rather, the bugs themselves which cause infections will, in time, mutate to become more antibiotic resistant. In theory, this will cause there to be more infectious bugs “out there” which can’t be treated as well with modern day medicine… overall, a negative consequence. But just because a super-bug exists doesn’t mean that a child with recurrent infections and antibiotic use will automatically start contracting the stronger strains—for the most part, everyone in a community is equally vulnerable, give or take a few factors. Therefore, limiting antibiotic use is more of a public service for future children than a personal safety issue for the currently infected child.
In certain situations, it is common practice, not negligence, for an on-call medical professional (not necessarily a child’s regular doctor) to call in medications without an examination. We consider this to be appropriate if the medical practitioner can attest to the fact that the caregiver has correctly identified signs of infection in the past, and verbally attests to the fact that the child has a history of either infections that require antibiotics to resolve in a reasonable time frame, or if the child is experiencing a great deal of discomfort. It is up to the discretion of the prescriber as to whether or not they will give preventative scripts to other family members. This tends to be based on previous history provided by the caregiver on whether illness tends to stay contained or spread throughout a family. If the prescriber has witnessed the RN stepmother regularly being a person of good character, then they may be helping the family save money on co-pays, lost wages, or other reasons that families list as reasons to avoid medical care. They may be seen as realistic and cost-efficient, not sloppy. Every provider has the ethical responsibility to recommend a check-up if a problem is recurring and worsening, or reaches beyond the scope of the original complaint. A concerned parent who didn’t notice that their child was continually worsening with an illness such as pneumonia or swelling to the point of respiratory failure is more likely to be at fault for negligence than overprotecting, and it doesn’t seem like the kids in question here are at death’s door with uninformed parents. A provider is usually obligated to offer services to a patient in need help, regardless of whether he/she is their regular provider.
It can be reasonably assumed that the RN step-mother can be trusted to identify a likely case of strep throat. Even if it turns out not to be strep throat per se, any sore throat with infectious indications would be treated with the same antibiotics as used for strep throat, if antibiotics are to be used at all. Certainly, the medication of a child should be discussed between parents. Heck, if it were up to my ex, our daughter would have had a root canal without any pain reliever, and I would have been furious. Being overly cautious swings on both sides of the spectrum. Before the claws come out, it would be wise to consider the step-mother’s motives for administering antibiotics. Unless she is mentally ill, it is highly unlikely that she is trying to be lazy or pull a fast one. It would be reasonable to assume that she is trying to protect the child from an infection that he or she is likely to contract, thereby sparing the child intense pain, loss of sleep, and inability to participate in school or fun activities. Augmentin is a safe drug; when side effects do arise, they generally present as nausea. If your child has an allergic reaction or severe vomiting or diarrhea, these would be reasons to protest.
As for the ex-husband, it seems to be common knowledge that Augmentin is a penicillin-type drug—it seems unlikely then, if not impossible, that an RN wouldn’t know this. Again, unless she is mentally ill, it is unlikely that she would give this to him out of spite or laziness. It’s quite common for people to grow out of their penicillin allergies, or for a penicillin allergy to be misdiagnosed. Is it possible that this is the case? If he’s already been taking it, it can be safely assumed that there is nothing to worry about. Besides, what he decides to take (as long as it does not impair his judgment while parenting alone) is up to him—he is a grown man, and he is capable of bypassing his current wife and taking himself to a doctor if he chooses to do so.
lealea1005
Senior Member
We're just going to have to agree to disagree on this one. The only way for the practitioner to attest that the signs of infection have been identified is to examine the patient. I'm not saying it's inappropriate to extend or change the antibiotic prescription in a patient who is at the end of their initial treatment, with the recommendation that the patient must return for re-evaluation if the symptoms are not 100% resolved at the end of treatment. As you said, it's up to the discretion of the treating Physician.
The Physicians I work with would like to know the qualification of the "we" you refer to. Are they practicing Physicians actually treating patients?
Just to clarify....The children I wrote about were not at death's door when the antibiotics were called in. Those Physicians did rely upon the history and reliability provided by the caregiver before calling in the antibiotic. The caregiver was not a Physician. Actually, the parent of the child with pneumonia was a well respected PA. Neither of the parents were negligent, but neither, including the PA, were able to assess what what going on with an objective eye, which is totally understandable since it was their child. Both children went down hill in a very short period of time, both after more than 72 hours of antibiotic therapy. Neither notified the Physicians that the children were not getting better.
One of the Physicians is still practicing, but never calls in a Rx with first examining the patient. Although I've lost track of the other Physician, I know she was being sued for the incident. If losing the patient wasn't bad enough, she was vilified by the very parents who initially assured her they knew their child "had strep again". She left medicine a few years ago.
Not trying to be adversarial, just out there on a day to day basis. I see and understand both sides. I've been there when the bad stuff happens, and it affects you.
Hi there,
I certainly wasn't meaning to be adversarial, I just wanted to provide another perspective from which the actions of the stepmother could be viewed. To clarify, by "we", I was referring to the physicians of the internal medicine facility within the hospital in which I work. I certainly cannot speak for all prescribers everywhere.
As for the children you mentioned, this is very unfortunate. Having lost my own 1-year-old daughter to a preventable condition, I personally tend to be hypervigilant about having my living daughter examined when illness occurs. I was simply stating that this is often common practice, and not considered negligible by many providers. I will say though, that I do not believe that because an individual is a PA, an NP, or an RN, that their judgment is automatically sub-par to that of an MD. I've seen a great deal of evidence to the contrary. Rather, I believe it is access to testing and breadth of experience that makes an individual more or less competent to make an absolutely accurate diagnosis.
As you said, neither of the parents you spoke of notified the physician when the children continued to go down hill... I think the problem we are dealing with is that the science of medicine also involves people, who are not infallible. In either circumstance, a treating physician would have to depend on the caregiver to accurately report changes. I don't know about you, but I rarely see a doc these days who calls a few days later to see how the patient is progressing. I sure wish this weren't the case.
Anyhow, I just wanted to let you know that this isn't what I would do if it were my daughter, but I was simply offering an alternate explanation as to why the NP and the RN were not neccesarily acting unethically.
When parents share responsiblity, it is in everyone's best interest when they can agree on the terms of medical treatment. By providing the information I did, I was hoping to offer some perspective from the side of the stepmother. While I don't necessarily condone her actions, I know from being the "real" mom myself that it's often hard for us to get past the feelings of resentment and betrayal that we feel have been perpetrated by the stepmom, and separate them from the issue at hand. We all have to step outside of ourselves at times and view the situation from our adversary's point of view when trying to reach an agreement.
I certainly wasn't meaning to be adversarial, I just wanted to provide another perspective from which the actions of the stepmother could be viewed. To clarify, by "we", I was referring to the physicians of the internal medicine facility within the hospital in which I work. I certainly cannot speak for all prescribers everywhere.
As for the children you mentioned, this is very unfortunate. Having lost my own 1-year-old daughter to a preventable condition, I personally tend to be hypervigilant about having my living daughter examined when illness occurs. I was simply stating that this is often common practice, and not considered negligible by many providers. I will say though, that I do not believe that because an individual is a PA, an NP, or an RN, that their judgment is automatically sub-par to that of an MD. I've seen a great deal of evidence to the contrary. Rather, I believe it is access to testing and breadth of experience that makes an individual more or less competent to make an absolutely accurate diagnosis.
As you said, neither of the parents you spoke of notified the physician when the children continued to go down hill... I think the problem we are dealing with is that the science of medicine also involves people, who are not infallible. In either circumstance, a treating physician would have to depend on the caregiver to accurately report changes. I don't know about you, but I rarely see a doc these days who calls a few days later to see how the patient is progressing. I sure wish this weren't the case.
Anyhow, I just wanted to let you know that this isn't what I would do if it were my daughter, but I was simply offering an alternate explanation as to why the NP and the RN were not neccesarily acting unethically.
When parents share responsiblity, it is in everyone's best interest when they can agree on the terms of medical treatment. By providing the information I did, I was hoping to offer some perspective from the side of the stepmother. While I don't necessarily condone her actions, I know from being the "real" mom myself that it's often hard for us to get past the feelings of resentment and betrayal that we feel have been perpetrated by the stepmom, and separate them from the issue at hand. We all have to step outside of ourselves at times and view the situation from our adversary's point of view when trying to reach an agreement.
lealea1005
Senior Member
Not to mention years of education, including approx. 5000 hours of post grad training as a resident Physician (NPs/PAs get approx 1500) before being eligible to sit for board certification, right?
I hope mwarren's son is feeling better. Have a good rest of the weekend everyone.
I hold to my opinion. An NP or a PA who has been in practice for 15 years has far more practice hours than a new MD. And yes, I'd rather have my child seen by an MD, but if PA's or NP's don't have the potential to be just as competent in diagnosing and prescribing, then it shouldn't be lawful for them to treat patients in the same capacity.
And they don't.. NPs and PAs are not allowed to treat patients in the same capacity as an MD..while experience and years of practice should not be discounted, the training required to be a MD is at a whole different level.
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