Originally posted on Reddit

Disclaimer: My school takes Step 1 in January (18 months into med school instead of typical 24 months) so I've been in the hospital/clinic for only a couple of months. I'm only finishing my second year so I feel like I still have so much to learn in the next two years so feel free to correct me if these aren't noteworthy. I just worry about all of the things I'm not noticing.

EDIT: I've also seen PAs/NPs that are badass, 20+ years of critical care/surgery, and are amazing teachers. A lot actually take time to teach medical students so I'm not trying to generalize everyone - just noting specific anecdotes.

⁃ ED PA continued all home meds including Eliquis and Aspirin for a 92 year old admitted for a GI bleed and a Hgb of 6.8.

⁃ FM PA said they couldn’t work-up a possible Parkinson pt because “we dont have neurologist here” and ignored a pill-rolling tremor in 53 year old man.

⁃ ED PA gave a 1 liter bolus to a lady in for CHF exacerbation (12 lbs up from last week and 128 sodium) because “nursing had trouble starting IV” (BNP was 26,000 on AM rounds).

⁃ ED PA “Everyone knows that CT scans dont help with diagnosing cancer. Its always so blurry and you dont even know what you’re looking at”

⁃ 2 PA students on hospitalist service (graduating this spring) arguing about a pt’s cancer diagnosis “just because the cancer moved to another organ doesn’t mean it’s malignant. We’ll wait for pathology”

⁃ FM NP giving amoxicillin to an 11 year old that tested negative for strep (sore throat/runny nose for 2 days)

⁃ IM NP never correcting patients when they say “Dr. _____” to her while on rotations.

⁃ PA in the ED putting an admission order for metoprolol to 90 year old CHF with underlying bradycardia (42bpm)

⁃ Peds NP testing a 12 month old for strep. Sent home with amoxicillin before test came back (was negative).

⁃ We consulted cardio from outpatient clinic on a Friday for a patient in clear heart block. NP answers and says the symptomatic pt with HR of 36 can set up an appt after weekend. FM doc says “absolutely not. check with the doctor” so she checks with the cardio fellow. Comes back to phone “actually have them come to ED now” and patient had pacemaker that night.

⁃ PA in the ED told me “You shouldn’t have to know first lines or drug dosages. They are all on google anyways” (EDIT: which I do kind of agree but that shouldn't be the status quo in the ED).

⁃ PA in psych spends 12 min telemedicine visit with 11 year old kid for inattention, started them on Strattera, Lexapro, and Atarax.

⁃ Our psych patient started a new med, went to ED for mild nausea and vomiting the next day (no fever no pain - likely GI upset from meds), the NP in the ED orders abdominal and chest X-ray, head CT, UA, CBC, and a stool assay. Patients ROS was just nausea and vomiting. No headache or cough. Patient discharged home and then said bill was over 5000$.

⁃ NP student “shadowed” in the FM clinic for 6 hours. Spent 5 hours on her phone. Saw 1 patient. Bragged about how her preceptor doesn’t force her to do a lot of clinic work. When asked, she says she wants to be in family med.

⁃ Family med NP diagnoses ADHD over the phone with a patient. Started on Strattera and consulted psych for med management.

⁃ Family med NP sending Epic messages to random psych docs asking what they think she should do for treating a patient’s depression - without any consults. Same NP has made posts in facebook groups asking for help on treatments.

⁃ Surgery NP looking patients up on facebook saying “oh they are a Trump supporter yuck”

⁃ Family med NP treating cogwheel rigidity and pill rolling tremor (in a man with family hx of PD) with propranolol for 6 months until family finally called for neuro consult once patient was "forgetful" . Textbook Parkinson’s case.

⁃ Surgery NP orders CXR on a patient in clear respiratory distress. 2 med students look and notice a pneumothorax, NP says “we don’t know that cuz radiology hasn’t read it yet”. Radiology called 2 minutes later.

⁃ Obgyn NP says she performs surgery and “should be allowed to do her own csections”- but only held the retractor for all 3 cases that day.

⁃ Surgical NP refuse to let med students close because “that’s not your job”.

⁃ Surgical NP asks if residents still want to prescribe Lasix with patient’s Cr being “so low” at 0.44 cuz “kidneys are clearly damaged”.

⁃ Acute Care PA orders chest and abdominal XRay for a patient with diarrhea. Indication was “possible bowel obstruction”.

⁃ Same PA as above sends patient home with Zofran, Reglan, Colace, Protonix, famotidine, GasX, Miralax, and Keflex for UTI but patient had clean UA.

⁃ Vascular surgery NP teaching an NP student that “Flomax is a diuretic to help older guys pee” (EDIT: I noted this because it made me worried that it was mentioned with Lasix - very different).

⁃ Surgical NP telling a new hire NP (who shadows for ~1 month) that the surgeon will be putting a line into the patient’s internal jugular and the new-hire (graduated NP) responds “is that an artery or vein?”

⁃ Surgery NP wanting to have the NP student (who is shadowing her) scrub in instead of the 3rd year med student on surgical rotation.

⁃ Surgery NP tells residents the patient’s UA was “clean” because “there’s no bacteria” but everything else was positive (leukocyte esterase, nitrites, RBC, and WBCs).

Does anyone else feel like this is a huge issue? My preceptors (most are like 60 years old) don't really care.