Tuesday, July 06, 2010


One of the criticisms of health care reform is that once uninsured people gain insurance, there won't be enough doctors to serve them. So, critics warn you might have to see a -insert ominous music here - a physicians assistant (PA) or a nurse practitioner (NP).

Ahhhhh! Oh noes!!

Guess what will happen then?


You might get better care!!!!

Ahhhh! Oh, wait, what?

For non-urgent, non-surgical problems, seeing a PA or NP may get you better results. NP's are especially good at helping patients manage long term health problems like diabetes.

I see a family practice doctor for my general health needs, she is the manager of my overall health, sending me out to various specialists, but she is the one who has the entire picture. Family practice docs are a critically endangered species and I hope they can attract more new docs to the field. They have a little different mind set than most specialists, in my opinion, it is closer to the way nurses look at health, which is looking at the whole person, physical, mental and emotional, instead of whatever body part the doctor specializes in.

But within a specialists office, a PA or NP can be a huge asset. Case in point, my ortho doc. If ever I needed someone to grab a scalpel or a saw and operate on my knees, he'd be my choice. Last week, I went to his office to go over the results of the MRI to my left knee. I know he looked at the results because I heard him talking to the PA in the hall. But I saw his PA, who must be new because I'd never seen him before.

Here is how an appointment with the doc goes: How's the pain? Do you want a cortisone shot? You've got arthritis and there is nothing we can do surgically at this time to fix it.

Here is how an appointment with the PA goes: What can't you do now that you would like to do? Other than the arthritis, most of your problem is caused by the fact that over the years, the swelling has rotated your knee caps slightly out of alignment and that is causing all the lateral knee pain. You need to build up your muscle mass on the quads here, you're built like Gumby (to which I added: Dammit). He then showed me some exercises to do to build the exact muscles I need to build up, gave me a prescription for an arthritis medication since the 10 billion ibuprofen I take obviously doesn't work, gave me a cortisone shot to each knee, had an honest discussion with me about my wants (probably will be able to do a 10 mile a day hike, probably won't be able to get back to working three 12 hour shifts in a row, most definitely should not attempt to return to yoga for quite a while).

I left there finally feeling like my $50 co-pay was well spent.

So, if you have to see a PA or NP, give it a chance. You might be pleasantly surprised at the quality care you get.

Thor sez: Nice try, but I'm still putting up a fight next vet visit time.


jaz said...

Nurse practitioners are awesome. Seriously. I wish more people had a clue as to the truth of this.

Sharon said...

Heh, Thor cracks me up.

I saw a P.A. for my knee when my problem first presented (complete tear of cartilage from patella, if I haven't mentioned it before) and had less wonderful results, but it's a busy multi-doctor, multi-specialist office and he did what he could--wrapped it in an ace bandage and sent me for an MRI. I've deleted the rest of the long, sad saga, actually

But, had first Euflexxa shot last week, saw slight improvement, going back tomorrow for second shot. Glad your knee is doing better--bummer about the yoga, though. I'm hoping to get back to tai chi soon, not to mention walking.

JanetLee said...

Sharon, hopefully I'll get back to yoga at some point. Just right now, the patella isn't stable enough and it's a risk of more damage so I'll have to wait a while.

Hope your recovery goes smoothly!

Sharon said...

Thanks, Janet. I start PT on Monday, have the last shot on Tuesday. Feeling much better already, but still a ways to go. Having trouble reminding myself not to overdo things, just because the knee feels better.

Hang in there, Janet.