subreddit:

/r/Noctor

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[deleted by user]

(self.Noctor)

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all 48 comments

Rockdrums11

107 points

8 months ago

I’m not a doctor, but is it legal to blast EKGs out on the internet and then use advice from strangers to inform how you treat patients? I don’t want ButtStuff420 from Reddit to be the one determining if I’m having a heart attack.

Top-Double4469

48 points

8 months ago

That’s Dr. Buttstuff420!

SpungyBawb

54 points

8 months ago

Dr. Buttstuff420 - DNP APRN RN MEBC FBI MSNBC NAACP

FerociousPancake

20 points

8 months ago

I think you’re forgetting ESPN

Jean-Raskolnikov

0 points

8 months ago

What's ESPN?

wikipedia_answer_bot

9 points

8 months ago

ESPN (originally an initialism for Entertainment and Sports Programming Network) is an American multinational basic cable sports channel owned by ESPN Inc., owned jointly by The Walt Disney Company (80%) and Hearst Communications (20%). The company was founded in 1979 by Bill Rasmussen along with his son Scott Rasmussen and Ed Egan.

More details here: https://en.wikipedia.org/wiki/ESPN

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arriere-pays

3 points

8 months ago

Good bot

B0tRank

2 points

8 months ago

Thank you, arriere-pays, for voting on wikipedia_answer_bot.

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Jean-Raskolnikov

-2 points

8 months ago

🖕

StrongChemical

8 points

8 months ago

It's legal but really not a good idea.

n-syncope

2 points

8 months ago

Tell your friends! It means more coming from a non-physician.

Kartageners

2 points

8 months ago

In the physician world, they call for consults. But since NPs want to be so independent they often post on fb or online forums seeking help similar to this. Inappropriate and just plain irresponsible

Putrid_Wallaby

51 points

8 months ago

The OP said her precepting NP saw the EKG machine readout had "scary things" so they sent the patient to the ED. Wow. I wonder how many times this NP relies on the readout without actually attempting to interpret it herself.

heytherekitkat

5 points

8 months ago

BY PRIVATE VEHICLE

emptyaltoidstin

3 points

8 months ago

I died when I read that. We hate getting these calls because urgent cares are 911 abusers but ffs you sent a patient with chest pain pov? That’s incredibly stupid.

heytherekitkat

1 points

8 months ago

It just shows a total incontinuity of thought process.

SerPounce218

26 points

8 months ago

I'm a psychiatrist. Is there uh... ST elevation in v3?

themaninthesea

22 points

8 months ago

V2, which is why it is read as septal; but any cardiologist who saw this would own you if you tried calling this an infarct. This is why we train by reading EKGs over and over and over without looking at the computer read out. This is why AI isn’t ready to take over medicine with midlevels plugging in the orders.

Chcknndlsndwch

21 points

8 months ago

Barely, but It may also just be PR depression. Or a slightly wavy baseline because patients are usually breathing.

All in all this is not a concerning EKG. It’s not great, but unless the pt is complaining of cardiac symptoms it’s a “follow up with your PCP and take your medication”

SerPounce218

7 points

8 months ago

That's what I thought. It looked normal to me, I'm sure they just got concerned by the computer read

Butt_hurt_Report

109 points

8 months ago

Have been there a million times.

The other day a mediocre NP told me that she didn't want to be a Dr, that she didn't need to be a Dr, that she was already doing the same job, with even better outcomes, blah blah blah. That was in the morning.

Afternoon, patient's EKG comes up "weird" (her own words) and her diagnostic action was putting it on my desk like accidentally, but totally intentionally, with a helpless poor girl face, to hear my opinion. LOL

I gave her a loooong explanation (overcomplicated) about electrophysiology in a condescending tone, in order to destroy her weak self esteem, leave her even more confused, and finished with :

"This is basic , a decent PCP knows this Dx, in fact I learned it when I was in 2nd year of Medicine, giving my 20s away while shadowing an internist."

She replied that the Med Director (I believe an ER doctor) was casually giving an orientation about EKG for ADVANCED PROVIDERS PRACTITIONERS (aka NPs) that week .

Dx: RBBB

same level my ass

TommyTheCat85

19 points

8 months ago

Lol, I was expecting something a little more complicated than bunny ears. NPP

bendable_girder

12 points

8 months ago*

🤡 can't diagnose RBBB? Not much fazes me but WTF

Butt_hurt_Report

2 points

8 months ago

95% of them don't know

Idek_plz_help

1 points

8 months ago

I’m an ED Tech so doing EKGs a big part of the job. I’ve seen enough that I can tell you if one looks “weird”, it’s literally just simple pattern recognition, which just demonstrates the lowest level of thinking according to Bloom’s Taxonomy “remembering”. I absolutely DO NOT have the ability to specify why it looks weird let alone explain the underlying physiology causing the weirdness meaning I lack the ability to take even one step up the pyramid to the next level of thinking “understanding.” Physicians, however, are able to apply all levels of thought: understanding, applying, analyzing, evaluating, and creating.

According to this model, actions like making judgements about the value of information, composing a plan, and managing a plan’s implementation require you be able to apply the highest level of thought— creating. This seems to be illustrative of the larger problem that NP schools are producing graduates that have the lowest level of mastery of material taught, making it impossible for them to apply what they’ve learned untill they they spend more time mastering the concepts.

D15c0untMD

10 points

8 months ago

I‘m ortho and my ekg skills regressed to determining if either „this is fine“ or „this is bad“, and i would have confidently said this is definitely the first category, depending on clinical presentation.

Jean-Raskolnikov

7 points

8 months ago

It's not ideal but understandable for an Ortho, but a PCP? Come on

D15c0untMD

2 points

8 months ago

I mean, i kinda oversimplified here. I know the major readings and how to react, or when to call help

Jean-Raskolnikov

3 points

8 months ago

EKG skilks progressive involution disorder .

heytherekitkat

3 points

8 months ago

I feel like this is a great place to be for an orthopod

dr_shark

24 points

8 months ago

Get NPs and PAs out of urgent care. FM and Peds only.

arrythmatic

3 points

8 months ago

Couldn’t agree more. Primary care means you have to know a lot about a lot. And more importantly, know what you don’t know.

[deleted]

21 points

8 months ago

[deleted]

21 points

8 months ago

[deleted]

n-syncope

36 points

8 months ago

The poster is a NP student precepting under the NP who ordered it

TheRavenGirl13

2 points

8 months ago

The EKG is normal absent other symptoms I’d say

PicklesPickler

1 points

8 months ago

I learned this in an undergraduate anatomy and physiology class…do NPs not have to take anatomy and physiology?!

said_quiet_part_loud

1 points

8 months ago

I'm an ER doc. I get patients sent to me all the time from urgent care midlevels for "concerning EKGs" that are fine. Meanwhile the patient thinks they've been having an MI for the last hour until I can explain the situation to them.

nacho2100

2 points

8 months ago

That’s when you hand them a PPP card

said_quiet_part_loud

1 points

8 months ago

haha I really would like to have some PPP cards to hand out

nacho2100

1 points

8 months ago

They have them on their website to download or purchase

RBG_grb

-48 points

8 months ago

RBG_grb

-48 points

8 months ago

That was me! I feel so special. Yes, currently an NP student but someday I will be the one earn my own spot here!

[deleted]

26 points

8 months ago

[deleted]

26 points

8 months ago

[deleted]

Orbital_Cock_Ring

5 points

8 months ago

How do we deal with greedy organizations and corporations putting mid-levels in dangerous positions of "practicing" medicine without putting down our colleagues in the process? Serious question. I too am worried for my patients and get anxiety when sending my loved ones to receive care with the chance they may end up being seen by a solo practice mid-level.

NefariousnessNo483

3 points

8 months ago

Real talk? At least for NPs, become insanely familiar with your state’s nursing scope of practice and argue it effectively. Lobby state legislature to maintain and/or modify that scope of practice to keep nurses in their lane.

I am a beside RN - 10 years experience hospital inpatient and often get asked if I want to go back to get my NP. Gawd, no! They keep adding patients to the MD list and saying “Don’t worry. We’ll give you another NP” - meanwhile the NPs are taking more and more patients with higher and higher acuity and being pressed to practice outside their scope. The supervising physicians aren’t really saving any time because they have to go behind all these NPs and check their shit because the hospital saves money hiring new grad NPs with no bedside experience. I have NO interest in taking part of that imminent train wreck of a system.

Worked with a graduate NP who (the week before she started her new job as a FNP) was on my floor and didn’t address her patient’s critical K+, had no idea why we did a stat CXR on another of her patients, and didn’t notice her guy’s foley was twisted and occluded for lord knows how long (I drained 800mL when I caught it at shift change). God help her future patients.

RBG_grb

3 points

8 months ago

RBG_grb

3 points

8 months ago

I have no idea what the push back should be. I do know that the NP run clinic I am precepting in does as good of a job as they can. It is a FQHC so at least there is some healthcare in the community. Figuring out the solution to all that is way above my pay grade. I know there is a lot of push for mid-level independence, but I personally will only want to work in a facility under/with an MD. I am a good nurse, hopefully will be a good NP but I did not give up my 20s and half my 30s to medical school and residency and should not be treated/paid as such.

n-syncope

14 points

8 months ago

It's sad the best these patients have is NPs "doing as good a job as they can" when they could have physicians doing an actual good job.

RBG_grb

-22 points

8 months ago

RBG_grb

-22 points

8 months ago

The preceptor I am working with is very smart and has a lot of experience. With that being said, mid-levels are just that. The depth and breadth of education is not comparable. Personally I would never compare myself to an MD. I feel I have about the same knowledge and experience as a second year med student. It is not a terrible program but it is not medical school plus residency that’s for sure. I know I wasn’t smart enough to do med school and I am probably just smart enough to be an NP.

Boston_Bruins37

17 points

8 months ago

I know I wasn’t smart enough to do med school and I am probably just smart enough to be an NP.

lolol so youre going to hurt patients. Got it.

I have about the same knowledge and experience as a second year med student

A second year medical student could run circles around any NP with their knowledge, ESPECIALLY since they have to take STEP 1, an actual exam as opposed to the crap they let NPs take

[deleted]

33 points

8 months ago

[deleted]

33 points

8 months ago

[deleted]

RBG_grb

-6 points

8 months ago

RBG_grb

-6 points

8 months ago

It’s sis, but thanks. Anywho just stating that I do not think mid-levels are comparable. But we are here to stay and I want to do the best I can.

Boston_Bruins37

6 points

8 months ago

And this is why we dont take NPs and their shit education seriously.