“I saw a nurse – Where’s the doctor?”

You went to see the doctor and then realized that you talked to the nurse practitioner who ordered some tests — but you never saw the doctor! What’s going on?

In some states, a nurse practitioner (NP) has the same prescribing authority as the doctor, and may even act as a patient’s primary care “doctor” — thus I wouldn’t rule this out as a case of negligence, but more a prevailing norm of healthcare in a particular geographic area.

That said, you should absolutely be comfortable with the care you are receiving. If you want to see an MD instead of an NP, that is within your right as a patient!

I’ve heard of patients complain about their doctors not scheduling enough tests to rule out possible conditions associated with their complaint, so “test ordering” may depend on the context of the appointment. Often, physicians are not financially rewarded for ordering tests (costs the insurance companies too much) when compared to prescribing a drug (cheaper for insurance companies to pay for pills than an expensive scan).

For example, I had an acquaintance whose doctor was writing prescription drugs for her diabetic elderly father without doing any blood tests or monitoring. Her father began vomiting on a regular basis, and this doctor simply switched to writing other prescription drugs without figuring out why the patient was vomiting and becoming increasingly lethargic. She took her father to another doctor, who promptly ordered a series of tests to look at what was happening, and determined that the vomiting was mostly likely a serious adverse reaction to one of the diabetes medication. This doctor used the results of the tests to make a more informed clinical decision on which drug may keep the patient’s diabetes under control while minimizing the side effects that would prevent the patient from taking the drug regularly to keep symptoms at bay.

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