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Can a first year med student legally treat patients without direct Dr. oversight?


DwayneEMTP

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Thanks Kate...

Yeah, I'm pretty pissed off now, so will be following this up to the highest levels that I'm able...

I truly expected, after all was explained, that they would say, "Ooops, sorry, we dropped the ball that day." But I'm a complete believer that mistakes will be made, and should be forgiven if those that make them are honest about them. Now that I know that they will try and cover their behavior with lies I can't really let it rest. Plus, I've kind of been aching for a fight, so this gives me one that I can feel pretty good about...

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Keep us updated as it goes on. You should see if someone else can go in there with a recorder of some sort and record the interactions. You could also look into filing a complaint with CMS. The govt loves to take our money, but it hates to have money taken away.

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Ok, after giving this some half assed thought, I've decided to expound...

When I went to the doctor, it wasn't only for the transient runs of tachycardia, but also, transient, at rest, 6/10 chest pain from sternum radiating to my left arm, upper back, and up into my jaw, though without any other commonly associated MI symptoms. I'd had the issues off and on for maybe 6 months, 30 seconds to 2 minutes per episode, maybe once or twice a month or so. But they'd been increasing to a couple of episodes per day, at rest. That's what had me the most freaked out previous to returning to the jungle and being away from care.

I was embarassed to admit to taking Cialis, so didn't mention it in my initial post, (though I did to the doctors involved), but finally decided, screw it, I'm not a kid any more, not home that often, my libido still thinks I'm 20 despite the Little Commander insisting on fair work practices...so....there you have it. It's not like I've no bared my soul her a hundred times before...

The reason that I was looking for a physician level assessment was that though those symptoms are scary when combined in a 50 year old male, I wasn't convinced that they were really linked symptoms. But if they were, I didn't want to come back to work without them being resolved. I wanted someone that would weed through it with me. That's why when the doc didn't come into the room that I didn't insist on seeing him. I wanted a doc that would be interested enough to root the issues out instead of going with the first, simplest answer. I was confident that a doctor that I had to force to see me wouldn't be terribly motivated to spend any time looking for zebras. And zebras were the issue, though not rare zebras...like, looking for the zebra at the zoo maybe...like that.

As I don't have insurance, I chose a walk in clinic instead, hoping to get lucky. The first clinic that I went to had PAs (Physician Assistants) on duty so I politely explained that I'd like to see a physician instead and they referred me to the clinic mentioned here. At the next clinic I made it clear that I needed to speak with a physician, and they said that they only had a physician on duty, so that was no problem.

After leaving the clinic pissed off I went the next day to my PCP who fit me in because I was getting ready to leave the country.

My PCP was unsure about the chest pain, ECG was clear, so decided to trial Prilosec (I think) for a month for acid reflux despite my not having common heartburn and such. I had no confidence in this plan, but it turns out that it completely resolved the chest pain/radiating pain issues. Exactly the reason that I wanted a doctors advice instead of continuing to follow my own.Thank goodness too, as they were scaring the hell out of me.

During her actual assessment we both felt that a logical place to start looking or tachycardia issues was with the Cialis. I assured her that I was careful to monitor it, and didn't really use it as often, or at anywhere near the commonly acceptable maximum dosages and had had no issues with it for year and a half or so that I'd been taking it. So she started walking down the list of relative and absolute contraindications and we came across grapefruit juice..that I'd started to drink periodically only recently. It seemed that the issues began with the grapefruit juice, in general, to the best of my memory. I've stopped drinking it and have had no further episodes.(You can Google grapefruit juice and Cialis if you're interested.)

At the clinic, no heart sounds, no lung sounds, no touching of any kind really except for the tech that took my blood pressure and the chick that did my ECG. Logic seemed to be, "Ahh...tachycardia, ED issues, stressful job, handicapped child= anxiety. " No physical assessment necessary with such an obvious problem. What about the chest pain? "It's probably associated with the anxiety."

PCP's logic seemed to be, "50 y/o male, stressful job, transient runs of tachycardia...I think he might be going to die, so lets do a full assessment and see if I can prove me wrong." Full assessment, ECG, 20 minute long discussion of history, differential, trial interventions to validate differential (while trying to stay within my non insurance budget.), issues resolved, provably so.

I guess that this is why I'm so pissed off, and really disappointed in the original clinics treatment. A 50 year old male with the above symptoms should have been taken pretty seriously, yet they didn't even do an EMT B level assessment, being satisfied with the medical student's diagnosis of anxiety issues. It's not just that I didn't get anything that I'd asked/paid for, but that it was really, really bad medicine. I've never worked for a company that I don't believe would have fired me on this one case alone if I'd done such an assessment on such a patient...

Anyway...This is my first access to a computer in ove two weeks so I'm kind of ranting, but I thought some of you might find the above interesting and I wanted to add it for those of you that were kind enough to give me your time and opinions...

Have a great day all!

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What is CMS?

The Center for Medicare/Medicaid Services. They are the ones that pay the bills and I'm sure you are not the first person this has been done to. They come down pretty severe on billing fraud.

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Thanks for baring your soul to the world.

Like it or not you are getting older and fit into the bracket of having possible issues in multiple places.

We are not 20 year olds any longer. [i can't even remember that far back in life ] Get used to the fact Dwayne. Be wiser and use your brain instead of your brawn.

Be safe

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