Accomodating Multiple Physicians
There are six different physicians in my practice and thus,
six different philosophical approaches to disease treatment and management. As
a new NP, this can be somewhat frustrating. Some days I wish medicine and
nursing were a bit more algorithmic. But alas, it ain't like baking a cake, so
here's to finding the silver lining.
Six different approaches offer a dynamic and heterogeneous
tutorial of practice styles that I have been trying to incorporate into my
clinical repertoire, cafeteria style. Some physicians are reticent to fully
discharge their patients upon completion of their antibiotic therapy, others
have zero tolerance for managing long term IV antibiotics in drug addicts, some
feel very confident managing infections in an outpatient setting, while others
prefer to see the patient admitted to the hospital for initial treatment.
Some are interested in the patient's comorbidities, others
less so. Some docs prefer oral antifungals to topical antifungal treatment. Some
will continue to prescribe oral antibiotics upon completion of IV antibiotic
therapy until the wound is closed, others will discontinue drug therapy with
the completion of IV antibiotic therapy.
Of course all of these approaches are predicated on
scholastic studies, so it's not like random hocus pocus, but its tough to wade
through the literature and determine what approach constitutes best practice.
While I sometimes imagine the physicians assume I know more than I do (or
prefer that I know more than I do) I feel completely comfortable asking for
advice or discussing a patient with any of them -- better safe than sorry.
Of course the trick is doing
this in a timely fashion and that part is still a bit anxiety-provoking. I want
the patients to like me and trust in my judgment but also not feel as though an
appointment with me will automatically double their time in the office. I
suppose this comes with experience, but for now I am content to continuously
study the approach of others and incorporate accordingly.