I was officially a part of the team. My doctor was so busy, he had his own nurse practitioner. She was awesome and very nice, very thorough as I have found most Nurse Practitioners to be. I also had to room for her some days. My doctor was always just wanting to get them in and straight out. He was very social with his patient's , made them feel like they were his best friend. He would give them whatever they wanted. There were even some that were nurses themselves. Prior to Hydrocodone practically being outlawed, my doctor did prescribe this to alot of his chronic pain patient's. The DEA had just started the crackdown. At this particular time, hydrocodone was not written on a triplicate yet. However, office visits had to be made prior to writing a script for them. Well, this wasn't happening just yet, because he didn't have a consistent M.A. 

Well, this patient, a nurse or RN, requested a script to be called in. I'm looking at her chart and see that she hasn't had a visit in over 6 months. She had been getting her narcotics, though. So what I do is tell her we can only send in a week, but, I will find a place for you to see the dr before you run out. She quickly ripped me a new one, then proceeds to tell me that she knows how the office works because she is a nurse. Basically, I didn't know squat. But, I just said, your right I am just a M.A. , you are a nurse so you SHOULD know that the doctor can get into trouble if he continues to ok your narcotics? I was as professional as any person could be about it. I just hit her with her own facts. She realized that and then she let up on the attitude quite a bit. She just said, ok, when can you get me in with the utmost disgust in her voice. I mean, I was new, but, I felt that if I'm going to be the go to person, we have to implement these rules, boundaries, etc. He had so many patients, each patient had at least 10 prescriptions on their list. He was an internist so he would see all adult chronic conditions, acute, you name it. I would have to refill at bare minimum, 5 prescriptions per patient that came in. With that came the 90 day rx's they would want sent to this pharmacy, then a 30 day at the local pharmacy for 1 prescription. Most wanted the paper prescription to take with them. And the majority had to have labs prior to leaving so the orders had to be added to the lab system after the dr added them to ours. So, I'd fill and print the rx's, then put the lab orders in. Sometimes, I'd forget and the patient would be waiting at the lab. Great idea, was just hard to work into the flow when your doc didn't like putting orders in.

I learned so much! For anyone that is new and wants a good foundation of knowledge to begin with, go to Internal Medicine! Everything I learned there, I used at some point in other clinics, because, when you are in a specialty you only learn the specialty. I learned all basic medications for all basic diseases, the small things that increase your liver enzymes to the statins that cause leg cramps. And the coQ10 you can take to get rid of the leg cramps. 

I learned how to perform INR check, normal and abnormal readings, how to adjust the warfarin. Diabetic check ups prick the finger for a drop of blood, have them take their shoes off for a full check, refer them to an optometrist for an eye exam. For allergies, colds, flare ups....depomedrol injections. I learned how to give a ztrack for the super potent injectable antibiotics. I gave testosterone injections to men with hypogonadism. I learned how to do ear lavages, order home infusions for patients with staph in the urine, gave breathing treatments to copd patients. I learned how to do surgical clearances, physicals with EKG's. I learned how to fill out home health paperwork, FMLA paperwork, send prescriptions to rehab facilities where my doctor did rounds. Everything was learned so fast I almost felt like I was a crash test dummy. After 2 days, I was on my own. I learned quickly how to take a patients history. I didn't even have to have my laptop, just a piece of paper. I had it memorized: Chief Complaint- Why are you here. Allergies? Past surgeries...past medical history, current medications, prior pcp, what are your symptoms, when did they start, have you taken anything for the symptoms, any fever, nausea or vomiting. My doctor even did prostate checks on men when they came in for their physical's. But the women.... NOPE... he did not, would not do a papsmear. There was no discussion, he was super adamite that he was not going to do them. He had no problem telling the office manager what he would and would not do. On the worse days, he would stop and come sit next to me and vent. He did not like drug reps at all, especially if they lingered during clinic. He would only speak to them if they brought him a smoothie. So one did, and she brought them twice a week for both of us. The reps brought an abundance of samples. I did give as many as I could, especially to those on a fixed income.  The doctor seemed to have found someone he could count on, so he decided to keep me. My office manager said my calm personality kept him calm. He was very high strung, you could tell he was ready to retire. His mind always seemed to be elsewhere, ready to go. I wouldn't let him go until he had half of his papers signed though. Boy did he have papers to sign.    TBC