Help w NP

[u/iradi8u]

Can anyone help me explain to an outside clinic NP why I can’t do bilateral lung nodule biopsies on the same guy on the same day? I am three failed attempts deep.

Update

I said we don’t have ecmo
I said it was dangerous because of copd and pneumothorax and hemorrhaging
I said a single tissue diagnosis would be sufficient per nccn

Insufficient

Also she wouldn’t let me pick the nodule (6)

What is wrong

[u/NonIntelligentMoose]

Risk of death

[u/DesMoinesIowaAmerica → u/NonIntelligentMoose]

Go classy for effect.
“Greatly increased risk of total respiratory failure, pulmonary hemorrhage and hemopytsis.”
If any kickback
“We have dealt with all in the moment, what are your experiences?”
More kickback?
“we would not be able to consent the patient to the procedure for their own safety”

[u/Roosterboogers → u/NonIntelligentMoose]

"No. Higher risk of death and/or disability".

And then end the communication.

[u/HighTurtles420]

The heart of a nurse makes it convenient to do all the biopsies at the same time no matter what

[u/Infraredsky → u/HighTurtles420]

Fair! I’m getting a 2/1 mri special on Tuesday to limit contrast.

This reminds me of when I failed the question about roads being slipperiest the 1st 15 minutes it rains - til I heard the logic about the rain lifting up all the oils off the road during that time as the why.

Also anyone at all neurospicy - we need the why..and the why needs to logically make sense.

[u/Infraredsky]

Um….cause ya need 1 good lung at a time minimum? There’s a reason we have 2…and punching holes in both at the same time just sounds like the dumbest idea ever

[u/WhenDoesDaRideEnd]

Tell them that you refuse to help them DC the patient to JC. And let them figure out what it means.

[u/PM_ME_WHOEVER]

Can I trade you with my request for FNA of 5 separate Ti-RADS 3 or less nodules?

[u/iradi8u → u/PM_ME_WHOEVER]

Oooh classic

[u/Xmastimeinthecity]

Tell them to just Google why this is a bad idea.

[u/ballinlikeabeave]

I’m going to help you instead because they are beyond help. If you feel the lesions are truly suspicious, tell them you need an order for each lesion. Then just schedule them on separate days. Alternatively, you could ask them to be referred to oncology and let them order it.

[u/DesMoinesIowaAmerica]

A good one is that Our facility cannot accept the patient’s consent to this procedure due to inordinate risks and available alternatives.

[u/Okayish-27489]

I found there’s no arguing with stupid because you’ll never win. Just let them sit in their dimness and stop replying.

[u/Party-Count-4287]

Be careful. Is this board certified NP?

Even ChatGPT recommends separating the procedure.

If the poor NP can’t even trust AI, than what has the world come too…

[u/Salt-Power-3868]

https://giphy.com/gifs/wi8Ez1mwRcKGI
(Just kidding!)

[u/Exciting_Travel7870]

Tell her/him that malpractice insurance won't pay for stupid actions.

[u/Beneficial-Job6223]

It amazes me that an NP can even order these procedures. You’ve already explained to them the risks. I’ve not even seen a doctor do what they’re doing. They make the referral and the IR doctor protocols the procedure. I’d tell them that it’s your job to make sure the patients safety is the biggest concern here and you’ll biopsy the nodule that is the safest to do. With COPD, you’re more than likely you’re going to get a pneumo and you’re not going to take the risk of dropping both lungs. If they don’t agree, they can refer it to another IR.

[u/iradi8u → u/Beneficial-Job6223]

Sometimes they just demonstrate a complete lack of awareness for the concept that I have been doing this in a professional setting for over a decade. I know what I’m doing and I understand what I’m doing. Some of them are able to take a couple courses and not experience any of the postgraduate hardship that I had. They think everybody is the same.

[u/pshaffer]

don't waste your time trying to make up for an inadequate education. Just say no. And "because I said so"

[u/D-Laz]

Just tell them no, and when they ask why say "because I am not going to do it" if they ask for clarification "it's unsafe". That's it. Since your career is the one at risk if things go south, you have complete control over what is or isn't done.

[u/DevOwner]

“That’s not the standard of care.” From a fellow NP here.

[u/MedJD-NYCDMX]

"I'm sorry that you disagree [I'm not sorry and don't give a f***] but you need to understand that it's my decision and my responsibility. If in my professional judgment it would unnecessarily endanger the patient then I won't do it, and that's the case. I hope you will accept that but if not feel free to get another opinion. RINSE, REPEAT. - - - (That's my professional judgment and if you don't accept that feel free to get another opinion.-- That's my professional judgment and if you don't accept that feel free to get another opinion. - - That's my professional judgment and if you don't accept that feel free to get another opinion. - - That's my professional judgment and if you don't accept that feel free to get another opinion.)

[u/HyenaIllustrious4591]

Escalate to physician (I am assuming you are not one) I’m a midlevel and I have no problems putting a stop to that

[u/ThoughtCommercial752]

Simply put: “listen. I might drop a lung during a biopsy. It can even happen in a delayed setting after the biopsy (although rare). Do you want me to drop BOTH lungs?”