(01-07-2014 04:19 AM)DeepBreathing Wrote:
(01-07-2014 03:55 AM)me50 Wrote: In the US, a nurse practictioner can prescribe medication and a physician's assistant can prescribe some medication as long as it has the name of the supervising physician and there are some medication they cannot prescribe except in an emergency
The issue here is the particular drug. In Australia, the government subsidises the great majority of prescription drugs, and negotiates with the drug companies to get the best possible price (though sometimes they fail to get a good deal - it's a case of bureaucrats trying to negotiate with Big Pharma). Some specialist drugs attract a much higher than normal price and consequently may only be prescribed by specialist medical practitioners or with prior authority from the PBS. Other drugs may be more strictly regulated because they are subject to abuse (eg strong opiates).
In the case of modafinil it must be prescribed by a sleep physician or neurologist in the first instance, with follow-up prescriptions by the patient's normal GP.
Here in Australian cities there's normally not too much problem seeing a GP when you need to, so nurse practitioners and doctor's assistants don't come into the picture as much as they seem to in the US. In regional and outback areas, however, there is a real shortage of doctors - communities are generally too small to retain them.
Some, and I emphasize SOME, doctors in the US have physician assistants and nurse practitioners and insist the patients see them after the initial visit with the doctor. Some doctors in the US have a wait to get in of 2 or 3 months, some longer, so they have alternatives in place just in case. Most doctors, you can get in within a week or two and most doctors set aside a certain amount of appointment times daily for those that need to be seen that day but are not serious enough to go to the ER.
It is a crazy system now and with insurance companies paying the doctors less and less, the doctors have to see more patients to compensate so appointments are done faster and you usually only see the doctor for a few minutes after giving the medical assistant all the information as to why you are there.
Medical assistants aren't always of stellar quality and you can bring in all of your medication, including over the counter that you take and I have seen them say, I don't care about these over the counters. Well, that is a huge mistake b/c a lot of prescription meds and OTCs will interact with one another. And nurse practitioners, doctors and physician assistants count on the medical assistants to document everything the patient takes.
Recently, I saw an NP for test results and she missed the fact that I was prescribed a beta blocker and that beta blocker was prescribed by her office. And, a lot of times, you may have a question and call for the NP, PA or doctor to answer the question and more often than not, the medical assistant takes it upon themselves to answer the question. I caught a medical assistant doing this with me.
So, it is up to us to watch this stuff and ask for clarification. A lot of times, it will make a doctor's office staff irritated when a patient does this. If I felt comfortable that a medical assistant could answer medical questions, I wouldn't need to pay a doctor to see me (FYI, I don't feel comfortable with medical assistants giving medical advice at all). A medical assistant should note the question, ask the doctor when the doctor is NOT in between patients unless it is urgently needed, and write down what the doctor says. I recently asked a specific question about a medication I take, the medical assistant called back and said the doctor encourages you to take this medication. That didn't answer the question I had asked.
Listening skills are pretty important in the medical field but that is getting to be out of the ordinary since medical personnel work faster to get through patients in order to make the money they need or desire to sustain the business and their lifestyle. It is a rare commodity in today's world to find a doctor that is a doctor for all the right reasons. Dr. Ben Carson is one of those in my opinion.
Off my soap box now. Anyway, the point is that I was trying to make is that psychiatrists in the US are not the only medical people that can prescribe medication.