The Cheapest Care Possible

I don't want to offend any nurses out there, especially the ones who can prescribe.

BUT, when you have as many co-morbid (proper term?) psychiatric conditions as I do, AND especially when you have as many chronic physical health conditions as I do, you really would feel most confident having a psychiatrist, an actual DOCTOR, prescribe your psych meds, since you have so many conditions and medications that can interact with each other.

Now, as I'll apparently be seeing an A.P.R.N, which is a psychiatric prescribing nurse? I'm sure that they have extra education for that, and plenty of experience since they are working for the county's behavioral health system, and see the most disabled and/or severe cases, since they only serve those with Medicaid/Medicare. Lots of people on disability with either of those insurances, so this would be where they go . . . the LCSW I saw for intake interview went out of her way to reassure me that the nurses see severe cases and are very capable (does this mean she thought I was a severe case, or just that knowing they treat severe cases all the time means they are competent to treat anyone?). I got the impression that seeing a nurse instead of a psychiatrist for meds is something alot of people aren't the happiest about.

Anyway, while I'm sure these nurses are capable in many cases, I just feel like I have so much going on both mentally and physically that I'd only be really comfortable knowing a doctor was seeing me; how can I know that these nurses know enough about all the physical health stuff besides the mental health stuff to be able to manage all the issues?

Then again, who WOULD be happy that they'd be seeing a nurse for what they've traditionally thought is a doctor's role . . . I think this is partly based on that, but still . . .

There is part of me that feels like, because this is a government-funded mental health care system, as well as government funded reimbursement for them, that this is why they use the lowest-level providers possible; I was told that they do have ONE psychiatrist, but I'm guessing he only gets sent the most complex or resistant of cases. I was told I'd be seeing a nurse.

I feel like, because I am dependent on government assistance for this, that I will be receiving a lower, cheaper (not necessesarily incompetent) level of care than I would if I had private insurance. I don't think you can argue that these nurses AREN'T less expensive than psychiatrists, which means they are cheaper (although I am not trying to imply that their care is valueless or without dedication, expertise, etc. - it costs less and is less educated than a doctor/psychiatrist, though, is all I'm saying). This makes me feel like I am a second-class citizen, but then, without regular insurance, I kinda feel that way anyway.

I'm sure if something like this was posted over at Shrink Rap, there'd be an outcry from prescribing nurses, and maybe even non-prescribing ones . . . the thing is, though, I feel that prescribing nurses should SUPPLEMENT what a doctor does, not REPLACE them, and it feels like in this case they are being used as replacements. THAT is what feels wrong to me, what feels like I am being given the least expensive care they can get away with.

I'm also annoyed at all the hoops and forms I have to jump through and deal with just to see a nurse . . . I'm sorry if that offends anyone, nurses are very valuable, but I do NOT, I definitely do NOT see them as the primary provider of the medical side of my mental health care. I do not think that is appropriate.

I'd prefer something like initially seeing a psychiatrist, or a psychiatrist with the prescribing nurse present (they'd never do that last, too expensive) for the first couple of appointments and then see the nurse the rest of the time, with maybe a twice yearly check by the psychiatrist; more often if moderate to high problems come up. THAT seems like it'd be more, well, working with both a doc and a prescribing nurse . . .

I guess this post is amounting to a big whine, that might affront a variety of nurses . . . but it's how I feel, and I don't think REPLACING psychiatrists with prescribing nurses is a good thing for mental health care. Supplementing, okay, I can work on getting used to that . . .

I'll have to get used to seeing just a nurse, I guess, but I will not be happy about it. And here I thought I'd come to a new, more open mind about my next shrink, about being more open-minded, more open to different personalities and learning whatever comes to be learned from them. Turns out, I don't get a shrink at all. I'm feeling like I, and other Medicare/Medicaid people, must not be worth it, in the eyes of the government and the people who vote in the people who fund or restrict how such places are staffed.