PRIMARY CARE PROVIDER: MD OR NP?

My husband and I moved to Raleigh four months ago. Yesterday, I went to the Farmers Market for the first time. It had opened just the week before. It was more eclectic than I imagined. Besides spring onions, sweet potatoes, a bunch of radishes, strawberries and a baguette from the stand of a local French bakery, I commissioned, for ten dollars, a cloth purse that would hang from my neck and hold my cell phone, and I got the name of a female health provider.

I was happy I didn’t buy more produce than I could reasonably cook. I love nothing more than talking with the farmers about various ways to deal with, to me, an unfamiliar vegetable only to have it sit, forgotten and rotting, in the refrigerator.

At one stall in the market, a woman was selling handmade cell phone cases along with drawstring cloth purses. At the airport on our way to Costa Rica in February, I watched an older woman pull out her cell phone from a small purse that hung about her neck. What a practical way to have a cell phone handy when you haven’t pockets in your slacks but you do have a family that worries when you don’t answer their multiple calls. Only later do they find out you couldn’t hear your cell phone left in the kitchen because you were upstairs in your office. Together, the woman and I designed a Velcro sealed pouch that will hang around my neck or over my shoulder like a handbag. I’ll pick it up next Saturday.

Next, I noted a stall with the sign: “Duke Raleigh Hospital.” Duke sponsors the market. A young woman sat at a table with stacks of brochures. My husband and I hadn’t, as yet, found local health care services.

“We live just a few blocks away from the hospital,“ I said to the woman. “Is there an outpatient clinic there? I need a new provider, preferable a female.”

The young woman smiled. “Yes, there is a clinic. In fact, I go there and see Mary Smith (not her real name). I just love her.” She continued to tell me how wonderful Mary Smith was as she searched for a pen to write down Mary Smith’s name and phone number. She handed me the card, which also had the Duke website for further information.

When I went home, I unpacked the produce, told my husband about the solution to the cell phone issue and that I had the name of a new provider. Upstairs in my office, I checked the Duke web site. I clicked the link “Doctors“ and there was Mary Smith. But she wasn’t a doctor—she was a nurse practitioner. She was listed among other NPs and physicians.

I sat for a moment appreciating the immensity of this: that NPs were listed along with MDs, therefore allowing patients to choose either as their primary provider. Knowing how some physicians still try to limit advanced nursing practice, here was a site, at a major teaching hospital yet, that treated both equally. And the young woman who gave me Mary Smith’s name never thought to clarify that Mary was an NP, not a doctor. How refreshing.

Then the reality set in. Why I didn’t think my primary provider could be an NP? Was it because I had seen a physician for the past fifteen years? However, I was a retired NP. I had my own patients, albeit in collaboration with a physician. I had been in the trenches during my long career fighting against limitation of the NP role and dominance by medical organizations. I promote the contribution that nursing makes to health care. I support the independent role of the NP.

I was appalled at my sudden amnesia.

While I try to explain this lapse, I’ll call the clinic to find out if Mary Smith is accepting new patients.