"Please help, thanks"

The practice of medicine (do nurse practitioners even practice medicine?) is all about rules, guidelines, and recommendations. Some of these are complex and nuanced, and some of these are just plain fucking common sense. Undoubtedly falling into the latter category is asking the Facebook peanut gallery what medication you should try next for your medically complex pediatric patient. "Add Zyprexa"? "Add a benzo"?

It's absolutely wild how casually this question is being posed, given that this poor kid is already on an SSRI, a stimulant, a centrally acting alpha-2 agonist, an atypical antipsychotic, and an antihistamine. For fuck's sake, the employees at the McDonald's drive-thru ask "Would you like fries with that"? with more gravity. And now you want to add another atypical antipsychotic and/or a benzodiazepine? "Holy fucking shit" is the best way we can describe the insanity of this clinical decision-making, let alone the fact that it's being asked on Facebook in such a cavalier fashion. This poor child needs to be seen by a fellowship-trained, board-certified child-adolescent psychiatrist with specific expertise in autism, not some midlevel nurse practitioner by the name of Munya (Munyaradzi) Rwakonda (NJ license 26NJ01436700, NY license 404751) who calls herself "Dr." because she bought obtained her "PhD in Nursing" from the highly esteemed, internationally-renowned R1 institution known as Walden University.

I don't know about you, but if I had a child with autism spectrum disorder, I certainly wouldn't be taking them to see a non-physician who got their degrees online at a "university" that is considered by many to be a bottom-of-the-barrel diploma mill with such a shitty reputation that some healthcare systems are refusing to train/hire their nurse practitioner students and graduates.

As evidenced by her own website, Ms. Rwakonda prides herself on possessing "a great sense of humor". Unfortunately, asking randos on Facebook whether or not she should start a vulnerable, mentally ill 11-year-old child on a benzodiazepine is anything but funny. And it's ironic that she believes that "mental health is as critical as managing diabetes and hypertension, requiring attentive and knowledgeable providers"; if we can't even trust a midlevel with chronic medical management on a basic level, why should we trust a midlevel with the management of (severe) mental illness?

Just as unfunny is Ms. Rwakonda's marketing of herself as an "NP in Psychiatry". As we all know, psychiatrists - i.e. physicians - i.e. someone with an MD/DO degree - practice psychiatry, not midlevel nurse practitioners. While not expressly prohibited by the state laws of New Jersey or New York, it's certainly misleading to patients for a midlevel/non-physician provider to call themselves "Dr." and claim that they are "in" a medical specialty. And need we flog a dead horse again and bring up that video of former AANP president Sophia Thomas stating that nurse practitioners practice "healthcare"? In any case, we sincerely hope that that the parents of this poor child find an actual psychiatrist who doesn't outsource their patients' medication management to Facebook. Don't get bamboozled by Zambezi NP!