The Customer is NEVER Right - A Nurse Practitioner's Perspective
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In a previous blog before going on the book tour, I mentioned that critics might speculate that after a patient complaint I might yield to others in order to avoid another complaint and although that might sound like the best idea in order to keep one’s job I will tell you that I will not compromise my integrity for a job. Having said that, and without boasting, I saw the following three patients consecutively.
A chemical hair burn telling me what to prescribe, not to mention the patient had multiple past events of the same yet for this episode had not sought medical attention for two weeks before coming to the emergency department and was not receptive to avoid recurring events.
A patient with chronic back pain for two week, yet she had not sought medical attention before I saw her and she wanted Tramadol, the only thing that works only to storm out of the room after I said, “No.” Not surprisingly, after the patient left I was closing her electronic medical record and I noticed the patient had excluded from her history of present illness that she had been to the emergency department two other times that month for the same back pain and was prescribed Tramadol both times.
The third patient, also with back pain but for ten days, yet she never sought medical attention before coming to the emergency department and saying she needed “something stronger” than ibuprofen. And although I asked her to pick her emergency, she also added she continued with vaginal discharge after seeing her primary care provider who treated her for a vaginal yeast infection and for Chlamydia and Gonorrhea before getting the negative results. The patient denied she had a pelvic examination, although a book anecdote included a patient who did not recall a pelvic exam was not done either, but for this patient how were the Chlamydia and Gonorrhea cultures obtained. However, there was no evidence a wet prep was done to rule out other differential diagnoses. Regardless, rather than follow up with her primary care provider the patient came to the emergency department, because of why? I have no idea as she instead the vaginal discharge and the back pain were not related.
Nonetheless, I thought I would do the pelvic exam and collect a wet mount but at that rural emergency department unless that pelvic exam was emergent the policy was the patient could follow up with the Woman’s clinic the next day. Vaginal discharge not being an emergent medical condition, however I was willing to do it, but when I told the patient she could follow up the next day at the Woman’s clinic she too stormed out of the room, without any disability I may add, making a comment I did not appreciate, “I cannot get anything done because they are all prejudice.”
Especially since I could not decipher the last patient was going to complain or if the following patient would complain or if the next one will. At times I just want to throw up my hands and walk out but it’s just a thought, not a choice.
It did not help the next two visits were family plans or visits of convenience as I call them. The first one was a child with fever the night I saw her and the convenience patient was the child’s teenage sibling for a headache since the day before that kept her out of school that day. At the end of the visit the parent requested a note for school and I wrote one to be off the following day I could only justify that it was almost midnight and the teenager would be sleeping in class and rather than argue there was no reason why the teenager could not go to school the next day I wrote the note. Of course the parent was not content that I did not and would not include the day before on the school note. By the way, neither child was given anything for the reason they were brought into the emergency department, the child for fever and the teenager for her headache of two days. On top of that, the emergency department included a walk-in pediatric clinic that was available until 9pm, yet neither child was seen there but coming to the emergency department two hours after the pediatric clinic was closed.
The next pair of patients was a mother and child. I usually ask who is the sickest but in this case either appeared sick so then I ask to see the youngest first, as was the case in the above family plan too as neither was sick. For this family plan the youngest being the child who injured his dominant hand the day before and the parent had not sought medical attention until her wisdom tooth extraction began to hurt the day she came in to the emergency department.
I do not mind seeing these patients but it does bother me I cannot tell them they could be seen at more appropriate clinics without their feathers getting all ruffed. Regardless if President Bush (#43) suggested going to the emergency department for medical care. Something else that infuriates me is when I ask parents, “Did you give them anything for pain or fever?” they say no. Yet here was a parent seeking comfort for her tooth extraction pain because the ibuprofen she took was not working yet she had not given the child anything for his pain. By the way, although there was no way of the parent knowing, the child had a fractured hand but regardless the parent brought the child in for pain and reason enough to have given him something for his pain.
When I say to parents, “So your child has a headache for two day...fever all day...hand pain for two day...and you did not give them anything for it...” they get upset. Not because you are looking out for their child but because they think you are passing judgment on them, the parent. I really do not care what the parent thinks because obviously they did not think about their child as I thought about their child so why are they judging me. Does that make sense?
The same goes for adults, “So you have had this pain or fever for x number of days and have not taken anything for it? Let me get you something for pain (or fever) then.” Then usually they get upset because I got them something for pain or fever, the reason they came in, but I declined the need for the x-rays or other test they thought they needed. It’s CRAZY!


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