Specialist referrals and impatient patients - vent

Nurse Ratched, RN · Apr 28, 2003

Pt called today having been seen (at her request) by three providers in our office last week for a flat non-painful red rash to her face. The proceeded to go to ED when she didn't get the answer she wanted (finally did take meds from the ED when they offered her the same stuff we did .) No swelling, no airway blockage, etc., nothing major except her vanity - probably just a viral thing. She's got her undies in a bunch. Wants to be seen by a derm TODAY. Told her we'd make a referral but I couldn't guarantee an appt today and was quite sure it would be two weeks down the line or more. Sure enough mid-May is as early as she could get in as a new patient with a non-emergent problem (granted, I can get someone in who truly needs to be seen today, but I'm not a fan of using up my chips on people who are merely short-term aesthetically challenged.)

Also invited her to call at-home derm to see if she could be seen any sooner and I would send the referral letter. I think she'll find out that things aren't much different in "the big city."

**canoehead, BSN, RN** · Apr 29, 2003

Good work, if she can do better somewhere else more power to her.

**canoehead, BSN, RN** · Apr 29, 2003

Good work, if she can do better somewhere else more power to her.

Vailgang · May 4, 2003

I work for two neurosurgeons and I wish all nurses were as good as you. I personally know what it is like to experience back pain as I have a herniated disc in my back so don't think I am unsympathetic. Recently we had an office call wanting us to see a patient in the next 24 hours. Surgeons are not in the office everyday like family practice doctors and we are very booked. When I asked why the patient had to be seen so soon it was because the patient is in alot of pain. So all of our patients hurt. Many times the patient won't even have an MRI for my surgeons to look at and they want the patient seen right now. Thank you for letting me vent. I understand completely from the speciality side.

OzNurse69 · May 5, 2003

Just like to add my 2c worth from a pt's point of view.....I was diagnosed with melanoma after a biopsy a few weeks ago.....got the histo results 5pm Friday night.....was in with the surgeon 1pm Monday afternoon.....& in OT having a further excision 10am Thursday. So I for one appreciate what you surgery nurses do to fit in those of us with genuine need.....will never whinge about ringing a Dr's rooms again, PROMISE!!!

gwenith, BSN, RN · May 5, 2003

Take heart those with the loadest voices are just trying to get squeaky wheel attention.

Nurse Ratched, RN · May 5, 2003

Originally posted by OzNurse69
Just like to add my 2c worth from a pt's point of view.....I was diagnosed with melanoma after a biopsy a few weeks ago.....got the histo results 5pm Friday night.....was in with the surgeon 1pm Monday afternoon.....& in OT having a further excision 10am Thursday. So I for one appreciate what you surgery nurses do to fit in those of us with genuine need.....will never whinge about ringing a Dr's rooms again, PROMISE!!!

Perfect example of the legitimate emergencies that may suffer when we office nurses cry wolf. I explained to the patient that I would not present her case as an emergency to get her in that day, as when the next REAL emergency walked in the door, my credibility was shot.

Glad they got you in so fast, Oznurse. I have never had a problem getting someone in when they truly needed to be in that day. (I like to use humor and say something to the effect of "Dr. so-and-so wanted me to call and find out whose bottom I need to kiss to get a patient seen today." Always gets a laugh and an appt .

darla80 · May 10, 2003

Do you have a very high percentage of HMO pts?

I find they have a "fast food' mentality about thier health care..

I often joke they would like nothing better than to have a drive up window..drop in the refferral request and get the specialty appt , referral number and a bag of french fries in three mintues or less :-).

drives me nuts some days..

I do agree with you..when there is a real need I too call in the favors and go above and beyond to get their healthcare organized..

I am a patient advocate.. one of the reasons we do what we do ;-)

Hey I got a nurses week gift .one of the most time intensive HMO's here in TN dropped the need for referrals WHOO HOOOO

Vailgang · May 23, 2003

I have to vent on this subject again. It seems these past two weeks have been full of "I need this patient in asap". We are currently booking in July. Today we gave an office an appointment June 10 and she didn't think that was soon enough. One of my doctors is deployed and another is taking a vacation next week, so that doesn't make scheduling very much fun. The same office called about two other patients and of course our next available isn't good enough. With one patient they pulled rank and said that their doctor wanted to talk to our doctor. Well, I have learned that is just a waste of time, just work the patient in. From a neurosurgery point of view pain is not a reason to work a patient in. Anyway, I would love to hear from family practice nurses. I mean this is driving me crazy. Help.

Nurse Ratched, RN · May 24, 2003

I just let people who are dealing with non-emergent issues know right up front before I call the specialist that it may be 2-4 weeks out on their appt. If it's sooner, they are pleasantly surprised. If later, then they are not disappointed.

There is definitely a fast-food mentality for some patients about their health care. If you've been running around with an ache or a rash for a year, it's not reasonable to think it will be cured today. And it's not reasonable to be mad when the health care provider does not consider your year-old problem a dire gotta-be-seen-today emergency.

The lady who presented with a hgb of 3.5 - only sx fatigue (ya think?) - now THAT gets my attention. And SHE'S the one that wanted to wait til tomorrow to drive herself to her regular in-network hospital 3 hours away (trust me, ma'am - we can get your insurance taken care of.) People are funny.

teeituptom, BSN, RN · May 24, 2003

Sometimes it seem that you just cant win or please everyone in this world.