Working with a new-to-our-ER doc the other night who totally lost his marbles when he found out I disclosed a positive urine pregnancy test to a patient. MD wanted the beds turned over and gave me the chart to D/C patient home (musculo-skeletal), "and just send the urine if it is positive". UHCG turned out to be positive, and became part of my counseling for home care teaching and pain control. I would not have normally just told a patient such a life altering result had I not already talked to her about her recently stopping the pill, her late cycle, and that she tested negative at home. Fortunately I had the tact to assess the patient's desire to keep her young child out of the loop by using adult-friendly terms "OB/GYN", "prenatal vitamins", ect.
The aid returned the d/c'd chart to the doc and showed him the urine as the patient was getting dressed to leave, clueless doc walks in a blurts "i guess you already know that you are pregnant" in front of the kid who clearly knew what that means. Poor woman. After she left we totally had it out because he was livid and said the most ridiculous things i could imagine: "Would you tell a patient that they had cancer? or an MI?" "I can understand that you would want to be a part of revealing such a fun test" and "Why is a +UHCG the only test that a nurse feels like they just have to run in to tell the patient immediately?". I'm not sure what prior issues he had with nurses, if all of his experiences with +HCGs have been great ones, or if discharging the patient as he requested qualified as rushing in. And as for the cancer comment, I told him i would absolutely never give a patient a diagnosis, but I felt it is within my scope to talk about test values, even the ones that patients already suspected they had.
But it is still on my mind and I can't help but wonder if it was out of scope. There is not much to the interpretation of this result to a G2P2 that requires a doctor to explain. What are people's thoughts? How about any difference for a pt who had taken multiple positive tests at home and CC was request for one done in the ER? (like ours are any different!) I find in our ER it is commonplace for the nurse to run the urine and give the result in that case, rather than making them sit there waiting for who knows how long to see the doc knowing full well every time I walk by the room that I already have the result.
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