Feeling insulted but not inferior

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    I has this discussion with my md today who I had to call for a referral to urgent care so insurance would cover itMe: hi dr soo soo, hate to bother you on the weekend but my asthma is really acting up nebs help but I see a problem brewing. I need a urgent care referralDr soo soo , no you need to go to the ER Me: I get great care at the urgent care that the military has designated for after hoursdr. Soo sooo: I understand you have a little medical training , I'm telling you need to be seen in the ER in case they need to admit yoI was able to speak in full sentences , peak flows borderline yellow/ green. I've been dealing with this my entire life, I knew all I needed was a urgent care visit get some steroids on board and I would be good to go. He insisted I go to the ER so a md could evaluate me. So off to the ER I went. Never once saw a md. I saw a Np at triage and the PA who discharged me both agreeing that urgent care would have been just as good , faster and not be crowding the ER . I'm infuriated by his reference to my education and the fact that this little ER. Visit is costing alot more than urgent care. Rant done
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  3. 21 Comments so far...

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    Why would the physician risk a potential lawsuit in case you turned out to be wrong? I refuse to give anyone a referral just because they ask if I don't physically assess them myself. The physician did the absolute right thing here, especially given the current medicolegal environment. It had nothing to do with your education.
    Last edit by traumaRUs on Jul 30, '12 : Reason: Deleted noncontributory sentence
    cmhnp, dimpledRN, and prettymica like this.
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    I can see his point: YOU diagnosed yourself and wanted him to basically "treat" you without ever having examined you. What if you were in serious trouble and he had sent you to Urgent Care when you really needed an ER? Yes, I know you KNOW what you needed, but he didn't, KWIM?
    I've never heard of needing a referral to seek tx at an urgent care site. Where I live, urgent care and ER are both at the hospital. They triage you and what you end up needing to have done determines whether your insurance is billed for an ER visit or an urgent care visit. Procedures performed automatically means its an ER charge. I understand in larger urban areas of the country that there are stand alone facilities designated as urgent care only, but I've still never heard of needing a referral to be seen at one.
    At any rate, I hope you're feeling better!!!
    dimpledRN and prettymica like this.
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    I agree - ER is the way to go. For someone who has had asthma "all your life", it sounds like you have had admissions before. As you know, asthma can turn on a dime and you are faced with more problems that require admission, intubation...etc..

    And...since your primary care MD wanted you to go to the ER, he knows your history. If you have a history of admissions, multiple exacerbations each year, then certainly an ER visit is warranted.

    NHLBI Guidelines for the Diagnosis and Treatment of Asthma
    dimpledRN and CCRNDiva like this.
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    Trauma I've never been admitted for asthma or anything else. He has had no issue sending me to urgent care before and I was very ill. This same dr sent me to ER for " pink eye" because it involved the eye. There too I was seen by a np. Colleen I never said I wanted him to treat me unseen, I just wanted to go to urgent care and not waste resources. And my insurance requires a referral for urgent care. The wonders of Tricare . I think I'm more upset by is snarky comment. He has let me know how he feels about PA's and NP's, he does not think we have any place in Health care. And yes I'm feeling better thanks.
    TeenyTinyBabyRN likes this.
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    honestly it seems like your pulling stuff out of.. to get sympathy or something at this point (surprised at the responses?). He didn't want to get sued, and he is a physician, you are a nurse. Case closed.
    studentdrtobe likes this.
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    whether you needed to go to the er or urgent care may be debatable. in either case commenting on your “medical education” was unwarranted. if i were you i would be considering changing pcms.
    SHGR, caliotter3, LiLoRN, and 2 others like this.
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    good heavens, here we have a person, the OP, that has advance nursing education. And specialized equipment to make careful judgements. Trying to make the best use of resources and WE are criticizing???? If the OP got to the urgent care, and needed more. ya think they couldn't call for transport?
    TeenyTinyBabyRN, wsuRN09, Stcroix, and 6 others like this.
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    I don't blame you for being angry. If you didn't need a referral it would have been a moot point, you could have just gone to UC. But unfortunately he has the CYA mentality. And yes, I agree that he didn't need to make that comment about your education.
    BTW, not sure why some people on here are being so snarky to you. Totally not necessary.
    TeenyTinyBabyRN, SHGR, DebblesRN, and 4 others like this.
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    No I did not want him to treat me I wanted a referral to Urgent care so insurance would cover it. Tricare requires referrals for urgent care but not ER. I wont treat patients over the phone but I will refer them to the urgent care or ER depending on the sx. . As it was i was seen by a NP and PA who both agreed this could have been handled just as well at the Urgent care. As a NP people have asked why did I just not call in my own RX seeing as how I knew what I needed. I wont do that for myself or family. But yes I am feeling better. Usually my asthma is well controlled but this triple digit weather is not helping , never thought I would welcome sleet and snow but I am
    caliotter3 likes this.


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