Fear Factor

  1. Hello all,

    I have an issue that I would like to have some insight on from practicing nurses since I have two years to go before I get to claim that honor.

    My mil received a copy of lab work via mail from her endocrinologist that stated (hand written) she was in third stage renal failure last week. There has been no contact from the FNP or physician at the endocrinologist's office other than this lab work. No phone call to request a visit to discuss the lab work or even explain the labs, nothing. When I contacted the office this morning to ask about the lack of follow up, the FNP told me that since my mil was "non compliant", she was trying to 'scare' her into getting things in control. When I asked about her needing to get into to see the nephrologist, I was told that they didn't normally do that until stage 4 and dialysis was imminent. According to the labwork and the FNP, my mil's eGFR has gone from > 60 to 46 since her initial hospitalization r/t the spider bite in late February. Despite repeated attempts to see the Dr. she keeps getting the FNP and while I normally hold FNP's in high regard, this one has me wondering where her head is.

    While I am not arguing the fact that my mil is non compliant, I question the way in which this was handled. My mil has lost her father, been in and out of the hospital due to a spider bite (she was dangerously close to being septic), and has had ongoing cardiac issues, all in the last six months. I am not making excuses for her, however it does affect how she handles things. She is fragile (there is depression there already) enough that many more situations like this and she is liable to say "the heck w/ it, it doesn't pay to try anymore". She does try to stay in compliance, she's just not incredibly consistent.

    My questions are as follows:
    1. Am I right in thinking that news of this nature should have been presented in person?
    2. Why on earth would you give someone news like this in the hopes of scaring them straight and not offer education, support and follow up?
    3. What would be the best way to handle this?

    My intention is not to go in there guns a blazing, however my job not only as her dil, but her advocate as well is to ensure that she gets the care that she needs.

    I don't want to come off as the idealistic nursing student or the pain in the rear family member, but this seems wrong on so many levels.


    P.s. I realize that I have a unique view of my 'patient' by being her dil and that I can't expect everyone else to know what I know. If I have left info out that you feel would help you help me then by all means ask me, I could have easily left something out with out realizing it.
  2. Visit Rensoul profile page

    About Rensoul

    Joined: Jun '10; Posts: 38; Likes: 71
    from US


  3. by   happy2learn
    first, i want to express my sympathy for what your family is going through. i can only imagine how difficult this is, and this event has not made it better.

    second, i am not a practicing nurse. i'm a nursing student and volunteer nurse aide at a hospital.

    1. am i right in thinking that news of this nature should have been presented in person? i would think so. i don't think a person should have to read their diagnosis on a lab note. i would be very angry if a loved one had to learn about something like this on paper.

    2. why on earth would you give someone news like this in the hopes of scaring them straight and not offer education, support and follow up? the only thing i can say is that there is a lack of compassion and true human connection in many medical environments. for every compassionate and caring nurse or doctor, there seems to be an uncaring one. people need to know what options they have and they need to be able to ask questions. they can't ask a piece of paper questions. even if the fnp lacked compassion in person, at least your mil could've gotten answers.

    3. what would be the best way to handle this? the only thing i can think of is to speak with someone above the fnp or doctor. but i'm sure others will chime in with more advice.

    there are too many people in the field who lack compassion like you. you will be a great nurse. don't ever think you shouldn't be compassionate for someones circumstances.
    Last edit by happy2learn on Jun 17, '10
  4. by   sharkdiver
    IMHO, the job of the health care provider, be they MD, NP or RN, is to educated the patient by providing them with the information to understand their condition and the potential risks of not taking the proper steps to deal with it. It is not their job to "scare" the patient into compliance, and, IMHO, it is unethical to attempt do so, the more-so if it inflicts unnecessary emotional trauma in the process.

    If a provider has become that frustrated with the patient, they really need to take a step back and re-evaluate the situation. Perhaps it is time for them to "fire the patient", insuring of course that there is still continuity of care for any major health issues. There was a good article recently on KevinMD on when this may be an appropriate action and how it should be done - will see if I can find the URL & post it....
  5. by   Rensoul
    Thank you both for your replies,

    I too thought that it was unethical. I am trying not to approach this out of anger as that get's nothing accomplished, however I am trying to see both sides and like you sharkdiver I think "firing" her would have been the better option in this case. We are in the process of firing her PCP. The PCP had made the comment "oh your not dead yet?" to my mil after one of her hospitalizations. I realize she is an emotionally needy person, but that was uncalled for. If my mil is such a burden to you then we will go somewhere else.

    I have made her an appt. @ the local Magnet Hospital, where I have had great care in the past. They have a comprehensive diabetes center that I hope will offer my mil the support she needs. Renal failure is scary no matter what state of mind you have, and should be treated compassionately.

    Her biggest issue is portion control. She does really well at choosing her foods, she just does really crappy when it comes to the size, and she is an emotional eater to boot.

    I am still considering what action to take in regards to the Dr.'s office. I would hate for any patient to be treated this way. Another thing I wonder about is a possible HIPPA violation. When I spoke to the FNP, it was over the phone and she had no way of verifying that I was who I said I was, yet she went right ahead and discussed my mil's case. Though my mil will eagerly tell you that I advocate for her, there is no paperwork that I am aware of that states this in any of her charts.

    Thank you again for your input and encouragement,
  6. by   happy2learn
    Quote from Rensoul
    The PCP had made the comment "oh your not dead yet?" to my mil after one of her hospitalizations. l

    What the heck!!!!???

    I would've been escorted out of the building after the comments I would've said in regards to that.
  7. by   CNL2B

    So sorry that you have to deal with all that. You are right in finding a new PCP after that kind of commentary. I would also be looking for a new nephrology office. If you have the option (and it sounds like you do), sometimes going to a different care system is the way to go. I would have to say that if your mil hasn't been angry/abusive/ugly to her providers, they would have no reason to treat her that way (and even if she WAS that way, it still isn't professional for a provider to retaliate with ugliness, but I would have understood it a little bit more.) I don't know how someone could say something about not being "dead yet." That is beyond horrible.

    I completely disagree with "scare tactics" as patient education. I think that sending that letter was a horrible thing to do and completely out of line with common practice. Typically if your labs are abnormal enough they will have you come in to discuss treatment options. If not severe enough, usually a letter just giving the lab results and a little explanation is enough, e.g. "slightly better, no follow up needed" or "slightly worse, will need to recheck your labs in 2 months" or something.

    I would encourage you to contact the clinic administrators (usually written is best. From your OP, I am sure that you can explain the situation very eloquently and accurately) of both of these offices. Yes, providers can act like jerk-offs, but someone IS paying their salary, and I bet you anything they aren't going to be fans of the poor decisions/choices of wording on their employee's part. Someone should be held accountable for the poor quality of care provided and the general lack of professionalism and empathy.

    I am thinking that you are an older adult (at least, not 22.) You seem like you have a good head on your shoulders. We are glad to have you joining the profession. Best wishes to you and your MIL.
  8. by   Rensoul
    An update:

    Today my mil saw the FNP that I use for primary care and was pleasantly surprised when she went through all of her meds one by one, set her up with a nephrologist and is working on finding some sort of water based exercise as even walking is painful r/t an old hip fracture and a pelvic fracture last July in addition to back and shoulder surgery in 99. I think all in all the FNP spent almost an hour with us explaining what she was looking for by drawing more labs , putting a note in her chart for additional tests when we get the labs back depending on what the labs say, and most of all, simply listening! I was almost jumping up and down for joy because I wanted my mil to know that this is what it should be like.

    Thanks again for the great advice guys, I'm glad to know I wasn't about to go off the deep end unnecessarily!

  9. by   BCgradnurse
    As a primary care FNP, I am appalled at the way your MIL was treated. I can't imagine how someone could say "oh, you're not dead yet?" and think it's ok. You are totally justified in being angry and looking elsewhere for care. I am so glad that you had a good experience with the NP that you know. I hope your MIL does well with her new provider...I know YOU will do well in nursing school!!
  10. by   Rensoul
    Thank you BC,

    Though I am going for my BSN for now, in the end I want to be an NP and possibly get my DNP. My NP is the whole reason I wanted to become a nurse and she "tests" me every time I come in with one of my crew. Everything from patient position in the room (especially when there are family members in the room), to letting me see my son's ears on the otoscope when he has an ear infection. Great lady That is why I was so disappointed in the level of care my mil was getting at the other place, I KNEW what it was supposed to be.

    Also to one of the previous posters who made a comment about age. You are correct, I just turned 34. I didn't figure out what I wanted to be until around 30

    But situations like this one only strengthen my resolve to be a nurse and advocate. Smiles cost nothing, compassion is free, and there is no excuse for treating another human being in the manner my mil was.

    I will state my case as suggested via letter to the director of the facility. My goal isn't to get anyone fired or in trouble...it is simply to make sure it doesn't happen again to any one.