Do you disclose a positive urine HCG?

[Salls25]

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.

[Thornbird]

It's the same as any other test. Even if the doc is a jerk, it's up to him to discuss test results/dx with patient unless he tells you to do it. You should have brought it up to him first and offered to discuss it with her. Sounds like he just wanted to be done with her and would have been happy to have you do the work. His anger seems out of proportion to the facts though.

[obliviousRN]

I talk to my patients about test results all the time. Potassium levels, INR's, Dig levels, etc. It's giving data - not a diagnosis. I am not diagnosing someone by saying "your pregnancy test came back positive." Just like I am not diagnosing someone by saying "Your potassium level is high." It's data.

And I would have done the exact same thing you did. Educated the patient in relation to the data given on the test.

Big whoop. Your doc seems to be a little defensive.

[Dolce, RN]

Sounds like the new doc is a really friendly sort of chap. :uhoh21:

[mwboswell]

Interesting,

I sure wish some of my nurses would take the initiative and do this - it would save time!

[GrumpyRN63, ADN, RN]

I worked in a women's clinic, we did uhcg's , gave all of the results and precounseling all of the time, then did all of the prenatal teaching for the residents thru the whole pregnancy, I don't get what the problem is ? Obviously from his crass attitude to this pt, you should have let him observe you how to teach. BTW, I always give pts results on minor things ie electrolye results, H/H, I will tell them if a test taken is neg ie CXR,CT scan or MRI after I have spoken with the MD, it only alleviates waiting or anxiety, I do not Dx or explain abnl test/pathology resullts------ that's the MD's job.

[suanna]

You know we are only nurses not DOCTORS. Who knows what that "positive" value on the HCG could mean- the Doctor wil have to interpret such complicated lab values- not us little old nurses.

[Salls25]

Thanks for the feedback. I think I will need to walk on egg shells with this MD in the future, clearly he need to study what an HCG is again, because I would never say "you are pregnant". This whole thing stinks because his focus seems to be more about turn-over than education, something that I am well versed in.

[Medic09, BSN, RN, EMT-P]

Okay, I'll start with, by your description, the doc is clearly a jerk. End of story.

Now, there are, as you know some exceptional circumstances that can skew the test to positive. A man, for instance, can test positive (and a woman) with certain tumors. A woman can test positive because of administered hormones. (Had one of those last week.) You get the idea.

Doctor High-and-Mighty might think he is the only one who can discern if that is relevant. And he probably doesn't like you forgetting that MD stands for Medical Deity. (My wife slaps me when I invoke that...)

[Thornbird]

i worked in a women's clinic, we did uhcg's , gave all of the results and precounseling all of the time, then did all of the prenatal teaching for the residents thru the whole pregnancy, i don't get what the problem is ? obviously from his crass attitude to this pt, you should have let him observe you how to teach. btw, i always give pts results on minor things ie electrolye results, h/h, i will tell them if a test taken is neg ie cxr,ct scan or mri after i have spoken with the md, it only alleviates waiting or anxiety, i do not dx or explain abnl test/pathology resullts------ that's the md's job.

after speaking to the md is the key, i think if the op had done that she probably would have gotten the ok. of course, once you know your docs, it's easier to know what they think is ok. i think, overall, clinics have a better atmosphere and a lot more teaching gets done.

this guy really does sound like a jerk and blew this all out of proportion. it's unfortunate for everyone, especially the patients, when all the doc cares about is patient turnover ($$$) and not patient care.

[Aneroo, LPN]

It's the same as any other test. Even if the doc is a jerk, it's up to him to discuss test results/dx with patient unless he tells you to do it. You should have brought it up to him first and offered to discuss it with her. Sounds like he just wanted to be done with her and would have been happy to have you do the work. His anger seems out of proportion to the facts though.

I agree.

What if she had a tumor that was causing the hcg to be produced? What if it were linked to her primary complaint and needed further intervention?

ETA- If they ask if their test results were back, my cover my butt answer was "I see they are back, but the doctor still needs to take a look at them".

[canoehead, BSN, RN]

A pregnancy test being positive is not a sign of illness in a young female. It's something she can test for herself at home, does not require a prescription or a doc to do it. I feel the same way about glucose tests in diabetics. The patient did not need a doc to interpret the test, and nursing is qualified to do initial teaching on care of a pregnant woman. Totally different from a cancer or MI diagnosis, and the doc is/was an idiot.