We had a Doc that liked to paw through the waiting room charts also. Anything with, "c/o CP" or "c/o SOB" got raced back and received an EKG before any of the staff knew what was happening. Her reasoning, "Well, it says the pt c/o is ____, which is an Emergent/Urgent classification" (never mind her checking the V/S or Sats, ie: the REST of the story...). When I thought about it, she was right.....if any chart review was done for legal purposes and "pt c/o CP (or SOB or chest tightness)" is on there and the pt sat in the waiting room for 4 or more hours....getting the picture? Never mind the rest of the chart that says that the pt was in NAD eating a bag of chips, sipping on a soda; the CC is "SOB (CP)" and that is all that "Buffy the former Cheerleader" is reading when she does the chart review (just a little joke there about that old HMO TV commercial...). Also, a pt c/o CP, SOB, chest tightness, or any of those other great buzz-words, can mandate the Physician to order full Cardiac/Resp work-ups (read: litigation fear). As one of our Docs put it, "You write a high-powered pt c/o on there and I have to order a high-powered work-up -- whether they need it or not -- based on any possible future chart review. Or, I have to cover my butt in a thick wooley blanket and explain in the chart why I didn't order it all." Medical and Nursing Admin agreed. The rest of us went..ooohhhh....
What we decided to do was improve our Triage skills. Ask more questions before writing down the "pt c/o..." Even perform a mini-PE out there. EX: So they are running in the Traige room c/o CP? When you get down to the nitty-gritty questions, they are really talking about some gas cramps in their mid-abd because they haven't had a BM in 3 days OR they like to use the c/o SOB or CP to "get in quicker" (we had a ton of pts that liked to use that line -- saw in on TV)......Soooo, your person witht the "cold": they may have come in c/o "SOB", but upon further questioning, their CC sounded like "c/o cold sx: cough, runny nose, blah, blah"....you get the picture.
This was just our soln and it turned out well (for the most part). Ms. Nosey Doc still pawed through the charts, but with better Triage and appropriate catigorization and description of pt c/o, she didn't race people back anymore (well, OK, maybe the occas S/T or OM that she could handle on her own w/o nursing). The hard part is with inexperienced/new nurses out there in Traige w/o the "eye" yet.....but I guess that's probably another subject
In our Level II center (approx 40-50,000 visits/yr), our Doc's and PA's also went out to the WR to "check" on the pt's on nites when Nsg was really bogged down. Many of them were D/C'd right from the WR (well, actually the Doc would take them into a little alcove off of the WR for some small sense of privacy and confidentiality). We never had a pt c/o generated from those nites when Doc did that. We knew he was trying to get out from under, and decrease Nsg's work as much as he could. We would get mad initially, but at the end of the shift we always realized it was a good thing and told him thanks.