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Front desk people giving medical advice

NP   (7,247 Views 7 Comments)
by pedspnp pedspnp (Member)

pedspnp has 17 years experience and works as a General.

13,124 Visitors; 583 Posts

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My receptionist has taken it upon herself too offer parents advice. Yesterday she told a parent that a repeat bili would not be needed on newborn who was getting home phototherapy, then told a parent I probably would not order a abx over the phone for his child, then came and handed me the chart and stated this child needs abx she has asthma and the other dr always calls one in, then too top it all off said to me I hope you told that mom with the kid with a skin infection to take the kid to the ED if he gets red streaks. Her medical education consists of her hospitalizations, and that's it. I'm about to hand her a copy of the nurse practice act that covers practicing with out a license.

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oramar works as a returned nurse.

1 Article; 32,278 Visitors; 5,758 Posts

My experience is that the licensed professionals are the ones held responsible for mistakes made by a person in this position. My feeling is someone needs to show her more than the nurse practice act, perhaps something like the door. PS This is not an isolated incident, I see people who are not properly trained taking way to much responsibility on themselves all the time.

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10,427 Visitors; 727 Posts

I agree that this happens a LOT. I think that, generally, people mean well but that does not mean they know what they're talking about when giving advice. Unfortunately, providers are the ones who will be named in a lawsuit - not the office staff.

I would have a private chat with her about how her giving advice reflects on you and that, even though you're certain she's only trying to help your patients, for legal reasons you just cannot allow her to continue doing this. Then have a general meeting with all the staff, present this new office policy, have everyone sign receipt and acknowledgement of the policy, and then place the original in each employee's file. If it's violated after that point, the person's employment is terminated. This covers YOU if an employee should give medical advice that is incorrect and causes harm to a patient. It covers YOU from a legal standpoint if you determine someone needs to be terminated. It communicates clearly to staff your expectation.

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oramar works as a returned nurse.

1 Article; 32,278 Visitors; 5,758 Posts

. It covers YOU from a legal standpoint if you determine someone needs to be terminated. It communicates clearly to staff your expectation.
I don't quite agree with part of the point you make. It might be helpful in deflecting a wrongful dismissal suit. However, in the case of a non licensed person giving harmful advice to a patient, I am wondering if you would still be resposible for the serious harm a non-licensed person did to a patient. I can just hear the lawyer making the statement, "my client would still be alive today if this person had been removed from their position at the first hint of trouble". Changes are the jury would be thinking, "yup". PS The person who wrote this is a professional and if they are comfortable dealing with it by issuing a warning it is OK by me. I just have a tendency to think of worst case senarios. Like I said this happens all the time and people for most part get away with it. I just pity the poor patient that suffers serious harm from bad advice.

Edited by oramar

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ivanh3 works as a ER Nurse Practitioner.

11,302 Visitors; 472 Posts

I guess I would ask what you mean by "my receptionist". Does this person work for you (directly, or for you and your partners) or do you both work at the same office? If she works for you that is easy. Pull her aside and politely ask her to take the messages and you will direct patient care. If that person is unable or unwilling then show them the door.

If they work with you then that is another story all together. How do the other providers (if any) feel? If you don't feel comfortable going directly to the receptionist then go to her direct supervisor (unless you are required to go to your direct supervisor first).

This scenario is not unfamiliar to me. Our staff will take messages, write them down, and come to the providers often with their plan or suggestions. Yes this often includes medication recommendations. You know what? I find it very helpful, and I listen to them. I do make my own decisions, and I make sure I don't just hurriedly/blindly sign a chart or RX. If I don't agree with their ideas I explain why. There is wisdom (and folly) everywhere. Don't just assume that because someone does or does not have a bunch of letters behind there name they do/don't know what's what.

Ivan

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520 Visitors; 1 Post

i just had a conversation with a "patient service representative" in an outpatient clinic setting who was crossing the line in regards of scope of practice- but not even to this point. unfortunately/ fortunately she gave her 2 weeks notice as (i assume) she felt her unsolicited "help" should have been appreciated vs. called out- identified. unfortunately, i feel there are a breed of citizens who don't understand boundaries and it can be dangerous in our field. i wasn't planning on firing her- but if she shows up for work mon to fulfill her 2 weeks- i will be showing her the door ("pending investigation of further issues"). if your receptionist reponds with anything but humility and apologies- i would fire her.

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NPinWCH has 15 years experience and works as a NP-C.

6,439 Visitors; 374 Posts

First, there should be a policy for documenting all phone calls and messages. We've all been taught, if it isn't documented, it isn't done and that includes any advice given by any person the receptionist/MA/LPN gives over the phone. So, if a pt calls in a note should be generated in that patient's chart with time, person who called and question/complaint. Then the message should be addressed to you or another provider to be answered. Once answered, that to should be documented in the chart and if a phone returned, med called in, advice to make appt or go to ER given that should also be noted.

Second, there should be a policy on about who can give what advice. In my office, if the receptionist takes a call and it is a medical question it is routed to one of the clinical staff, who is a trained MA or LPN, they triage the call and take a message, advise appt or ER or they will ask one of the providers (NP/MDs) if they have a question about what to do. Our receptionists don't give advice, they may take a simple message like, "Ms. Smith would like her atenolol refilled and please send it Walgreens" but they forward questions such as the ones in your post to the appropriate triage person.

Third, speak up if you have a problem with someone. If you aren't in charge, go to whoever is. I once heard someone give advice and I went to our office manager and spoke with her, she then spoke with the girl at the front desk, she was actually filling in from another office, she stopped after that and has not been back to help out since. Also, encourage any non clinical staff to ask questions if they have them and thank them when they do. I have had the receptionists come ask me a question that a patient has asked them at the desk at check out and have no problem letting them pass the info along and honestly, the girls "know" the answer, but they always check. "Sally, wants to be sure that if the baby gets a fever it's 1/2 a dropper of tylenol right?" -Yes- "I was pretty sure, but I wanted to check before I told her."

I'm always sure to tell the girls, "Thanks for checking and taking good care of my patients." It is a team effort and I want them as invested as I am.

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