Imagine a mid 20s young woman who likely has PCOS but has not received a definitive dx. Last year, she bled for 8 months and then went to the ER of a large university hospital where she was found to have a Hgb of 7 something, was admitted and transfused. She followed up with the docs at that clinic and they were able to get the bleeding stopped with hormones (BCPs in high doses). They wanted to do an endometrial biopsy and other tests but the patient had just started a new job and her insurance had not yet kicked in. She simply could not afford that care.
Fast forward to the present. Same young woman...now working for another employer, this time in an MD office FT with no benefits. She has now applied for and receives Medicaid coverage. She is having a hard time finding a PCP. She has been bleeding since October of 2009 and at last check had a Hgb of 8.5 (approx 1 mo ago). Approx 3 weeks ago this young woman went back to the gyne clinic at the university. They gave her a high dose of hormones (BCPs) which stopped her bleeding over several days. Then they requested that she return, at which time the docs asked for and then completed an endometrial biopsy. They told the young woman that she would bleed and cramp lightly for several days after the procedure. Metformin was started and the young woman is taking it daily (it causes nausea daily). They changed her to a new BCP (one that is currently in the news with some litigation type stuff). Immediately after the biopsy this young woman started cramping and bleeding heavily again. She is now bleeding as heavily as she was before her visits, now with cramps...and the nausea. She is a single mom working FT.
Seven days after the biopsy this patient called the gyne office and spoke with a nurse. The patient was concerned that she was bleeding so heavily and having cramps. The nurse told her that bleeding and cramping were expected for several days after the procedure. The young woman told the nurse that she expected some bleeding for several days but was under the impression that it would slow and stop over a short time, and it has not slowed or stopped. As well, during that conversation, the patient told the nurse that she does not feel that this new "designer" BCP was working and she had concerns about its safety because of information she has seen on the tv about it, particularly related to heart patients (this young woman has a congenital heart defect and has been completely pacer dependent since the age of 2). The nurse advised the young woman to continue to take her meds as prescribed, to be patient..."it may take several months for the plan to work", and to keep her next appointment (2 months in the future). When the young woman asked to speak with a physician, the nurse told her she would write a note in the chart and put in on the physicians desk.
The young woman waited 48 hours with no call from the doc...so she called the clinic back...and spoke with a different nurse. A very similar conversation followed with the patient providing a reasonably concise outline of her symptoms and concerns. The RN stated that she would put a note in the chart and have the doc call her...this was an A.M. conversation before 0900. No phone call from MD that day or next morning. Patient calls back afternoon of next day and speaks with another RN who can find NO notes or references about any of the calls in the chart...the patient must repeat all aspects of her concerns etc.
This RN spends almost 30 minutes on the phone with this young woman during which time she questions the young woman's judgment about the BCPs ("you were on a much bigger dose before and THAT didn't seem to worry you, why would you be worried about this little dose?") She told the young woman that she would "just have to tough it out until the medications can work" When the patient asked why they weren't concerned that she was still bleeding and cramping, now day 10 post biopsy, when that was not "normal" by their own standards the RN replied that she had been a nurse for over 30 years and she wasn't going to "argue" with this patient. The RN did agree to notify the MD and advise of the patient request for a phone consult. The patient was in tears and in fact was distraught by the end of the conversation. That conversation was on a Thursday afternoon. The young woman verbalized to me that she felt, each time, like what she felt, thought, or wanted really had no importance to the nurses she spoke to. She stated that "it was like they could have cared less what I wanted when I called, I was bothering them and the doctors". The patient called the office on Friday morning and requested an urgent appointment for Monday AM.
The MD called this young woman on Friday evening about 5:30. It was a brief conversation. The doc immediately changed the hormone back to the previous orders (pre-biopsy), told her to cancel her appt and resched it immed after she stopped bleeding. The patient said that the doc was pleasant and sympathetic and she felt reassured after the conversation.
I am curious as to how you view these patient/nurse interactions...I personally feel that these nurses were not acting as patient advocates and in fact, slowed the health care process for this young woman. I am saddened that this patient, who called for help, was again and again told that she had no reason to be concerned and was seemingly "blown off" by the nurses. I am concerned that these RNs didn't even apparently document their conversations with this patient in her clinic chart.
