Gotta off the wall question

[bakpakr]

This may be a bit off the wall but here goes.

I'm not a nurse YET. But while in the military I recieved more medical training (ALS) than the normal troop and through out my life I have tried to stay up to date and educated in the field of medicine.

I am no where near as educated as a CNA or a nurse but I know enough to be dangerous. hehe.

My question is this. What do you feel about a pt who knows what is wrong with him or her.

As an example and this may be TMI but it is relevant.

I have an enlarged testicle. No pain. I researched all possible causes and conditions. I came to the conclusion on my own that it was a Hydrocele. But I am not a doctor. So I did the smart thing which I always do and went to see my MD. As the nurse was doing my assement I told her of my findings and what I thought it might be. After all the tests I am back in the exam room and see my MD getting out a book and looking up my symptoms so he can make a diagnosis. After reading he come in the room and tells me I am correct. I have a cool doc. He then asks me the treatment. Which I tell him and I am correct. How cool is that. As an aside here I need surgery to fix it.

Does it irritate you or is it helpful if the patient has an good idea as to what is wrong with them?

[Grumpygs, MSN, RN]

I'm not a nurse yet either, but had to comment. I think that there are doctors out there that expect their patients to 'diagnose' themselves - with all of the information that is available to the general public - alot of times I think that patients do their research and are able to come up with a diagnosis that is pretty close to what the MD would arrive at.

I also think that there are doctors that will take the patient's diagnosis (right or wrong) instead of actually doing some of the testing. I have no clue, but could only imagine that this could lead to disaster...

As far as it being helpful or irratating - I suppose it would depend on the patient. Are they insisting that they have something that they do not - or do they simply want meds???

[deeDawntee, RN]

It really depends. The thing is, as a nurse, it is not my job to diagnose, so if a patient seems to have a good idea of what is going on, I just listen and then tell them to talk to their Doc about it. Certainly, I am more diplomatic about it....but you get the gist....

Personally, I really respect an educated patient, knowledge is power. The question is, will the highly educated MD think so?? As a nurse, when I come into see my Doctor I expect him to listen to me and treat me like an educated health professional and isn't threatened by my questions and requests. It has taken me a while to find a Doc who will do that. A nurse should also treat their patients with respect.

Personally, I really like the patient's bill of rights it is an excellent guide from whatever end of the stethoscope you are on.

[fultzymom]

It is sometimes easier to have a patient that is educated about what is going on. But on the flip side of the coin, it is hard to educate someone who thinks they know everything that is going on et know what should be done because the problem is......a lot of times they only know what they have heard, not what is right.

[bakpakr]

Excellent posts. I never walk in and say what I have and expect treatment based on my findings. The nurses and doctor I see have gone to school a day or two more than me so they are the ones I rely on to come up with the correct diagnosis. The office I go to knows me and have learned over the years that more often than not I am correct about my condition. What is so great about this group of individuals is that they listen to me but still come up with their own conclusions. I feel with my background I am able to give them more information which I hope is helpful to them than the average pt. Thanks for all the replies so far

[fultzymom]

excellent posts. i never walk in and say what i have and expect treatment based on my findings. the nurses and doctor i see have gone to school a day or two more than me so they are the ones i rely on to come up with the correct diagnosis. the office i go to knows me and have learned over the years that more often than not i am correct about my condition. what is so great about this group of individuals is that they listen to me but still come up with their own conclusions. i feel with my background i am able to give them more information which i hope is helpful to them than the average pt. thanks for all the replies so far

the good thing is they listen to you. that helps a lot. and they know you. i know that my md also works with me. but even before he worked with me too, he always listened to what i had to say. and i do think that is good that you know what is going on with your body not just comming in et saying, "i don't feel right. fix me." we actually need to know what does not feel right before we can start investigating possible problems. also as the nurse, the doc never wants you to say, "patient x doesn't feel right." hee! hee!

[Medic/Nurse, BSN, RN]

I always will respectfully listen to any reasonable patient. I think that folks should really be in tune with their machines (bodies).

I also always listen to a patient that tells me (without yelling) "I think I'm going to die." Generally, they are on to something...And then I work hard to prevent that from happening. :)

The ones that yell that comment usually follow with..."unless I get my _____". These folks will generally NOT die, even if you don't get them what they request.

Now, as to your situation from the OP - great! I'm glad it is working out for you. Informed, reasonable patient, good communication and a respectful doc - perfect for accurate diagnosis and treatment.

Other times to be deliberate: breast lumps, skin lesions, vision changes, bowel issues - I think informed, determined patients can save their own lives at times!

Practice SAFE!

[Super Nurf]

This is fine if its for yourself.

I brought a family member who had a history of CHF into the ED/WalkIn with elevated temps, gurgly, coughing up mucous, etc etc. and the triage nurse said "oh, I think you have an upper respiratory infection". (And when did this triage nurse get her MD license?). Well, that went through the bedside nurse and when the PA came in before doing any type of an assessment he said "Well, sounds like an URI". I said "well, we'll see what the CXray shows and he said "oh I wasn't going to do a chest xray, but I will if you want"!! I couldn't believe it. I had to ask three times for that darn xray, and when it came back the PA was visibly surprised as there was a lower lobe pneumonia, which would have gotten missed had they all gone along with what the triage nurse said it "sounded like" and most likely been treated very differently while the actual problem worsened.

[leslie :-D]

i always listen to my pts., and relay applicable information.

it doesn't take too long to distinguish between hypochondria or a healthy sense of self.

when my mom was inpatient receiving chemo, she was consistently c/o abd pain to the nurses and doctors.

they just kept on giving her mso4.

when i arrived there, i became insistent that they do a ct scan.

by the time they agreed, she had developed peritonitis, then sepsis.

a doctor told me it could have been treated when it started out as colitis.

i was so frustrated.

but i returned to my job, more determined than ever, to listen to what my pts are saying.

i admire those who seek as much knowledge as possible.

leslie

[RNisme]

As most have stated... knowledge is power, and you are lucky to have an MD who listens. Actually, if my MD didn't listen to me, I would have to replace her; listening is part of the job.

BTW - love your name 'bakpakr'

[EmilyUSFRN, RN]

I think that with all of the information available to everyone given a click of the mouse or a turn of a page it is wonderful that so many out there are willing to take control of their bodies and health.

when i was in school we went over hypothyroidism and i had many of the symptoms pertaining to the disease. I made an appt w my PCP for some bloodwork and when the MA asked what I was in for, and I told her all she said was "Well, then, I guess you know everything don't you?" I thought it was very rude, esp. because I had felt "not right" for a while and when the shoe fits....

well, my bloodwork was fine and it turns out I had depression with some really somatic symptoms... but I have never in my life, even when I knew someone was dead wrong made them feel as small as that woman made me feel for wanting to find out what was wrong with me. I always say "talk to your doctor" or "what makes you think you may have xyz?" I can't imagine what she may have said to someone else and turned them off from asking the doctor about a symptom, esp. since many of them think she is a nurse...

[FlyingScot, RN]

I think that with all of the information available to everyone given a click of the mouse or a turn of a page it is wonderful that so many out there are willing to take control of their bodies and health.

.

I'm all for patients learning about their bodies but I don't think the internet is necessarily the best place to do it unless you go to very reputable websites. I don't mind if a person says "I think I have fill-in-the-blank" but what really burns me up is when they expect us to use their "diagnosis" and treat them according to what they "read on the internet" and then become screaming howler monkies when we don't. Case in point: 30 something year old man comes into triage yelling that he needs to be seen first because he needs immediate surgery or he's GOING TO DIE!!!! I, the ever suspicious triage nurse, ask him what exactly he is going to die from. His response "I looked up my symptoms on the internet and it says I have a CONGENITAL heart defect and I need emergency surgery or I'M GOING TO DIE" At this point I am chewing on the inside of my cheek in order not to burst out laughing but I maintain my composure and explain to him what a CHD is and that it's highly unlikely that he has one, particularly one that requires immediate surgical repair/palliation, but he was relentless in his opinion. Needless to say he got the usual chest pain workup and a visit from the social worker for a psych eval. He wasn't crazy which is unfortunate because it would have made his behavior more forgivable. He left with a diagnosis of costochondritis (failed to mention that he had moved the day before) a script for Ibuprofen and a short walk with our lovely security guards because he was still demanding surgery for his new onset CHD.