My daughter's experience today in a Phoenix Emergency Room

[BrnEyedGirl, BSN, MSN, RN, APRN]

It sounds as if your daughter has some chronic health problems which makes it even more important for her to have a close relationship with a PCP. I understand the frustration of being new in town and finding a new doc. It might help for her to get a referral from her previous PCP. Something as simple as a quick phone call from the previous PCP and faxing her records might be enough to get her seen sooner. Best of luck to her.

[traumaRUs, MSN, APRN]

Other resources for your daughter:

1. Go to a hospital that provides charity care.

2. Seek assistance from her township or city where she lives.

3. Move back home with you temporarily to obtain medical care.

4. If she is in school - try the school clinic.

I certainly feel your frustration. I will say that as an advanced practice nurse, I've never ordered a stat MRI in the ER - the reason is that there are few reasons to do an MRI to diagnose chronic conditions. However, I would have provided her with adequate pain meds, antibiotics for her ear infection and the number of the local sliding-scale clinic.

[Altra, BSN, RN]

The girl never said she thought she might be pregnant! The doctor bringing it up shows he is an idiot. And that's the nicest word I came up with.

Sorry, can't agree with you there. Females of child-bearing age c/o nausea need to have pregnancy ruled out as one cause of their nausea. Any ER nurse who has been practicing for any length of time can recall dozens, if not hundreds of SUPRISE urine hcg tests in women of all ages, all imaginable life circumstances, who had not considered the possibility of pregnancy. If we only performed testing on those who "thought they might be pregnant" ... that's a lot of delayed prenatal care.

OP -- your daughter needs to see an orthopod. Unfortunately a lot of time has already been lost because it appears as though she/you wouldn't accept an appointment that is 3-4 weeks out. However limited her health insurance coverage is ... on the back of her card will be an 800 number to speak to a member services representative who can provide a listing of orthopedists in the local area. There may not be a particularly convenient location or appointment time ... but many times in life priorities have to be adjusted to accomodate the unexpected.

In the meantime - please educate your daughter on the s/s of possible joint sepsis (fever, warmth at the knee, etc.) so that she is aware that these s/s warrant a return to the ER.

I also agree with the above suggestion that you & she consider her returning home for a time to recover from this injury.

[Neveranurseagain, RN]

Emergency rooms are for EMERGENCIES!!!! Knee pain for an injury that happened 2 mths ago is not an emergency, esp. if she able to ambulate. As far as her PCP not being able to see her til she has a well visit means she needs to call her health plan Mercy and let them know she has an acute condition that her PCP won't see her for. They will intervene and get her the much needed appointment as Mercy doesn't want her in the ER either. If for some reason Mercy feels this trip was not an emergency but something that could have been handled in a PCP office they may refuse to pay it.

And she can't self refer to an ortho--she has a form of Medicaid.

Nausea without severe vomiting is not a medical emergency. If she has chronic ear fungus then she should get an extra RX antibiotic from her PCP to treat it to prevent ER trips, esp if it happens this fast.

But it does sound like she needed a mental health referral to help her cope with the stresses of life. Maybe moving back home for a while til she regroups her finances might be in order too. She may need a little more time to grow up to help face lifes challenges.

I hope her the best...it is difficult, at best to try and make it in the world in todays economy.

But the ER is for emergencies!

[PeaceonearthRN]

Fortunately, she found an ER that would see her. Apparently, she is sick to her stomach from a UTI; they did make a referral to an ortho guy and treated her with dignity and respect. This is all a mother can ask who is three thousand miles away trying to help her twenty one year old daughter get established in a strange city! Thank you much for your input!

Regarding contacting Senator now President elect Obama, I am actually a political advocate for improved, available health care for everyone. That letter was written last night.

I saw too much of this in Trenton, New Jersey when I would bring a mental health client in with SOB. As soon as 'psych' was on the triage notes, the patient was ignored. In this particular case, the woman was sent home only to end up back in the ER with pnemonia.

I have seen this way too much and often people have died.

The human body is too complex to make assumptions about why someone is presenting to the ED.

Amen

[Little Panda RN, ASN, RN]

To the OP, I am so sorry about what your daughter went through. I am sure most of us at some point in our lifes have felt that the pain was to much and visited the ER for treatment. Sounds like your daughter has had a very difficult time these last 16 months. Getting mugged has to be just a very horrible and traumatic expierence and one that I am sure she relives every day. I personally think she should have recieved better care during her visit. I think some healthcare workers become detached from what they do, due to all the abuse of the system. This does not make treating others without compassion exceptable. I pray that your daughter will recieve the care that she needs.

My prayers are with you!

[PeaceonearthRN]

Emergency rooms are for EMERGENCIES!!!! Knee pain for an injury that happened 2 mths ago is not an emergency, esp. if she able to ambulate. As far as her PCP not being able to see her til she has a well visit means she needs to call her health plan Mercy and let them know she has an acute condition that her PCP won't see her for. They will intervene and get her the much needed appointment as Mercy doesn't want her in the ER either. If for some reason Mercy feels this trip was not an emergency but something that could have been handled

She wasnt able to ambulate. The knee was treated after she was mugged. She woke up with it swollen and could not put pressure on it hence her desperate attempt to get treatment. Again, it was not a matter of not being willing to wait for a well visit. The knee was interfering with her doing anything productive. As far as coming home, I would love to whip her butt out of Phoenix pronto. However, if she is ever to grow as a human being and learn life is not a cake walk (not that she didn't know that already) or if she is ever to learn about making 'blind' decisions e.g., her move 3000 miles away, it wouldn't serve her to 'make' her come home. I wish she never left!

[smartenough]

It is a very sad situation, it seems as though there is this deep crack between the different types of care available and your daughter is suck in the middle. I think that our healthcare system needs to have more defined roles for each type of facility. Ideally everything for your daughter should be taken care of at a pcp's office, but d/t the limited availability of service hours and the overload of patients she has not been able to get in and her condition has progressed to an urgent care situation. So at this point the urgent care facility dropped the ball, they should have treated as best they could and then refered and made appts for the pt to have f/u care with a pcp they have an established relationship with. We have an interesting set up here in TN, there are pcp's that have urgent care clinics attached to their office, so not only are they avail for urgent care of established patients but they have the opportunity to take walk-in clinic pts and turn them in to regular pts. This is a great system and everybody wins, the pcp can up their revenue and by visiting the clinic you can establish your self with a pcp. You may check with clinics in your daughters area to see if there are any like this, this way she can be treated for all of her problems and have responisble f/u care. Hopefully she will find care before this becomes a problem that qualifies as an emergency.

[Little Panda RN, ASN, RN]

Fortunately, she found an ER that would see her. Apparently, she is sick to her stomach from a UTI; they did make a referral to an ortho guy and treated her with dignity and respect. This is all a mother can ask who is three thousand miles away trying to help her twenty one year old daughter get established in a strange city! Thank you much for your input!

Regarding contacting Senator now President elect Obama, I am actually a political advocate for improved, available health care for everyone. That letter was written last night.

I saw too much of this in Trenton, New Jersey when I would bring a mental health client in with SOB. As soon as 'psych' was on the triage notes, the patient was ignored. In this particular case, the woman was sent home only to end up back in the ER with pnemonia.

I have seen this way too much and often people have died.

The human body is too complex to make assumptions about why someone is presenting to the ED.

Amen

Looks like I was typing while you were posting:) I am so glad that she recieved the care that she so needed. The lack of compassion these days, runs rampant!

[CoffeeRTC, BSN, RN]

I'm amazed at how health care varies from region to region. In our area they would have given her something for pain be it a few days of a vicodin or motrin, drew labs and then refered out for an xray at an ortho appt.

Seems like the ER was frustrated and blew this one with bad attitudes.

This happens everywhere..Sad.

[PeaceonearthRN]

Yes, I am all too aware this happens everywhere. I have a lot of experience working with individuals with complex issues that are often presented with a primary dx of 'mental health' Axis I diagnoses.

Unfortunatley,I also had a friend that went to three ED's. No one did a full work up. She had a bad valve and needed a valve replacement. This was back in the early 90s. She was a very high strung person.

Bottom line, by the time the last ER saw her, they admitted her. She was diagnosed with the heart valve issues as well as thyroid disease. She never got the valve. Her thyroid medications were miscalculated, she blew a valve and died at age 39.

This is only one of many horror stories I have witnessed hence my passion for seeing each situation as fresh and individual.

We all get burnt out from people we presume are abusing the system; nine times out of ten, there is actually something wrong. When I directed a psychiatric facility, many of our patients died because they did not have the proper initial assessment and diagnosis. They also had difficulty accessing appropriate follow up health care.

We have a lot of money to throw at other countrys to 'strengthen them ' as well as our own economic status but we cannot provide appropriate basic health care.

I do not have the answers but would hope we would all look at ourselves as having some small responsibility in this by looking at each person as an individual and not see them as wasting our time regardless of what aspect of medical care we are providing or we are seeing patients.

[pererau]

If I walked into your psych unit and asked told you that I had just been shot in the arm and blood was dripping everywhere, what would you do?