No wonder people abuse the ER...

[hoppermom3]

I called my FNP's office (30 miles away frome home) this am to get my 10 yr old son in for c/o L wrist et arm pain X approx 1 wk. I was willing to see any NP or doc available. Only appt was with our FNP @ 1500. Well...since I work this noc, I am not too peachy keen on this time. I asked receptionist if she could maybe have FNP give me a call this am, because she will most likely want an Xray, which will need to be done at the hospital. So...I am thinking maybe FNP will order Xray and we can go do that before 1500 appt, rather than going to office, then to hospital, then back to office. Receptionist was incredibly hateful, states "No, I will not ask her to call you. She will decide if she wants an Xray after she sees him. Either be here at 3:00 or don't take the appointment." I was SO tempted to tell her to just forget it, load the kid up and run him through ER. Yes, it is more $$ than office call, but worth it to not have to deal with the office staff. If I was not a nurse, I would probably be sitting in ER right now rather than venting here!

[canoehead, BSN, RN]

After a week of pain, needing an appointment that day would send up a red flag for me. Xray orders without an exam is just not done where I live, and we have instructions to just turn that request down. Asking to speak to the FNP to reverse clear instructions to her office staff- staff might not be able to even bring it up because it has happened so often.

In our ER some of the docs have private practice patients that try to get around the system when they know their physician is on. They still won't prescribe based on a phone call. Many, many times I have explained the pt can't speak to the doc with the doc right there listening and nodding. Everyone thinks they are special, and the thing is that even if you are one of the chosen few that might know they need an xray the next time you talk to your neighbor, you might mention about calling ahead and getting the Xray first, and then they've got someone else calling wanting the same treatment.

Depending on how many calls the receptionist has gotten that day, how many lines are lit up on the phone at that time, how insistent you were, and how many true emergencies are waiting for an appointment the receptionist might be more or less blunt about what she could do for you. Unless she was out and out rude I would just be glad to get in the same day. It takes at least two weeks to get an MD appt around here, and they will tell you without hesitation to go to the ER if you need it sooner. The ER wait tends to eliminate nonurgent issues without the hassle of a negotiation.

[rjflyn, ASN, RN]

Ah what about going to an urgent care clinic.

As far as the ER unless there is apparent trauma, point tenderness or a deformity I wouldn't order a xray at triage either, which means a wait to see the doctor. At my current facilty we have a minor emergency care area that would speed the wait but it still could be from a few mins to 4-5 hours.

And canoehead I only wish the wait would eliminate the non-urgent issues, unfortunately the ER has turned into the primary care provider for alot of people.

Rj

[smk1, LPN]

i think that a client that lives 30 miles away and works night shift could at least be given the chance to speak to the PCP though...

[canoehead, BSN, RN]

Everyone has special circumstances- if only in their own mind.

rjflyn- people usually stick around for just 2 hours for nonurgent problems and then leave raving about how uncaring we are. We get them in but they leave without being seen. When we page a code blue overhead we get a grace period of about an hour, but be darn sure that two codes don't equal two hours- no sir.

[rjflyn, ASN, RN]

Unfortunately ours wait around much longer than that. Iv'e had them wait 8 hours for nothing complaints. As far as paging goes our pages in the house dont go out to the ED lobby.

Rj

Everyone has special circumstances- if only in their own mind.

rjflyn- people usually stick around for just 2 hours for nonurgent problems and then leave raving about how uncaring we are. We get them in but they leave without being seen. When we page a code blue overhead we get a grace period of about an hour, but be darn sure that two codes don't equal two hours- no sir.

[TopherSRN]

You're not going to like this post, but I feel it should be made anyway and I see it has, by llg.

Wrist pain x 1 week? Then it obviously isn't that urgent if you waited a week to call the MD office. Schedule an appointment next week since whats another week after you sat on it for one to begin with? To me this sounds as more of a rant that the MD office wouldn't squeeze you in to accomodate your schedule moreso than them not taking your child's complaint seriously.

While there very well may be problems with the receptionists you still must realize the above.

[fergus51]

I wouldn't get too angry the receptionist didn't allow you to speak directly to the NP. She may have been told specifically to never do that.

[KidsRNstill]

I have been a peds office RN (and now office manager) for many years, and there are many facets of this post that need to be considered...First, the receptionist in my office would be reprimanded for speaking to you in this manner--ours are instructed to defer to our triage nurses on all medical matters (they can't even give you a Tylenol dose). I would ask to speak to the office manager, or write your doc a letter, telling them how you were treated--feedback, positive or negative, helps the practioners know how they're perceived by their clients/patients and helps identify and correct problems (esp. in the front office, the docs "face" to their patients.)

Now, a problem that's been going on for a week--unless there's a change in sxns--isn't an emergency and needs to be worked in without destroying the schedule within a reasonable time--a day or two. We never order labs or Xrays before seeing the patient--without an exam, how do you know what to order? Wrist, hand, elbow, upper arm X-ray? We've seen people who INSISTED the kid had a hip problem and needed a hip X-ray, when physical exam shows it's a knee problem causing hip pain...we've had kids with leg pain/limp as the presenting sxn of ALL--parent didn't notice the child was pale, tired,and bruised.

Everybody has time constraints--work, school, kid's naptime, mom's tennis match....offices can't accommodate everyone's schedule (we'd NEVER see preschoolers from noon-2pm otherwise:lol2: ). Sometimes the best medical practice may not be the most convenient for everyone--sometimes there's a wait while we work in an emergency, sometimes the patient may have to come in at a less than convenient time, and sometimes the office staff misses lunch and goes home late in order to accommodate everyone.

I agree that the providers can't speak on the phone to every patient--else they'd never be able to see patients! That's why our triage nurses have protocols they follow that have been set up by the providers--therefore they already know that no tests will be ordered without seeing the patient, so no need to have the PCP speak to the patient.

And don't forget that PCPs are the gatekeepers of insurance $$$$$--unnecessary labs, xrays, etc......

Oops, didn't mean to go on and on...........

[withasmilelpn]

Diffferent perspective about length of symptoms on my part. When I somehow injured my hand and could not use my thumb, I did what I knew the MD would tell me, ice and rest. The night I finally decided I would make an apppointment if it wasn't better was about day 4. The next day thank goodness it was much better. So I just continued doing that for about 4 weeks until it was all better. Same for illness that appear to be viral. I'll wait them out, because alot of times medicines won't be effective anyway. I do that out of my knowledge, consideration for the Dr.s time and quite frankly sometimes because I can't afford it sometimes. So I don't think staff should ever dismiss a patients complaints because they waited x amount of time to come in to see the doctor.

[ZippyGBR, BSN, RN]

I don't think that she was upset about not getting the XRay, she was upset because she wasn't give the opportunity to speak with a PROFESSIONAL. A secretary is NOT the one to make the decision to order an XRay or not. She has no right to deny the op access to the NP. I would tell her when you see her (him?) about the conversation. It was rude and out of line.

how can a referrer even attempt to make a legitimate and approrpaite request for an X rays without examining the patient?

the Admin person was absolutely correct no referrer is going to make an imaging referral without seeing the patient ( or at the very least without the patient being examined by someone who is a referrer for other imaging but organisational policy restricts their referral rights)