I'm a new grad NP on my first job, so am on a steep learning curve in a rural primary care clinic. A female patient came in with her children and hubby for an urgent appointment. She had seen her regular doctor the day before for what she thought was a cold or flu, but now reported she felt worse and was jaundiced since this morning. She looked really sick and as I began the physical exam, she began crying due to anxiety and just feeling horrible. She was slightly jaundiced and had abdominal tenderness over her entire abdomen. The patient and her husband were also upset because when they saw their regular MD the day before, just as he was leaving he said her annual labs indicated some liver issues, but that they would have to come in for another appointment to discuss those (LFTs elevated twice the high end of normal). While the patient was in the bathroom leaving a urine sample, her husband told me he was thinking of taking his wife to the ER. He also said he knew his wife was an emotional person (which I remembered from the one other time I saw her), but he strongly felt there was something really wrong. He wondered if he should take her to the ER. My honest response was he knew his wife better than me and he needed to trust his gut feeling. I also felt something was seriously wrong.
I have a good relationship with this MD and I later reported to him what had happened. to my astonishment, he was upset because "it make him look bad" that I had said to go to the ER! He ranted on and on, said her liver issues were trivial, they were (several four letter words) and so on. He never asked how she was doing. I asserted that 1) I didn't want him blindsided if they complained about him (he doesn't have the best interpersonal skills), 2) I couldn't forbid them from going to the ER, 3) we are in a rural area and if I had ordered more tests, it would have been a 48 hour turnaround and 4) in my clinical judgment something was really wrong with her. That shut him up.
The next morning, as I walked into the office we share, first thing the MD said was ranting about that patient and he bet there was nothing wrong with her and I should call her. A couple hours later during a break, I did call her. She was glad I called and said she was admitted to the hospital and still there; a lot of tests had been run and no diagnosis had yet been made. When I reported this to the MD, he was visibly surprised, but then began ranting again! I was shocked and dismayed. Again, he didn't ask how the patient was doing. If the hospital admitted her, this clearly was not a trivial issue.
My school taught us to trust the patient and their family if they felt something was seriously wrong, and also to trust our own gut. This is because a toddler had died in that hospital when staff ignored the mother's conviction that something was seriously wrong with her child, prompting a vigorous quality improvement program for the hospital and associated schools.
I feel I did the right thing, but was very upset by this MD's attitude. If the roles had been reversed, my first concern would have been for the patient. Is his attitude common?
