overreacting or not, that is the question!?!

[luvmyhubbybunches]

My feelings are so hurt about this, but could possibly be overreacting!

So here is what happened: I have been sick with URI since this past Friday, throat so sore I could hardly even swallow my own spit (sorry to be so graphic), coughing my head off, SOB, fever, and my lower back was hurting so bad I could not sit still. After couple of days like that, on antibiotics and getting worse I broke down and went to ER, (where I work).

First off the nurse I had ordered urine preg on me and I have had complete hysterectomy-DUH!! Then I told them I couldn't take Morphine or Lortab so doc said he wasn't sure what to give me for pain since I was allergic to so much stuff. I hardly think 2 things qualifies as so much stuff!! I see them give our frequent flyer drug seekers less of a hassle about getting something for pain as they did me! Finally after getting to point of tears, I got an IM shot for pain. Had pretty significant amount of blood in my urine so they ordered CT with stone protocal-had stone in left kidney. My nurse was one to tell me this which was no big deal, but then she added "o by the way, you have a rt sided soft tissue mass in pelvis that they are unable to identify, so here is prescription for you to come back and have another CT as outpatient with triple contrast". I asked her, "and why are you the one telling me this insead of Dr"? Her reply was "well when you first came in we only had 4 patients, now we are full". "SOOO" was my next response. Maybe I expect too much, but I would think as a nurse that works side by side with this Dr that he could have at least called radiologist and asked for some more specifics, or for sure made sure that I didn't leave ER that night freaked out! I had to hunt Dr down before I left to get him to sign my work excuse and only then did he see how upset I was and said well why don't we just go ahead and order that scan tonight so you won't have to go home worried sick. Why he didn't think enough of me to do that earlier is beyond me!! I mean I already did not feel good, was in a lot of pain and then to hear that just threw me over the edge! I thought that it was truly unprofessional and tacky of Dr to send Nurse in my room to give me that kind of abnormal test result. I had 2nd CT which was still inconclusive, so now my next stop is my OB/GYN per ER Dr suggestion.

Am I overreacting to this, expecting too much? As a nurse, I would have told Dr, I think this is news that needs to come from you and not me! Thanks for letting me vent!

[MassED, BSN, RN]

I stand by my post. I don't know how it works in your ED, but we do not routinely work up incidental findings that are asymptomatic. Once the emergent (as in an immediate threat that requires intervention, otherwise death or disability will result) medical condition is ruled out, incidental findings, such as a soft tissue mass (NOT acute appendicitis, NOT ovarian torsion), the patient is referred to the appropriate outpatient health care provider for follow up. The part I agree with the OP on is that the doctor should have given her the diagnosis in person so that all of her questions and concerns could be addressed. Maybe if the doctor had taken the time to do that, her fears would have been allayed and all of the hurt feelings and distress would have been avoided.

we don't know from her post if she was "asymptomatic" - she didn't mention VS, but she did mention pain. If that CT for stones revealed a mass and the rad suggested a contrast study for further eval. There's not enough information in her post to suggest outpt f/u or not. She pointed out that the RN had to come in and tell her and the doc probably just wrote her up for discharge to f/u with her PCP/referring MD, without paying attention to the CT result. We all know that happens. We, as responsible nurses, need to make sure something isn't missed as well as the doctor being informed of such.

How do you know this mass wasn't more serious at that time? Not knowing what it was... back pain/abd pain... sure, it COULD wait, but not even an u/s to figure out WHAT it was?? It's prudent medicine is what it is.... I have taken care of patients who came into the ED, stating they had a cxr, CT, etc only to reveal there was MORE on that study that nobody bothered to tell the patient. Often an ER doctor will focus on what that issue is and not care about the incidental finding, which may require a bit more investigative medicine at that moment. There are caveats to everything we do....we are often steered into different directions...

Of course I know what you're saying, once the emergency is over, follow up with PCP for all other concerns/questions related to visit, BUT each situation is different.... that's all I'm saying. Have a bit of compassion re: taking up a room, having an un-necessary CT.. etc. What do you care if a patient is having another CT? Is it YOUR CT scanner? Is it YOUR ER room?

[luvmyhubbybunches]

I did go to ambulatory side of ER where I work, because it only cost me $150 and had I had to have gone back for CT as outpatient it would have cost me another $150. May not sound like a lot of money to some of you, but as a single mom of two teenage boys, it was/is to me! I was having low back pain and was definitely freaked out when told a mass had been detected. I see people come in for a lot less and get a full work up, stay in ER for 6+ hours, have no insurance and probably no intentions of ever paying hospital a dime. I don't feel as though I was misusing anything!! MD was one that suggested I go ahead and get second scan, I didn't even ask for it to be done. When someone says "mass" I want to get some answers as quickly as possible, call that selfish, stupid or whatever else, but I am all my two boys have and all I had going through my head at that time was what if this is cancer. I wasn't exactly thinking too clearly about anything else at that time. At least I have my second CT report in hand so I can present to my OB/GYN tomorrow so she can determine what further testing may or may not need to be done. At this point I am just praying for good news.

[Anna Flaxis, BSN, RN]

MassED, the ol' "where is your compassion" red herring? I had fish for dinner last night, so I'm not biting.

To the OP, thanks for coming back and elaborating. However, it doesn't really change the fact that the second CT was non-emergent and totally appropriate for an outpatient setting. Even if it is cancer (and I truly hope that it is not), you still have time to get a diagnosis and begin a plan of treatment with the appropriate provider. I'm sure the doctor ordered it to appease you because he could see how upset you were, and it's a heck of a lot easier for him to order a scan than to take some time to communicate therapeutically with you.

Just because you see other people do x, y, and z, does that mean it's okay for you to do it too? I would think that those who work in Emergency medicine and see how the system is misused on a daily basis, how ED overcrowding due to nonemergent complaints affects the delivery of care and allocation of resources to the truly emergent conditions would feel a certain obligation to use resources responsibly; in fact, your chief complaint could have been handled by your PCP. This was an unnecessary ED visit.

As to your original question of whether or not you are overreacting to have your feelings hurt so badly by the behavior of this doctor, as I said before, I wouldn't get my feelings hurt over it, but yes, I'd be annoyed that he did not deliver the diagnosis to me in person and give me the opportunity to ask questions.

Now, let me say that lest I sound like a stone cold dog of the female persuasion, that is just my opinion, and as they say, opinions are like @$$holes, everybody's got one. I wish you no ill will, and really do hope your mass is some kind of benign cyst that is easily treated and causes you no further distress.

[MassED, BSN, RN]

OP, ignore Stargazer's post...

not helpful.

[MassED, BSN, RN]

I did go to ambulatory side of ER where I work, because it only cost me $150 and had I had to have gone back for CT as outpatient it would have cost me another $150. May not sound like a lot of money to some of you, but as a single mom of two teenage boys, it was/is to me! I was having low back pain and was definitely freaked out when told a mass had been detected. I see people come in for a lot less and get a full work up, stay in ER for 6+ hours, have no insurance and probably no intentions of ever paying hospital a dime. I don't feel as though I was misusing anything!! MD was one that suggested I go ahead and get second scan, I didn't even ask for it to be done. When someone says "mass" I want to get some answers as quickly as possible, call that selfish, stupid or whatever else, but I am all my two boys have and all I had going through my head at that time was what if this is cancer. I wasn't exactly thinking too clearly about anything else at that time. At least I have my second CT report in hand so I can present to my OB/GYN tomorrow so she can determine what further testing may or may not need to be done. At this point I am just praying for good news.

all true and valid points you make. I think having the second CT was probably the best way to go at that time. I wouldn't WANT to have had it, but not knowing future information ahead of time, this sounds like the best decision.

I don't blame you for wanting to know. We can't walk in your shoes, dealing with your situation and having a mass. No one can sit in judgment and suggest that you wait to see your pcp, wait for a referral/authorization from an insurance provider who MAY or may NOT pay for said referral. You did the right thing.

[Anna Flaxis, BSN, RN]

OP, ignore Stargazer's post...

not helpful.

Yes, ignore me. I raise absolutely zero valid points. When you post on an internet forum looking for opinions, best policy is to *always* ignore opinions you don't want to hear, and only pay attention to the ones that reinforce what you already think.

[leslie :-D]

i would only hope that whatever you attempted to get for yourself, that you'd seek the same for your pts.

leslie

[luvmyhubbybunches]

Stargazer

I don't mind reading and entertaining your opinion! Even if I had read your opinion before hand I would not have done anything any different, given the situation at the time. I don't utilize this site to get smoke blown up my butt, I use this site to get different views on certain situations, rather I agree with them or not!

[MassED, BSN, RN]

Yes, ignore me. I raise absolutely zero valid points. When you post on an internet forum looking for opinions, best policy is to *always* ignore opinions you don't want to hear, and only pay attention to the ones that reinforce what you already think.

not all opinions.... just yours. :doh:

[leslie :-D]

Stargazer

I don't utilize this site to get smoke blown up my butt, I use this site to get different views on certain situations, rather I agree with them or not!

isn't that what stargazer was offering...

a different view?

all educated opinions are worthy of consideration...

even if it's not what you want to hear.

leslie

[Butterfly0328]

Stargazer- Are you completely nuts????? An ER visit wasn't warrented???? She was in pain, and pretty severe pain according to her post. SHE HAD A KIDNEY STONE!!! I have had over 20 of them, and have had at least that many lithotripsies. I have had 2 children and let me tell you-that was a cakewalk compared to a kidney stone. I don't know how you can say an ER visit wasn't warrented. I am only assuming you have never had a kidney stone as that is one pain you can't ignore and wait to go to your PCP. Just saying....

[Butterfly0328]

Stargazer- a complete hysterectomy is removal of the ovaries, tubes, uterus, and cervix. So the potential of a tubal pregancy is impossible-obviously. Ordering such a test on a person who has had a complete/total hysterectomy only drives up the total costs and is completely unecessary. One big reason why insurance premiums continue to skyrocket- but thats another thread.