Parents/Patients demanding investigations

BabyLady, BSN, RN · Feb 27, 2011

I fully support parents asking for more comprehensive testing...if it is warranted. However, instead of telling parents "no"...a reason needs to be given to them as to why.

I have seen way too many cases where further investigation should have been ordered and wasn't...I took care of an infant that had 2 to 3 weeks of major bradycardia, asleep, feeding, etc..with huge sat drops that went with it. The baby was too old to be doing that...I never could understand why an echo was never done on this infant...the reason I was given was that there was no murmur...I said, "So every heart defect in the world has a murmur?"...it made no common sense to me. Being a newer nurse, nobody listened to me even though I had taken care of the infant more than anyone else had.

Well, they discharged that baby and the parents, a couple of days after discharge, we heard had a major scare after they got home...an ER physician got an echo and I cannot remember the name of the exact cardiac condition the infant had...but I did remember hearing that it was major and was going to require surgery to correct...the ended up shipping the infant to antother facility for the surgery.

Anytime I have parents asking for certain tests, I always ask them (in a professional way), what their reasons for wanting a particular test is...you may be surprised to hear the answer...but you also do not know how much research a parent has performed.

I just do not think that because a suggestion comes from a parent, it should be dismissed because they are not healthcare professionals.

proudnurseRN · Feb 27, 2011

Odd... I just read that thread.

Esme12, ASN, BSN, RN · Feb 27, 2011

I agree with babylady. Especially parents......they just seem to know when something is wrong. But........there are those who push for no reason. Our MD's go on a case by case basis and ry to find they happy middle. Here in the US I would think there is more "demanding" that goes on because of the accessability of knowledge and facilities. Here in the US the CT scanner IS used for R/O appendicitis as well as or instead of an ultrasound.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 27, 2011

You also don't know when a parent is a health care professional. Our ped has no idea I am a nurse.

proudnurseRN · Feb 27, 2011

Oh, and I've been placed in that situation before. I was halfway through nursing school and my 18 month old had a huge lump on his neck. For two weeks I got diagnosis anywhere from possible tumor, to swollen lymph node, to abscess. My son was on 3 different antibiotics during those 2 weeks and it kept getting worse. On my second trip to the ER I had a cocky resident say "what makes you think I'm going to tell you to do anything different than the other doctors have?" I told him that either they were going to tell me what was wrong or I was going to go to every ER in this state until I had an answer. He got his attending, the attending walks in and immediately says "he needs admitted" CT scan, ENT consult, IV antiobiotcs...ended up being a MRSA infection.

I didn't demand any of those tests, but I did demand that someone figure out what was wrong. Wouldn't think that would be so much of a request.

Airidis · Feb 27, 2011

My eldest daughter was three months old when she had her first febrile seizure. We rushed her to the hospitlal and by the time we got there she was back to 'normal' we got sent home with no vtests done and told to do tylenol/advil routine. I had this gut feeling something was wrong half an hour after being home it happened again we got a different dr who ran some tests and discovered she had a bilateral kidney reflux and a massive kidney infection from the reflux. The difference between the two visits was I KNEW in my gut something wasn't right and when I got back to the ER the 2nd time I demanded they do SOMETHING other then moniter her and pat us on the ass and send us home.

tablefor9, RN · Feb 27, 2011

My "you have to do something" came after my toddler stopped talking. Made only a high pitched scream following lethargy & fever for a 3 day weekend after shots on a Friday. Ped told me after initial high fever tylenol & motrin, come to ER if not taking fluid. I got fluids in him with a sippy, because he would drink almost in his sleep. By the following week, we were told by different provider "kids this age do this sometimes, we hear this all the time, yada, yada, we'll see how he is at his 2 yr old visit".

Encephalopathy and my child is not neurotypical even today. I am thankful for parents who will advocate strongly for their children and encourage this with my new parents, the ones born in my L&D.

Are there nutburgers out there? Sure. But I like to remember that "just because you're paranoid doesn't mean somebody's not out to get you". Even whackjob parents may have a gut instinct that will scream for their child. And, dare I say, in our litigious society, you have to really have more of a reason *not* to follow parental request than you do to decline.

hannahmaepunk · Feb 27, 2011

Say yes to parental instincts! As nurses, we have to uphold not only the rights of parents but also the medical profession. All we have to do is maintain a therapeutic and non judgemental approach. Even if parents/patients spit you on the face or threaten to sue

you, always state the medical factaon why this test/drug was given/not given, and at the same time understand the parents'/patients' concerns. And at the end of the day, you could say. "job well done,nurse."

MassagetoRN · Feb 27, 2011

I've learned from Ped's that a) parents are the patients just as much as the kid and b) the parents are the expert on their child, not us! Go parents!!

And Tablefor9, I am sorry for your experience and pray blessings on your family.

Elvish, BSN, DNP, RN, NP · Feb 27, 2011

It depends. I had a parent bring her son in to the office (back when I worked in a community health center) because he looked yellow (he did). She'd heard some PSA on Spanish-language television about how hepatitis causes jaundice and she was certain he had hepatitis, so she brought him in. She was not a health care professional; as a matter of fact, she was barely functionally literate. But darn if she wasn't right - he had HepA. Took him a while, but he recovered completely and I learned a lesson in not rolling my eyes just because I'm a nurse and mom is not.

And sometimes, there are people who really do go overboard. We've had people whose babies didn't have Apgars of 10 and 10 want to know why they got points taken off, and what are we going to do about it to see what's wrong with their kid. Never mind that I can count on one hand the number of times I've seen a baby that truly did have 10/10 Apgars. That's when I pray the parents are willing to listen to a little explanation of normal newborn findings, and what Apgars really mean.

It works both ways, really. Working people up for a hangnail really makes no sense at all, but there are times when the patient/family really does know what's going on.

proudnurseRN · Feb 27, 2011

Now, when it comes to me...who can talk to the meanest neuroligist with just a roll of the eye when the phone call is over, cannot seem to stand for myself when it comes to MDs for myself. I'm currently dealing with an issue that my family doctor didn't take my suggestion for a colo-rectal consult, ended up sending me to a general surgeon, who against my better judgment let him do work... that didn't work (it was a minor procedure, but still...), to hear him say after the fact that my town doesn't really have the technology to treat this kind of problem, but he could try again, etc.. but also mentioned several times I could also go to another town an hour away and see a... colo-rectal surgeon. So now that's what I'm doing.

If that had been a conversation between me and a dr about my son, that would have never flew over. Since my insurance doesn't require a referral for in network providers, I would have just called for an appt after doing some research on who to contact. Why in the world didn't I do it for me?