Patient Questions

[Watchtower]

Hi everyone!

I'm a BSN educated RN newly working in an urgent care setting and something has perplexed, and I'm curious as to what is considered general practice among such setting in regard to a specific situation.

We receive phone calls all the time from patients and potential patients who, as our FNP provider says, are seeking free medical advice. I have experience in telephone triage and was literally scolded for "wasting" time doing anything but insisting a patient come in for an office visit at our clinic. My training and understanding has always been that telephone triage is not to treat patients, but rather facilitate bringing together the patient to the right treatment and information in the right amount of time. This reduces unnecessary office visits and the subsequent extended wait times. And I schedule office visit if my tele-assessment indicates it's necessary. Is this something others encounter?

On a similar subject, when patients have a question about an abnormal test result that they are notified about via a phone call (another thing I've never encountered - it's always been my understanding that abnormal results merit a return to the clinic) or if they call back and request a call back from the provider about an abnormal result and I can't answer it, the provider won't make the time to call back and downright refuses to speak with them.

I try to answer any questions I can or find out answers and call them back because I understand that is a nursing responsibility. I even it make it clear to the patient that the NP is busy seeing other patients and it isn't always feasible to speak directly to them.

Sometimes I don't possess the clinical expertise to answer some questions (especially if they come up during explanations) and the NP does NOT want to be bothered whatsoever with any requests from patients for clarifications on abnormal test results even if they are just requests for a call back when she has time. Please note, I only pass on such requests if my expertise is not satisfactory to the patient.

My attempt to problem solve is that I've scheduled follow ups for these patients to their annoyance and to the NP's annoyance (again her time was being wasted because all these people wanted was to ask a question) and I've been "scolded" because the NP didn't like how I explained a test result.

I'm only asking because I've worked with MDs who do return patient phone calls if the patient asks and is not satisfied with the nurse's explantion - it may not be the same day, but they do it. Is my past experience a rare thing? How can I help my patients better? I'm at a loss now on how to remedy this.

[Vespertinas]

I think the crux of this problem is that you work in an urgent care setting. Isn't the idea here to treat them just temporarily until the patient can get in touch with their PCP? So if you've discharged a patient and later contact them about an abnormal lab result, presumably it's not a life-threatening one otherwise you WOULD tell them to seek immediate medical treatment. So now they are informed of this abnormal result (like they should be) and it's also presumed that they should FOLLOW UP with their PCP.

As urgent care providers, you probably are already packed to the gills with patients who are physically in your practice actually requiring urgent care. It's really not in your scope of practice (according to your specialty) to be tagging along with them outside of the care facility to hold their hands through the course of their illness.

If I were you, I would answer the patients question to the best of your ability while keeping it general and making the biggest take-home message that they should TAKE THESE RESULTS TO THEIR PCP. Don't feel guilty. You already did your job.

[Altra, BSN, RN]

I agree with the previous poster's comments -- at an urgent care you are not building a long-term relationship with patients. Any abnormal lab results that come up after discharge mean one of two things: either they indicate a true emergency, and you are directing patients to their nearest ER, or they are an abnormal result which may require intervention from their PCP.

Unless we have two entirely different definitions of an "urgent care" ... I'm not even sure how you are "scheduling" patients for follow-up visits with the urgent care provider.

[BostonTerrierLover, BSN, RN]

I totally agree for your situation, and I know it should be common sense, but. . .

I have worked at several small "Critical Access" Hospitals where they were very strict about giving NO medical or health advice over the phone (Beyond saying: We would be more than glad to see you in the ED.

I once again use common sense. If it's life or death, and it just may not seem that way to them at the time, I advocate.

Example: Phone Caller: Will you please tell my husband that chest pain is serious, here he is. . .

Husband: (Barely able to talk, SOB obvious) "-lo, I'm okay, she's over, . . .(breath, moan, labored breath) . .

reacting! It's just indigestion."

Me: "Do you have HBP?"

Husband: "Yeah, and I had 2 heart attacks before, not like this, I took my Nitro, didn't help, so this isn't

angina!" (I hear him tell wife that arm is sore b/c of some lame excuse.)

Me: "Don't pass go, Don't collect $200, Eat an Aspirin Now! Get to an ER 5 minutes ago, you are probably

too late already-Hang up and dial 9-1-1, or get wife to drive you!"

I don't like being a drama queen!, but if it saves a life, I can deal with the fallout. I hope he took my advice.

:redbeatheBoston

[classicdame, MSN, EdD]

say as little as possible on the phone or you might be accused of giving medical advice. If they have a problem they need to see someone. Period. I took call for a group of MD's for several years and that was my mantra. I did not want to be sued for misunderstanding a lay person's interpretation of the situation. If it is worth calling about it is worth seeing someone.