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allnurses Guide · Apr 11, 2014

I know it does help and I am sure I am in minority, but, I feel very strongly that good medicine/nursing is addressing every problem possible during the visit, regardless of the "15 minute" visit.

I really shake my head at the patients that come in and tell me their last provider only let them talk about one complaint. Most of my patients have 10-15 items on their problem list and I try hard to at least touch on each one briefly. It's bad the first time but after that I can normally let the patient feel like they have all the time on the world, talk about each problem, review labs, and do an exam in 15-20 minutes.

globalRN · Apr 11, 2014

You will never be on schedule if you allow patients to voice all their issues,

Primary care: I think it is quite reasonable to ask the patient which concern is the priority and to address one or two of them if you can in the same visit.

In acute care, we have to deal with most of the issues. It is stressful because we too have large patient loads and patients are increasingly complex.

Big Blondie, ASN, BSN, MSN, APRN · Apr 11, 2014

Hahaha, I as I read your post I was thinking "one chief complaint"! Or how about as your grab the door to leave, the oh, by the way! I saw a patient today whose mom brought him in with complaint of Tinea Pedis. I addressed it, education about prevention, wrote script, to get told about his ear being stopped up. I looked in his ear, hmm, wax impaction, educated about ear drops, to come back for irrigation, to then get told he has been sneezing a lot, discussed allergy season, whew, finally, said our pleasantaries, put my hand on the door knob, and got the oh, by the way...I have something I need you to look at, she dropped his pants, and he had an abscess on his buttocks, that needed to be I&D'd. Priorities a little off kilter dont ya think! So much for the easy in and out. I have worked in a clinic where patients were asked all problems if when they scheduled appointment, and that is all that was allowed to be discussed. We had walk in clinic, and they would be told to come back for walk in clinic if had more issues, and with complex patients they were scheduled for 30 min visit and billed by time for education provided, just required documentation. Didnt always work out though!

SCSTxRN · Apr 11, 2014

I think it's reasonable in urgent / walk in care to be seen for the problem that brought you in.. but when my insurance is being billed $574 for my annual physical, I think we can talk blood pressure and cholesterol meds in the same visit as a TSH level.

coast2coast · Apr 12, 2014

Primary care here ... I take a lot of "behavioral" and chronic complex care new patients. As soon as I realize a patient has 25 complaints on their first visit ... I stop my h&p and make them tell me their list. Document it into the chart. And then I tell them that we are establishing a long term relationship, and that we will work on a few items on the list each visit. Unless they are floridly psychotic or manic it stops them in their tracks pretty well. Most of those patients just want to feel heard, they seem pretty satisfied just to get The List put into their medical record.

Sometimes, with the talkers, the extremely anxious, the haven't-been-medically-evaluated-since-the-dawn-of-civilization... I just let them go, and talk my ear off, and it takes 25 minutes and is really painful but like Boston said subsequent visits get easier.

BlueDevil, DNP · Apr 13, 2014

I think it's reasonable in urgent / walk in care to be seen for the problem that brought you in.. but when my insurance is being billed $574 for my annual physical, I think we can talk blood pressure and cholesterol meds in the same visit as a TSH level.

They are still billed separately. The only thing covered by the "health maintenance" code is the wellness exam. If we discuss your HTN and TSH, I'm going to attach those diagnoses and bill a 99214 for them in addition. You would be billed for that copay if you didn't make it at check-in. No such thing as a free lunch. A wellness visit is a *wellness* visit. Mention complaints and now it is no longer wellness.

allnurses Guide · Apr 13, 2014

Absolutely! I nearly always bill wellness visits along with a modifier and a level 3-4 E&M.

chillnurse, BSN, RN, NP · Apr 13, 2014

To each their own. But for me urgent care is two complaints at most. Some may differ but it's unfair to other patients to give some people a 40 minute 15 complaint visit vs others a one complaint five minute visit. Yes we can bill on different levels but we still need to lead the visit. We can't walk into Walmart and ask for 15 items with one dollar. Sorry for the uncreative comparison but I agree with the limit on chief complaints.