Triage question- what would you do?

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Hi guys- pretty new poster/long time lurker here

This actually happened to a colleague and not (yet) to me - I'm wondering what on earth would be appropriate in this situation. I was bored (working urgent care, you see) and rooting through the charts for pts in the waiting room and came across one which basically said "Pt refuses to answer any questions, states she will only talk to a doctor." I cannot recall if she even allowed vital signs. The patient in this case was apparently a young, comfortable-appearing woman with an attitude problem - the nurse who triaged her said he put her down as a "4" and left it at that- he didn't have the time to argue about it with her (which is undoubtedly true, seeing as how there's often a line of 20 to 30 patients waiting just to be triaged during the day).

Now, MY first inclination, right or wrong, would be "Listen, if you want to see a doctor, you go through me. You don't want to talk to me, you can wait out there until you do. Have a seat." My patience over the one and a half years I've done level-one trauma has already become, shall we say, limited where triage is concerned.

On the other hand, since you don't KNOW for sure that there isn't something serious going on (however unlikely that may be), what's the right thing to do? Not triage at all? Triage the way my the nurse did in this case? I mean, legally, ethically, etc., this could potentially be problematic- and undoubtedly the nurse would get blamed if anything were to happen.

So what the heck would you do?

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Specializes in Neuro ICU and Med Surg.

I just don't understand why the patient refused to talk to the nurse who was triaging the patient. Why the heck did she come in?

I don't work ER/urgent care so I think I would have said, "If you want to see the doc then you need to tell me why you are here and let me take you vitals."

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Specializes in Emergency.

I would have made sure to chart "patient uncooperative at triage". I would also try my best to get something out of the patient, and I'd explain to her that I need to know why she was coming to the clinic so I can get her a room faster. I would definately do my best to get her to answer some yes/no questions regarding any chest pain, SOB, headache, fever, etc. I probably would have made her a level 3, assuming VS were stable (if you were able to get them). This is assuming you are using a 5-level triage system, and the facility only had one patient care area (opposed to a "major" area that cared for triage levels 1-3 with a seperate "minor" area caring for levels 4 and 5).

I would definately chart "Patient denies SOB, chest pain, fever, or headache; pt is refusing to discuss chief complaint with nurse and states 'I only want to talk with the doctor'; pt reassured of treatment, encouraged to provide reason for seeking care. Pt continues to be uncooperative at triage. Pt in waiting area, awaiting exam room; pt was instructed to alert writer if she has any concerns. Pt, is well-appearing, speaking in full sentences without distress; skin appears warm, dry; pt ambulating at triage without difficulty".

Based on her age and assuming she wasn't in any distress, I'd be thinking that she was there for female/STD workup, which would mean she'd probably need a UA and GC/chlamydia (2 resources, which would make her a level 3).

I dunno, that's just me though. I'd also try not to push her too much because I wouldn't want her to leave without an exam - should something go wrong, she could then state "the nurse wouldn't let me see a doctor".

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Specializes in Community, OB, Nursery.

I used to deal with this sort of thing a lot when I worked at a community health center (saw more emergencies than one might think) - we had a lot of folks come in saying "I need to talk to the doctor." Of course, the nurses were the first line at triage. A lot of the younger guys wouldn't want to tell us what the issue was; what I usually told them was, "I need to know how serious your health problem is, and I can't do that if you don't tell me at least a little about what's going on." After that and a reassurance that what they tell me is confidential, they usually at least opened up a tiny bit.

It sounds like this was one of those situations; either that, or she thought that by saying she only wants to see a doctor she'd get seen faster. JMHO.

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Specializes in Emergency, outpatient.

I reread the original post. Triage nurse was a man. Pt was a woman. I would have done the same questioning that kmoonshine did, while I:

1. Offered a female triage nurse, or

2. Offered the charge nurse, if said charge was a female, otherwise maybe the nursing supervisor.

Maybe that would have helped.

As a female, I have had male patients refuse to give me info; the approach suggested by Elvish usually worked for me.

Otherwise the documentation offered by kmoonshine is sufficient, with additions that you offered same-sex interview options.

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Specializes in Critical Care.
Hi guys- pretty new poster/long time lurker here

This actually happened to a colleague and not (yet) to me - I'm wondering what on earth would be appropriate in this situation. I was bored (working urgent care, you see) and rooting through the charts for pts in the waiting room and came across one which basically said "Pt refuses to answer any questions, states she will only talk to a doctor." I cannot recall if she even allowed vital signs. The patient in this case was apparently a young, comfortable-appearing woman with an attitude problem - the nurse who triaged her said he put her down as a "4" and left it at that- he didn't have the time to argue about it with her (which is undoubtedly true, seeing as how there's often a line of 20 to 30 patients waiting just to be triaged during the day).

I'd document that she didn't want to tell me what was going on; take a bit of time to ask her WHY she had to only see an MD, and explain that not answering symptomology may lead to her being seen last. Have her agree to that, and chart it. I wouldn't put her at any level other than the lowest, after explaining the severity of me needing to triage her. I've been in the ER as a patient with 10/10 pain, and believe you me, I was BEGGING for help and telling them everything they could possibly want to know (and probably didn't).

Document, document, document. Don't just write someone off on a level because you can.

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I reread the original post. Triage nurse was a man. Pt was a woman. I would have done the same questioning that kmoonshine did, while I:

1. Offered a female triage nurse, or

2. Offered the charge nurse, if said charge was a female, otherwise maybe the nursing supervisor.

Maybe that would have helped.

As a female, I have had male patients refuse to give me info; the approach suggested by Elvish usually worked for me.

Otherwise the documentation offered by kmoonshine is sufficient, with additions that you offered same-sex interview options.

More than likely the physician is male.....

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Specializes in Emergency Room.

I've had this happen a couple of times myself. Once, it was a STD issue, and another time it was a paranoid schizo patient. I agree with Moonshine...chart, chart, chart. Get as much out of her as you can, maybe she'll let you at least take a temp and put the pulse ox on her finger, get her O2 sat and HR quick. I'd also specifically ask her if she was pregnant. Then I'd just make sure she understood that without more information, I would do what I could but it would be impossible for me to triage her to the best of my ability.

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Specializes in Emergency Dept, ICU.

I have had that situation before and it has gone both ways in the past. First I usually try to let them know there is a process here that has to be followed.

Then if they continue to be uncooperative, I would just move along and leave their triage uncompleted if they did not allow it. I would not have given them a '4' due to lack of evidence. I would have just left their triage blank and documented their uncooperation. Put them in line for a room without a triage #.

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Specializes in ER.

I had this happen one time. It was not a male/female or STD issue. The pt finally admitted to the doctor that he "was paying to see a doctor, not a nurse". It was crazy. The doctor came to my defense and told the pt that he better change his attitude since "those nurses run this place"! LOL It was great. BTW, I documented the the pt refused to answer questions althought he did allow VS (all within normal limits) and I did not see any visible injuries.

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Specializes in ED staff.

I'd document that she wouldn't tell me a thing. I would also encourage her to talk to me but sometimes that just doesn't work. Some people think nurse are morons. If someone can walk and talk and not tell me what's going on, wouldn't let me do vitals I'd make them a 5 which is very NON emergent where I work.

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