Thursday, September 08, 2005

Day 8

It is the little things that will throw off your day.

For instance, new FNP had a patient today who has diagnosed diabetes but has never been seen in our clinic. She wants to begin receiving care with us, which is great. But she had a 15-minute appointment and no medical records regarding prior care. And her blood sugar was 356 in the office. Granted, it's no 500, but it's certainly not helping her at all to be cruising around with sugar in the 300's. Can I get a hell yeah?

Another example that new FNP experienced today was the problem of patient flow. Now, new FNP was the only clinician for a few hours this morning, which is theoretically fine as the other provider was accessible. New FNP felt OK until 8:45 and her 8:30 patient wasn't in the room. Ditto for 9:00. All it takes is a patient not being moved through the clinic fast enough to get you 30 minutes behind before you have even started. By the time new FNP was rescued, she was so frazzled that her Spanish was unintelligible and her hair was frizzy. How unbecoming.

Another thing that might throw off your day is the kid with the 104.2 fever. This kid had been seen by new FNP 2 days ago and by another provider last week. At the prior week's visit, he received an antibiotic. New FNP did not prescibe an antibiotic 2 days ago because A) he had just had one and B) there was no obvious source of infection. He did, however, have a 103.1 degree fever that responded to Tylenol in the office. So, new FNP let the kid leave with Tylenol and strict instructions for returning or going to the ED. So when he rolled in this afternoon with his high temp and still no obvious infection, new FNP was frustrated and a little scared.

Upon a closer read of the chart, the kid had been seen by a few providers for a total of 8 times in the past 3 months. Hmm.... let's go for the urine cx and the CBC. Oh wait, no, let's lay on the floor kicking and crying because you don't want your blood drawn. Now, new FNP is not callous and she understands that little kids are scared of needles. But she also understands the significance of a high fever of unknown origin. So, after consultation, she writes the note for the ED consult.

It's now 5:15 PM.

Let me just say the the social issues within the family made for a very, extremely, unusually difficult experience. It wasn't abuse or neglect - nothing like that. It was just that their lives are complicated, that they don't have money, a car, a cell phone, or support.

That last part is true of many of the patients I see. I hope that all of you student NPs and other new NPs are screening for depression. I don't always know what to do for the patient, but they deserve to have our concern. We can't help if we don't ask, right?

New FNP left the clinic around 6. The last 45 minutes were spent negotiating with a 5-year old and trying to figure out how in the world to support this kid's mom, impress upon the dad the seriousness of the situation and not cry myself.

I saw 17 patients today. I realized that I like seeing patients, but I fucking hate not knowing how to help or what to do. And I hate to be behind.

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