Wednesday, August 30, 2006

Knocked up

As a part of newFNP's continuing growth, development and work stress, she has taken on the role of prenatal care provider.

Here is newFNP's ideal first prenatal patient: 25 years old, normal weight, 8-10 weeks pregnant, non-smoker, no drugs or alcohol, taking prenatal vitamins, stable home life. She can have a cup of coffee per day because, come on, newFNP isn't a fascist.

Here is newFNP's actual first prenatal patient: 22 years old, G3P2 with a 7-month old, living in a shelter due to IPV, quit her 2 PPD smoking habit "2 weeks ago," in the 19th week of her pregnancy seeing newFNP for the second prenatal visit of this pregnancy, no prenatal vitamins, with both children in foster care, overweight and missing a front tooth. NewFNP knows that the front tooth isn't relevant, but it does paint a certain picture. Did newFNP mention that this patient was a walk-in? Of course she was! Only the non-complicated patients seem to make appointments in newFNP's clinic.

Trial by fire, this prenatal care bit.

Look at all of the opportunities newFNP has to provide education, support and care.

That is newFNP's new mantra. The old was one "fuck this" and that mantra just doesn't always work.

Tuesday, August 29, 2006

Celebrating one year of newFNP

Three hundred and sixty-five days ago today, newFNP had just completed her first day as newFNP.

NewFNP saw five patients that day - today it was thirty.

NewFNP is certain of one thing - being nice to patients makes all the difference in the patient experience of their care. NewFNP had a patient last week with cerebellar ataxia. What is cerebellar ataxia, you might ask. That is precisely the question newFNP was asking herself as she sat staring at her patient. No matter, because newFNP was nice and took time to talk to this woman. Midway through her visit, she told newFNP, "I want you to be my doctor." Well, sister, newFNP can't be your doctor but she can be your FNP even if the only thing she knows about cerebellar ataxia is that she needs to get your ass to neurology.

NewFNP also has to remind herself that many people in her practice are, quite frankly, health illiterate. Many people do not know how to care for themselves; they don't know the difference between what is healthful and what is dangerous. For newFNP, that is sometimes hard to fathom. Before newFNP was newFNP, she knew that Gatorade was not a health drink. She didn't learn that in NP school or in MPH school - she just knew from sometime long ago.

This lack of basic health knowledge is frustrating to newFNP at times, such as today when she had an urgent walk-in for, no joke, a bruise. A run of the mill purple bruise. But as newFNP felt herself thinking, "What in the motherfucking fuck is this person doing here," she backed off that ledge and remembered that this person was in clinic to get newFNP's professional and educated opinion about her bruise.

Ah, the wisdom we amass.

Although newFNP has yet to submit her request for a salary increase, she did receive a brand new chair at the end of the day today. For the past year, newFNP has had this ghetto-ass hoopty chair. No more - newFNP is now ergonomically correct and does it ever feel good. Now if she could only get a computer.


Thanks for sharing this year, newFNP readers.

Saturday, August 19, 2006

Scoot down

Quite frankly, newFNP does not understand how it is that women who have had many children, who have had prior pelvic exams, and who are in their 30's & 40's do not understand that they need to scoot that shit down in order for newFNP to do a pap. NewFNP feels a bit akin to Hannibal Lector as she repeats, "Closer. Closer, please. Closer." Imagine, if you will, a woman on the exam table, feet in the stirrups, legs fully-extended. What do they expect newFNP to do? Shimmy up on the table with them in order to get a peek at their cervices? And why is it when newFNP instructs them to move closer to the edge that they inch their way down the table? Is there an epidemic of women falling from the exam table - ass first, feet a-tangled in stirrups - that has these women stricken with fear about scooting? Ay ay ay.

Friday, August 11, 2006

You're fine, now go away

Frankly, having no insurance sucks.

NewFNP had a patient whom she began to treat for anemia last week when she entered our clinic with a heavy period and a hemoglobin of 7.2. For those not in the know, that qualifies as 'fucking anemic' as opposed to 'holy shit, is this patient ever anemic.' NewFNP's approach was three-fold:

1) iron supplementation (duh) and repeat hemoglobin in 48 hours
2) oral contraception (no provera available in the clinic)
3) CBC

Upon said patient's return, her hemoglobin had increased to 7.4, not an amount for which anyone will win any prizes but enough to calm any fears of imminent bleeding out. This is no faily tale, however as this lady's OCP was causing vomiting and a lot of it. NewFNP operates from a philosophy of avoiding insult to injury and, therefore, changed up homegirl's pills.

Alas, while the patient tolerated her new pills well, her menses was one tough customer and didn't feel the need to leave her the hell alone. She went to the ED and received 2 units of blood. Although newFNP did not see her in follow-up, she did see that her hemoglobin was a nice 11.8 the next week. Her period, however, was tenacious! It was not to be stopped by hormonal contraception alone. She was referred to an OB/GYN and received essentially no care.

She returned to newFNP's clinic the next day, clutching her head and crying in pain. She had been seen in the ED the night before, received no imaging and was discharged with a diagnosis of migraine. In the clinic, her right eye was deviating from its normal gaze. She was the most distressed patient newFNP has seen, excluding of course first rectal exams and male GU accidental erections. NewFNP called 911 and the friendly firemen took her to the hospital.

A quick phone call to the patient's home the next day revealed that she was, yet again, discharged with no imaging and told that she needed to see a neurologist. Yeah, no shit ass-crack. That's why newFNP sent her to the fucking hospital in the first place. How the fuck can we tell if the reason she has such heavy periods isn't from some underlying bleeding disorder that is causing her to also bleed in her brain if we don't do imaging?

When a 17-year old with anxiety comes into newFNP's clinic complaining of chest pain, she is likely to get the full cardiac work-up (read: an EKG and auscultation in all essential spots instead of just one or two). When a tyke with a sore throat comes in, newFNP checks him out as though he could have something aside from the 85% likelihood diagnosis of viral pharyngitis. NewFNP does not send every case to the ED. Apparently, that's a good thing given the crappy care they receive.

NewFNP knows that the EDs are overburdened with patients as well, but seriously, what the fuck?