Friday, April 13, 2007

A community health fairy tale

NewFNP works for an organization that has four clinics. She is generally at one site, but floats from other sites time to time. Some might say that we are all sister clinics. Others might call one clinic or another an evil step-sister.

As newFNP's readers know, newFNP's clinic is down one full-time provider. The other NP works three days per week. That leaves newFNP alone two days per week. So fine, newFNP has to go it on her own. NewFNP has to fill out the paperwork for all of the kids needing school physical documentation, organize the type 2 diabetes group, help the HR director re-apply for the HPSA score and write letters for patients applying for disability. By the way, is having dyslipidemia a disability? Hmmm, newFNP thinks not. Denied!

Did newFNP mention that she has zero hours of administrative time during her work day?

All this to say that, frankly, newFNP doesn't need anything extra. NewFNP most definitively does not need another clinic, her organization's biggest clinic, sending her a walk-in s/p abscess I&D wound care patient. And furthermore, newFNP does not need that patient to walk-in without a either a courtesy phone call from the dickhead at the front desk of the other clinic or a copy of the patient's registration info and progress note faxed from the clinic.

Why can't other people understand that taking five minutes to extend professional courtesy makes a difference? This is what continually floors newFNP about working in community health. Some of her colleagues just don't have common sense, nor do they think to extend courtesy to each other. Certainly a phone call is a chance to express thanks for the extra work, to give a heads up that you might be keeping your staff over an hour late due to the complexity of the walk-in patient and that you will likely be missing a date with your boyfriend.

But no. In walked newFNP's patient with a 2-inch gaping wound in her buttocks, covered with approximately 800 bandages and 35 rolls of tape. It took 15 minutes just to get the bad dressing off this poor lady's irritated skin. After diluting the wound with one liter of diluted hydrogen peroxide, newFNP packed her patient's lovely lady lump with three feet of iodoform. Three feet. During this process, newFNP's patient told her that the other clinic sent her because newFNP's clinic was bigger, that the evil step-sister clinic was closing early and that they didn't have the supplies to do the dressing change.

Interesting phenomenon indeed. The clinic had the supplies to slice open this woman's butt, pack the wound and cover it, but not to check on her healing and change her bandage.

It's one thing to have patients dumped from other clinics, but to get screwed by one's own colleagues! That just leaves a bitter taste in newFNP's already tart mouth.

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