Friday, June 22, 2007

Ah ah ah - stop right there

NewFNP has been slacking because all that has been occurring in her clinic is drama, drama, drama. It is exhausting. Save the drama for you mama is right!

Anyway, clinical telenovelas aside, newFNP's clinic has instituted this "new" practice policy of addressing just one concern per visit. It's not revolutionary, it's just that some of us (read: newFNP) have a difficult time adhering to it.

In newFNP's clinic, it takes about 3 weeks to get an appointment so newFNP can understand why a patient may want to kill you for saying that they need to schedule yet another appointment, for which they must arrive on time and subsequently wait 30-90 minutes to get seen. Would it kill newFNP to look in your ear when you're truly there for your pap results? Unlikely. Will you assume that this willingness to overlook the rules extends to each and every clinical visit? Definitely. Honestly, someone else needs to be the bad guy. There needs to be a triage nurse or some type of signage up in every room letting patients know that it's 1 - not 3, not 5 - concern per visit. No, no signage. All of newFNP's patients ignore the 'turn your cell phone off' sign, as well as the 'shoes off if you're diabetic' sign. No, newFNP's appointment needs a triage nurse that pins the real concern down.

And for the love of all that is holy, what is newFNP to do when her 50 year old patient with normal lab results tells her that his lower back is hurting? Should she even begin to ask about it? Should she punch him in the gut and ask, "Any less pain in the back now?" Seriously, once newFNP hears a complaint, she feels a little compelled to address it. What if his prostate is the size of a Buick? What if he has the horrifyingly freaky cauda equina syndrome? NewFNP would assume that over the counter Tylenol, even extra-strength, wouldn't touch that motherfucker!

NewFNP printed an article from the current issue of Family Practice Management entitled "How to Manage the Difficult Patient." It's pretty helpful and reminds newFNP that, no matter what, she should not be another problem on the already exhaustive chief complaint list.


Rebecca said...

I'm a new nurse and FNP student. Wanted to say that I love your blog. Just started a job as a RN in a community health center and am seeing a lot of the same situations that you write about. One issue per visit seems rather extreme, if it is includng management of chronic disease as well. But I guess one new issue and one or two chronic issues is not too bad. Do you have a lot of patients who don't know why they are there?

I had a young guy (in his 20s) the other day who couldn't tell me why he was there. He wasn't being facetious, he genuinely didn't know.

plong dong said...

I'm an RN with 24 ding dang years of clinical experience. I'm now in an FNP program, about to start my clinicals. Just wanted to say, first of all, that you are hilarious and secondly, your candor is a relief. Most of what I've read thus far in my textbooks regarding maintaining a holistic mindset makes me want to puke. Clearly the writers have spent very little, if any time in the actual world of health care, where we're chronically short-staffed and often have no choice but to settle for mediocre care. Your blog is real, man, real! Thanks for that.