Wednesday, April 16, 2008

Keeping it new after all these years

Oh, how newFNP fucked herself by not immediately saying "no way, Jose" to her lorazepam seeking patient.  Blog commentors, newFNP hears you and acknowledges just how correct you all were.  Just when newFNP begins to think that she is no longer so new, something like this happens and newFNP realizes that new has a shitload to do with context.

Of course she came back and of course she wanted more of the sweet, sweet Ativan.  This time, newFNP really did need a prn dose to make it through the encounter.  Instead, she had to rely on her endogenous adrenalin.

Since she had last seen her, newFNP reviewed this patient's former med records which did not elicit the etiology of either the anxiety or the lorazepam prescription.  When newFNP let her patient know this, her patient found this to be an unacceptable obstacle and demanded more pills.  

NewFNP said no.

The encounter was one hundred shades of crazy, but involved soap opera-worthy acting, crying, laughing, the patient telling newFNP that the only reason she returned was that she felt like newFNP treated her with respect during the initial encounter (?!?!) and that she wanted to give newFNP a second chance.  Thanks.  Thanks a million, hon.

NewFNP still doesn't know if she handled this situation correctly, but she does know that if this woman does have a genuine anxiety disorder, Ativan is likely not the optimal choice for primary, long-term treatment and newFNP is not the person to decide what is.  NewFNP would just like you all to imagine what the response was to her offer to complete the psychiatry and counseling referrals.  Good fucking times, my friends.  

NewFNP was mercifully absent from today's all-staff meeting, but her spies expeditiously let her know that the CEO had received some complaints from board members about employees - apparently front desk staff - not treating them well.  Being an FQHC, a percentage of our board members are also our clients. While they say that we are not supposed to treat them any differently, that is a big fat lie.  The take-home message was that we are all supposed to ramp up our customer service.

NewFNP worries that patients like her lorazepam-seeking patient will complain.  She does not want to work in fear of patients who want something that she would be ill-advised to provide. She knows that while some patients are uniformly pleased with her, others are not always satisfied with her service.  The clinic is really not set up for provide great customer service and some of the patients really expect more that newFNP or her colleagues can reasonably provide.  

What to do, what to do.


by: PM, SN said...

geez, when you find out the answer, let us know, will you?

I'd hope that if they were looking at trends and patterns in subjective things like surveys and complaints that they'd be able to normalize their data for occurences like this.

Stephen Ferrara, NP said...

Stick to your guns newFNP! If they equate good customer service with cowering to patient demands and handing over a blank Rx pad, you are setting yourself up for disaster.

Good customer service is treating people with dignity, compassion and delivering high-quality service. Patients should be encouraged to ask questions and have their concerns heard. That does not mean that you give them everything they demand. Remember who the one is with the education, training, license and the most at stake here: its newFNP!

Bean said...

Whenever you doubt your customer service abilities please look at your post below.

BostonFNP said...

I completely agree that good customer service does not mean giving patients everything they want. I'm sure many of my diabetics would like a Snickers bar, but I'm not handing those out at the end of my visits.

I'm sorry to say that these types of encounters do not get much easier- especially if the technique of flattery is employed- but your skin will get tougher. At the end of the day, we really must do what we think is best and not promote or aid addictions/poor health choices.