Is this nurse crazy or am I missing something?

In My Humble Opinion
1

My husband has had a high fever and sore throat since Friday. We went to the urgent care clinic on Saturday, where they diagnosed “tonsillitis” and gave him penicillin. No effect-- despite the meds and ibuprofin, his fever was still over 100 and his throat was still hurting. He could not get out of bed, or eat, or anything.

I called his doctor on Tuesday, and the receptionist said that she spoke to the nurse, who said he should go to the emergency room because she thought he might need a blood culture and chest X-ray.

What?!? Is she crazy? I am 6.5 months pregnant, and he can barely walk. We have insurance and this is his family doctor. But she wants us to go to the ER, sit there for hours in a room full of people with real emergent situations, and other sick people, so he can be seen by a doctor he doesn’t know and get some tests?

I refused this. It took some arguing. The receptionist did not want to give me an appointment, so I asked for the nurse to call me. I explained to her the situation, and that there was no way we were going to the ER. I had her find him an appointment to see him. He went in there, she wrote some scrips, and sent him over to urgent care to get the labs. We were done with the whole thing in less than an hour.

Turns out he has mono with a secondary bacterial infection. With the new meds he is feeling much better.

So my question is, is there some rationale for her to send us to the ER that I’m missing here? Seems crazy to send a sick guy and a pregnant woman to the ER when the doctor or his nurse could see him and order the labs themselves, which is exactly what happened when I pitched fit about the ER plan. But maybe there’s something that I don’t get about this suggestion that someone could point out. Also, I needed to vent, because the receptionist really ticked me off with her unwillingness to schedule an appointment for us.

2

The only thing I can think of is that she had some reason to believe that he might need emergency care at some point and they’d have to ship him over to the ER anyway. Or she just wasn’t thinking about how much time it would realistically take for the ER to get to the tests vs their office. A lot of people think ER = immediate care and office visit = waste time waiting that the patient might not have to spare.

Good for you for insisting that he be seen in the office, and I hope he continues to feel better and recovers soon.

And congratulations! (On the baby, not the mono.)

3

Maybe they were really full and had to bump other patients around to fit you in, and she didn’t want to do it?
I had almost the exact same thing happen to me when I had mono, oddly. Went to urgent care b/c my doc wasn’t open, diagnosed with tonsilitis, didn’t get better, tried to get out of bed and keeled over - when I finally got in to see my doctor, they actually did tests and I had mono & strep.

4

She isn’t crazy, she is busy. She may have had other people that she had to cancel so that your husband could be seen or she may have been screamed at by the doctor for an hour for cancelling his lunch to see you guys or something.

On top of that she is probably used to people crying “Emergency!” for every hang nail and stubbed toe. I know you really did have an emergency and he really did need treatment, but I am a health insurance agent and I promise that at least 75% of the people I talk to need their information right away because “it is a medical emergency” and that emergency turns out to be that they have a doctor’s appointment in 10 days or something like that. Most people’s definition of an emergency is something that is happening to them as opposed to someone else.

5

More lazy than crazy, IMO. It’s not crazy if you put yourself in the nurse’s position and value 5 -30 minutes of your time higher than some random patient’s four hours or so, their health, the time of the Emergency department, the higher costs of being treated and seen by the ED just for some lab referrals. I mean, what do you think, she became a nurse to help people?

I’m being harsh, really, I think she just wasn’t thinking. Does she know that the patient’s wife is 6.5 months pregnant and that he can’t go get treated without her? The nurse just went with the solution easiest for her and the office. It sucks that she said to go to the Emergency dept., but at least she didn’t dig in her heels and refuse to see your husband, instead she found time for a same day appointment which is IME pretty hard to get, and you guys were able to get it done. Good for you for standing up for the health and well-being of your family.

6

This is exactly the way I see it. I know even specialists only have 10-minute slots in which to see patients, and many doctors are double-booked, so it’s quite possible she didn’t want to deal with the hassle of rearranging things with such short notice to get your husband in, especially if she didn’t take into consideration the inconvenience of waiting around in the ER and didn’t know you were pregnant.

I think it’s crappy that doctor’s offices do that to patients and I love those offices where they set aside times for urgently-needed care and walk-ins, but not many do that for adults (the only doc I know of who does that is my son’s pediatrician). I’m glad you got your husband in and that he’s doing better.

7

This is what my dad said when I told him the story. Lazy/doesn’t give a crap about us sitting in the ER for 4-5 hours, or the cost. I even gave her the option of not seeing him and just writing the orders for the tests, but of course, that wasn’t going to fly either for liability reasons.

Well, I called on Monday, after he’d been taking penicillin for 48 hours, to say that he was still feverish. She said she didn’t have any appointments for Monday or Tuesday, but that we should go to the ER if his fever got higher. I said no way at that time too, but that I’d call back tomorrow if piggy backing the Tylenol and Advil every 4 hours didn’t drop the fever below 100.

Lo and behold, Tuesday rolls around and nothing has changed. I called for an appointment. She reiterated her ER suggestion, after I’d already expressed my sentiment that the ER was not happening. I felt like she really did not want us in the office for some reason.

She didn’t know I was pregnant until I told her, but she had to realize that a person who was running a fever for 5 days straight could not drive himself to the ER.

If she had dug in her heels and refused to see him, the shit would have hit the fan in a much bigger way than she would like. I would have insisted that I speak to the doctor himself, who I’ve known for years and who I know for a fact would not be OK with the whole thing. He’s the kind of guy who stays until 6pm when his hours end at 5 because he spends too much time with his patients and takes emergencies when he doesn’t have time for them. My complaints would have been put in writing, and I would have become a titantic, pregnant bitch from hell. Fortunately, that did not have to happen. I like to save that for special occasions. :wink:

He was literally in and out of that office in 15 minutes, anyway, with his test orders and scrips. That’s all I wanted. And he’s a lot better today, which is really what I wanted.

8

Funny, when I had mono they told me the same thing. And two years ago when I had another similar situation they told me to get to the ER, too.

I think maybe it’s to prevent lawsuits? But ER is fucking expensive. And both times it was able to be resolved by ordinary stuff.

I have been to the ER, once. I wish I hadn’t gone, of course. Nothing was life-threatening but I was very young and didn’t know any better.

9

Isn’t the swine flu presenting with a sore throat and high fever? Is it possible that’s what she was thinking and thought he should be seen in the ER because of that? That’s my totally random stab in the dark.

10

If you said certain key words, ER will probably be the preferred option to suggest for triage staff.

Key words like “can’t get up, can’t get out of bed, can’t walk, barely conscious” etc. will tend to trigger this recommendation, and in many health systems will actually trigger the health systemto call 911 and dispatch help to your location, whether you will it or nil it.

Lotsa medical people have been burned by hearing similar descriptors, and telling the patient to come to the office, where they show up in cardiac arrest or septic shock.

11

I didn’t say any of those things. I told her he had a persistent fever that was not helped by analgesics or the antibiotics. He felt just as bad on Tuesday as he did the previous Friday, despite her advice to step up the analgesics to alternating meds every 4 hours. That was all. When I said he “couldn’t get out of bed,” that was a bit of hyperbole, and I didn’t say it to her. He could and did get out of bed, but he was like the shambling dead, and I would not have let him drive himself to the ER.

12

It sounds like a liability issue against the chance your waiting for the time it takes you to get to see a your doctor the patient dies, because they really couldn’t wait that extra half a day. You would have been put a first priority at the emergency room if he was that critical. Learn to live with the fact the doctor can’t work in every person the instant they need to be seen, and they want to cover there ass if you didn’t have the sense to go to the emergency room when it was the right place to have gone. The person scheduling is not able to make a medical diagnoses ever, and the doctor can’t come to the phone for most patients not at the office or he’d never get his scheduled patients seen. He sure wouldn’t diagnose your husband over the phone. Your pregnancy has nothing to do with your husband needing to see the doctor either. A high percentage of patients can give you a reason why they deserve special treatment and should come before other people.

13

Maybe because the doctor doesn’t have chest x-ray or blood culturing equipment in his office?

Having dealt with seriously ill friends and family, I saw this a lot. ALL THE TIME. It seems to be the standard protocol for getting immediate tests and procedures.

It’s also how doctors get patients admitted. My late ex was often sent from the doctor’s office to the ER, in several cases it was because the doctor wanted a procedure or scan done right away and in one case the doctor was suprised by his condition and wanted him admitted.

I also have an oncologist friend that directs patients with emergencies to the ER all the time, …and it is not to save his time because he goes there and meets up with them, they have equipment he doesn’t have in his office.

14

I can see where she is coming from based on my fairly recent experience. I went from feeling just plain bad and calling my primary care doctor to collapsing and unable to be revived within just a few hours. I spent two weeks in the ICU, wasn’t expected to live and it came on with little warning. I am only 36 years old.

The ER has plenty of equipment and more medical professionals than a regular doctors office in case something goes horribly wrong. I know it sucks sitting there for hours but there was the real possibility that your husband may have needed that chest x-ray in which case you might be telling us how thankful you were for her judgement.

15

One thing I’ve noticed is that lots of people seem to ignore urgent care as a potential way to address a medical problem. You hear so much about ER overuse, and I’m not sure why you don’t hear about urgent care more often as a potential solution. It usually costs you more out of pocket than primary care, but is way less expensive on an overall basis than the ER. For a while my primary care had an urgent care branch right next door. That seemed to work well for them.

16

Clearly, he wasn’t at death’s door, or I would have taken him to the ER. It was a matter of him needing additional tests. The quickest way to do this is to see the doctor or nurse, get the orders, and go to the lab. This is precisely what happened, and it took less than an hour total. A trip to the ER would have likely taken 4-5 hours for the same result. My way was more efficient and had the identical outcome.

One must wonder if you’ve been reading along. He wasn’t that critical. That’s why I didn’t want to abuse the ER. He simply needed the correct medication, for which he needed a blood test. Does this seem like an appropriate use for the ER to you? I live perfectly fine with the fact that we actually never saw the doctor at all, we saw the nurse for a whole 15 minutes, a day and a half after my first call to her. I see no indication in my words that I required or demanded immediate attention, and I know for a fact we wouldn’t have gotten it at the ER.

Wow, again, you didn’t read what I wrote. I never expect to see or speak to the doctor. The thread title even includes the word “nurse.” I never asked for a diagnosis over the phone. I asked for an appointment. I was hassled about getting one over the course of two days. Turns out that my decision as to the course of action was correct, and was vindicated by the outcome.

Nor did the pregnancy warrant “special treatment.” It was another good reason not to want to sit in an ER full of sick people for multiple hours unless it was necessary… which it was not.

I had to know that someone was going to come in here and play the “turn it around on the OP game.” Glad we got that over with.

He doesn’t, but the lab in the urgent care facility (not the hospital) is in the same office park. Write the orders, roll on over to the lab. Much easier and more efficient than going to the ER IMO. Someone needed to see my husband in order to write those orders, though. That was the hang up, seeing him. Turns out it was pretty damn quick.

17

We went to urgent care on Saturday, got some medicine that didn’t work. We also used the urgent care for the blood work we got yesterday. I’m not averse to using urgent care, but in this situation, I’d rather see my family doctor and then, test orders in hand, bypass the whole “wait in the waiting room to see an unfamiliar doctor to get the same orders” thing. If we saw the doctor or nurse, and she said, well, you really need to be admitted to the hospital, then we would have proceeded immediate to the hospital. This is exactly what would have happened at urgent care, except it would have taken many hours longer, in a much more crowded waiting room.

18

Yes I really read your post and you took my comments like I expected. There is no point in repeating them. It’s obvious we won’t connect on what I said. The nurse isn’t crazy.

19

No, we won’t, because your disagreements with me weren’t fact based. Some of them were in fact a bit insulting and bound to ruffle my feathers, as you must have known when you posted them. A sampling of your errors include:

–“You would have been put a first priority at the emergency room if he was that critical.”

Never said he was critical. Just needed some blood work. No need for an ER, just some lab orders. Imagine a person with mono. He’s just feverish and miserable, but totally stable. Would that person get put at the top of the list in an ER? Nope. He would sit there, languishing, likely for many hours. This is what I wanted to avoid. That, and the expense.

–“Learn to live with the fact the doctor can’t work in every person the instant they need to be seen, and they want to cover there ass if you didn’t have the sense to go to the emergency room when it was the right place to have gone.”

Your tone is rude and you are making a false assumption that I wanted him to be seen right away, when I in fact waited 2 days. Also, don’t like the implication that I am lacking sense. Believe me, we’d have been to the ER PDQ if he needed to go. He didn’t.

–“He sure wouldn’t diagnose your husband over the phone.”

Yeah, where did I say that I wanted that? I just wanted an appointment and tried for 2 days to get one.

–"Your pregnancy has nothing to do with your husband needing to see the doctor either.A high percentage of patients can give you a reason why they deserve special treatment and should come before other people. "

It has everything to do with wanting to avoid the ER, though. One would expect that I would not enjoy the implication that I wanted “special treatment” because I wanted a doctor’s appointment. I didn’t demand one immediately, or even the first time I called.

Think about it: I called at noon. We got an appointment for 3:30. The waiting room was empty when we got there and waited less than 5 minutes to see the nurse. Several patients left and arrived in the time we were there, so it’s not that they were closing up and we were making them stay late. She saw him for 15 minutes, we went to the lab, which was in the same office park, got the tests, and were home by 4:30. Now, if I’d gone to the ER at noon, do you think we would have been home by 4:30? Even if so, we would have spent 4 hours in a waiting room to achieve the same effect. Am I such an entitled bitch for wanting to avoid that? Can you see the merit of my position? The nurse did, eventually, when I explained it to her.

No, she just didn’t want to deal with it. I retract the accusation of insanity and substitute “didn’t think it through.” Once we spoke, she did see it my way and it worked out.

20

I can’t stand “wives from hell” like this. Do you think that it’s cute that if you don’t get what you want, you can become a “titantic(?) bitch” and throw a big fit? Did that work for you when you were 5? Come on- a difference of opinion, a disagreement, that’s one thing, but nobody has the right to flip out on someone that’s just doing their job, and probably saying what the doctor told her to say in the first place. Acting out like this in the office I work in will get you dismissed, thank og. Respectful communication is much more likely to result in your satisfaction than being a bitch.