How Do You Make Them See The Light?

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I see so many patients that are in various stages of mental health difficulties. Most are coping fairly well, but a few are not doing as well as others due to the time of year. I am sure that you all have noticed that October through January is a tough time for patients due to family member losses, changes in their income, insurance status or just the winter time blues.

I screen for anxiety and depression on just about every visit and it's not hard to do. Just ask them, "How are you really doing?" You will amazed at the number of patients who are struggling and just wanted someone to listen. In the rural setting where I work there is almost no access to mental health resources. It would be nice to just sit and talk to patients and counsel them but I only get paid by seeing them for medical reasons. I wish that we were in the old days when your health care provider took care of the entire person. I feel like the trend may be coming back with nurse practitioner led medical homes.

Unfortunately, I also get patients who try to take advantage of my concern for their mental health and ask for inappropriate medications such as xanax or valium without having tried any of the baseline drugs such as Celexa, Prozac, Lexapro, and Wellbutrin etc. I ESPECIALLY hate when patients ask for meds by their street names. Don't they realize that it makes big bells ring in our heads when that happens? Or the usual "I've tried all those and the ONLY thing that works is Xanie bars." I tell them that if that is the only medication that works, then they need to be under the care of a psychiatrist and that it's out of my scope of practice in Florida to write those meds.

As soon as our expansion finishes, I hope to hear that a mental health counselor will be available to help us with the longer consultations that are needed. For you new NPs, brush up on your mental health meds because it's becoming more and more part of Family practice.

Change of Shift Is Up At Emergiblog

It's that time again! Change of Shift is up over at Emergiblog. My post was chosen as her editor's pick and I am honored. I only wish that I could write as well as Kim. Click here to enjoy!

He's Gotta Ticket To Ride and The NP Says It's Okay

I had a new patient show up at the office the other day and my office nurse called me into the room quickly. She was concerned when he said that he was a diabetic and that he hadn't been feeling well for the last few days. As my trusty nurse knows to do, she got a glucose reading which said "hi". He also showed her a draining abdominal wound. His color was a a pasty greyish tone and he was slightly diaphoretic.

After obtaining a set of vitals, I told the nurse to prepare to make a call to EMS for transport to the local hospital for this patient. He asks why I think that he needs to be admitted and I proceed to explain the significance of "hi" on a glucose monitor and the likelihood that his sugar was at least 500 and was probably higher and that he needed IV antibiotics, fluids, and monitoring for a few days. With a grateful smile, he said okay. I left my nurse to monitor him and to give report to the EMS for me as I had several other patients that had been waiting.

 After I finished with the patient, I asked my office nurse if the information was handed to the EMS and she was rather upset. She said that the female paramedic walked into the room and said "oh, it's you again to the patient." Excuse me? My nurse responded. The paramedic said,"  We've taken him to the hospital a few times and that the ER just releases him and tells him to find a primary." She asks the patient, "So, what's wrong with you now?" To which he replies, "I'm sorry to bother you again." The paramedic turns to my office nurse who proceeds to give report of a blood sugar of hi and that he has an infection that needs to be checked. The paramedic then proceeds to question whether our machine was right so she goes out to get their machine off the ambulance to recheck our work.

Well.....that just pissed in my office nurse's coffee.. Here's what she said, after of course, their monitor read hi too.

"First off,  this man is a new patient to us and he is very ill. We don't care how many times that he's been taken to the hospital before, if my NP says he needs to be seen, then he goes." Second of all, turning to the patient, "you don't EVER have to apologize for being ill. You are here obtaining primary care from my NP and when you get out of the hospital, you come back and we'll see how you are doing and make a plan from there." She hands the EMT his packet of paperwork and tells the patient "here's your ticket to ride and it'll be okay."

Footnote: He was admitted with a blood sugar of 654 and was in for three days. He came back to the office for a follow up and states that he was feeling much better now. He thanked us profusely for my nurse making him feel important enough to take care of.

How sad is that? I was so angry that a patient was made to feel that they were a bother and that they weren't good enough to treat with common respect. Don't get me wrong, I get a little burned out by some of my difficult patients. You can better believe that they leave my office feeling like they are the only patients of mine to take care of  because that's my job.
If you don't like your job, find another one. Just find another one that's not in health care.