Friday, March 22, 2013

Nurse Practitioners Walk The Line

I often find myself wishing for the good old days when your family doctor was truly a part of your community. Back in the prairie days, docs and teachers would rotate staying in family's homes and often ate dinner with people in their community. People appreciated their care and the medical provider had a vested interest in helping people. Too often, many health care providers don't really know anything about their patients and aspects that influence the decisions they make in life. We are such a litigious society and providers are all about the numbers game. I have socialized with patients outside of taking care of them at work. (My husband and I have gone to the movies with a patient and her daughter, and they have come to our home for dinner) That doesn't mean that I would ever do something for them extraordinarily or outside what the normal care would entail. They know that once I leave work, I don't cross that line again until I clock in the next morning. You have to make hard fast boundaries such as I NEVER write any controls for anyone that I have ever seen outside work. I don't show favoritism in scheduling or callbacks. I don't discuss their healthcare outside of the office. If they need a script for something, they have to see me in the office and it's all documented in their chart.
I work in a very small community and every day people ask me how so and so is doing or that so and so sent me to see you because you take such great care of them and you really listen to their concerns. I find it stupid that I cannot officially acknowledge that fact, due to privacy laws, that I do take care of people here. It's not like they don't know already. They just passed each other in the waiting room for God's sake. Whatever happened to the good old days when people proudly proclaimed that you were their healthcare provider and you didn't have to look around to see if anyone else heard them?  I have constantly remind them that if they try to ask me a medical question about their care outside the office, that they are officially breaking their own privacy because it could be overheard by others at the restaurant that I was eating lunch at.
What you do think about it?


  1. Amy J5:37 PM

    I understand what you are saying. I am getting ready to graduate as an NP in 4 months and I have been completing my residency for my DNP at a small rural health clinic. Unfortunately, I know many of my patients outside of work, and several of my patients are friends that started coming to this clinic simply because I was there. I have had email requests to ask for refills of a medication and have also had facebook messages concerning medical questions. This in a way flatters me that they value my opinion, but there is a much stronger feeling of annoyance because my Facebook time and time outside work is time with my family and I don't want to have to think about what is going on at the office. I know that I have to set boundaries and start before I even graduate to nip these behaviors in the butt, but how do you eloquently tell your friends that work is work and home is home and you don't care to mix the two?

  2. Don't even get me started! I was told recently that I can no longer email with my patients because our firewall isn't strong enough...that it is a HIPAA violation! I stopped blogging because it was likely that anyone could see themselves in my stories.

  3. I am not a nurse practitioner, but as a nurse I do understand the context of your post. I am torn in my response because I do believe that in the past when were able to make a personal impact this created a relationship that enhanced the healthcare compliance and overall patient outcomes; now a days I feel like I am avoiding patients in public so that I don't have to act as if I haven't seen them before in fear someone will want to know how we know each other. Then on the other hand, as one commenter mentioned, it is so annoying and inappropriate when getting face book messages for advice on personal, confidential, health information. I think there has to be a balance and I think it is very wise of you to emphasize that you will be keeping the two separate as this creates clear expectations for both parties. I find nothing to be easy anymore in healthcare; lots of input from politicians and less from healthcare professionals!