My most recent NP referral...

[BoardingDoc]

So last night I had a 40F come in at the behest of the NP at her PCP's office. She was rear ended the day before. No airbags, self extricated, restrained etc etc. Now has some anxiety about driving and has some diffuse back pain. Gradual onset. NP sent her in for imaging of some kind. I assume it's for a BS Head CT request and look up the records. This is verbatim from the chart.

"...with her overall, complete body pain, including CVA tenderness, patient is advised to go to the ED for possible pan scan ...
Called CT to see if there was the possibility of a Pan Scan. Not available in this outpatient setting. Options only for head, neck, torso imaging ... Sent to ER for further evaluation and management."

So this NP got a chief complaint of TBD after a minor MVC ... thinks the patient needs a pan scan ... calls rads to order a Pan scan and is told "there isn't an order for that. You can order a head, neck and torso though" ... takes this to mean that she can't image the patient because she apparently doesn't know what "pan scan" actually means ... sends the patient to the ER for a "pan scan" who I summarily discharge with no workup and a few tabs of flexeril for her back spasms.

I get all sorts of *****ic transfers, but this was truly special. She was dumb enough to want a full trauma scan for a BS complaint, but then yet even dumber to the point that she didn't actually know what that scan was and thankfully couldn't figure out how to needlessly irradiate this woman's entire body.

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[Neopolymath]

We can't make our beach house mortgage payments if you keep blocking these 2 minute negative panscans we do as a break between all the negative CTAs the midlevels order from the waiting room.

-Rads /s

 

[FlaminHotER]

This is emergency medicine folks…

 

[southerndoc]

I had somebody transferred the other day who fell down 3 steps and needed a CT of her lumbar spine. She was too heavy to fit on the table. They transferred her, I examined her and determined she had no midline tenderness, and then discharged her without ordering any imaging.

 

[RustedFox]

Did I see "TBD" (total body dolor) creep it's way in there?

That's racist, you're a racist. Cancel BoardingDoc /s.

Also, this needs to be posted to r/Noctor.

 

[WilcoWorld]

Turned the thread political by post #5, is that a record?

 

[WilcoWorld]

So last night I had a 40F come in at the behest of the NP at her PCP's office. She was rear ended the day before. No airbags, self extricated, restrained etc etc. Now has some anxiety about driving and has some diffuse back pain. Gradual onset. NP sent her in for imaging of some kind. I assume it's for a BS Head CT request and look up the records. This is verbatim from the chart.

"...with her overall, complete body pain, including CVA tenderness, patient is advised to go to the ED for possible pan scan ...
Called CT to see if there was the possibility of a Pan Scan. Not available in this outpatient setting. Options only for head, neck, torso imaging ... Sent to ER for further evaluation and management."

So this NP got a chief complaint of TBD after a minor MVC ... thinks the patient needs a pan scan ... calls rads to order a Pan scan and is told "there isn't an order for that. You can order a head, neck and torso though" ... takes this to mean that she can't image the patient because she apparently doesn't know what "pan scan" actually means ... sends the patient to the ER for a "pan scan" who I summarily discharge with no workup and a few tabs of flexeril for her back spasms.

I get all sorts of *****ic transfers, but this was truly special. She was dumb enough to want a full trauma scan for a BS complaint, but then yet even dumber to the point that she didn't actually know what that scan was and thankfully couldn't figure out how to needlessly irradiate this woman's entire body.

I'm trying to think of alternate interpretations of "pan scan".
A scan of the pannus?
Put them on the trauma pan (i.e.: back board), and scan them?

 

[Neopolymath]

I'm trying to think of alternate interpretations of "pan scan".
A scan of the pannus?
Put them on the trauma pan (i.e.: back board), and scan them?

Next level NP thinking about a pannus CT for Dercum's disease. Good detective work.

 

[JacobMcCandles]

She just wanted an ocular pan scan. This shows the failure of the entire educational system from the NP to the patient. The NP is an idiot. Unless the patient needed to be ‘seen’ for insurance purposes then they have not learned anything from their life experiences.

 

[TooMuchResearch]

So last night I had a 40F come in at the behest of the NP at her PCP's office. She was rear ended the day before. No airbags, self extricated, restrained etc etc. Now has some anxiety about driving and has some diffuse back pain. Gradual onset. NP sent her in for imaging of some kind. I assume it's for a BS Head CT request and look up the records. This is verbatim from the chart.

"...with her overall, complete body pain, including CVA tenderness, patient is advised to go to the ED for possible pan scan ...
Called CT to see if there was the possibility of a Pan Scan. Not available in this outpatient setting. Options only for head, neck, torso imaging ... Sent to ER for further evaluation and management."

So this NP got a chief complaint of TBD after a minor MVC ... thinks the patient needs a pan scan ... calls rads to order a Pan scan and is told "there isn't an order for that. You can order a head, neck and torso though" ... takes this to mean that she can't image the patient because she apparently doesn't know what "pan scan" actually means ... sends the patient to the ER for a "pan scan" who I summarily discharge with no workup and a few tabs of flexeril for her back spasms.

I get all sorts of *****ic transfers, but this was truly special. She was dumb enough to want a full trauma scan for a BS complaint, but then yet even dumber to the point that she didn't actually know what that scan was and thankfully couldn't figure out how to needlessly irradiate this woman's entire body.

Insert Oof meme here.

 

[WilcoWorld]

She just wanted an ocular pan scan. This shows the failure of the entire educational system from the NP to the patient. The NP is an idiot. Unless the patient needed to be ‘seen’ for insurance purposes then they have not learned anything from their life experiences.

Is an ocular pan scan a transfer of liability that only requires eyeballing of a patient by a BCEP?

 

[cyanide12345678]

So last night I had a 40F come in at the behest of the NP at her PCP's office. She was rear ended the day before. No airbags, self extricated, restrained etc etc. Now has some anxiety about driving and has some diffuse back pain. Gradual onset. NP sent her in for imaging of some kind. I assume it's for a BS Head CT request and look up the records. This is verbatim from the chart.

"...with her overall, complete body pain, including CVA tenderness, patient is advised to go to the ED for possible pan scan ...
Called CT to see if there was the possibility of a Pan Scan. Not available in this outpatient setting. Options only for head, neck, torso imaging ... Sent to ER for further evaluation and management."

So this NP got a chief complaint of TBD after a minor MVC ... thinks the patient needs a pan scan ... calls rads to order a Pan scan and is told "there isn't an order for that. You can order a head, neck and torso though" ... takes this to mean that she can't image the patient because she apparently doesn't know what "pan scan" actually means ... sends the patient to the ER for a "pan scan" who I summarily discharge with no workup and a few tabs of flexeril for her back spasms.

I get all sorts of *****ic transfers, but this was truly special. She was dumb enough to want a full trauma scan for a BS complaint, but then yet even dumber to the point that she didn't actually know what that scan was and thankfully couldn't figure out how to needlessly irradiate this woman's entire body.

At least she tried to do the work herself by ordering the test lol.

Even a first year med student would know what a pan scan is.

I don’t know why NPs think that medicine is learned by writing papers on BS topics 🤣

 

[CajunMedic]

Unless the patient needed to be ‘seen’ for insurance purposes then they have not learned anything from their life experiences.

Ah, yes. The old "Pre-litigation physical"

 

[Fox800]

At least she tried to do the work herself by ordering the test lol.

Even a first year med student would know what a pan scan is.

I don’t know why NPs think that medicine is learned by writing papers on BS topics 🤣

What a pan scan is? Maybe. Ordering a pan scan? Dude a noctor would probably order a CT everything with and without contrast, with oral contrast, and forget dedicated spinal imaging.

 

[thegenius]

I love these threads. We get them a few times a month. First post is the ridiculous mid level occurrence, then it’s like 25-50 posts all admonishing the ridiculousness like we always do and then we move on

 

[JacobMcCandles]

I had a referral yesterday from an urgent care NP for “r/o osteo and IV abx” from a mildly infected sebaceous cyst on a guy’s upper back.

*Looks at the area*…osteo ruled out.

 

[emergentmd]

OPs tenure at this hospital will be short once admin finds out that you let a 100K payment out the door.

I jest but auto insurance are about the highest paying coverage there is. You just lost a huge bonus for the NP

 

[Tenk]

 

[WorkNoteEmergency]

I got one a few days ago for a little old lady with dysuria and clean UA (I mean pristine clean) but sent by the NP to ED for “admit and IV abx” because she had a multi drug resistant urine culture a couple of weeks before. I ask the very nice lady if she had any rashes and she said “ yes, I wear a diaper for my incontinence at night and it’s been irritating me”.I take a peek at her yeast infection, treat that and send her home.

 

[hoot504]

I mean I get boneheaded MD referrals on a fairly regularly basis as well. Outpatient dimers come to mind. Patient gets a frantic call to get to the ER for their dimer of 501. Of course, I’ll do the scan, but why are you working up PEs as an outpatient?

 

[NYEMMED]

I mean I get boneheaded MD referrals on a fairly regularly basis as well. Outpatient dimers come to mind. Patient gets a frantic call to get to the ER for their dimer of 501. Of course, I’ll do the scan, but why are you working up PEs as an outpatient?

I’m confused by this, is there a medical rule that says PEs don’t occur outpatient?

 

[Zebra Hunter]

I’m confused by this, is there a medical rule that says PEs don’t occur outpatient?

It’s like ordering a troponin in an outpatient setting. Sure, you can do it, but doing so is rife with medicolegal liability, and both dimers and trops are generally considered inappropriate tests to order outside of settings where a physician is waiting to act on results immediately and in a location where a patient can be monitored closely for the feared condition.

 

[VA Hopeful Dr]

It’s like ordering a troponin in an outpatient setting. Sure, you can do it, but doing so is rife with medicolegal liability, and both dimers and trops are generally considered inappropriate tests to order outside of settings where a physician is waiting to act on results immediately and in a location where a patient can be monitored closely for the feared condition.

Exactly. In outpatient if you're worried about a PE just get a stat CT scan done.

 

[TeddyBoomBoom]

Literally yesterday:

Super worried elderly couple drove to the ED from urgent care for their “emergent CTA” to evaluate their likely “hemorrhagic stroke.”

Pt had a clear-as-day mild subconctival hemorrhage and ZERO symptoms other than the subconjunctival blood.

I asked them if they had the UC paperwork because I told them I didn’t believe a physician would have told them that. Sure enough they had the paperwork… Jenny McJennerson.

😞

 

[RustedFox]

Literally yesterday:

Super worried elderly couple drove to the ED from urgent care for their “emergent CTA” to evaluate their likely “hemorrhagic stroke.”

Pt had a clear-as-day mild subconctival hemorrhage and ZERO symptoms other than the subconjunctival blood.

I asked them if they had the UC paperwork because I told them I didn’t believe a physician would have told them that. Sure enough they had the paperwork… Jenny McJennerson.

😞

Hooooo boy.

 

[Beeftenderloin]

Exactly. In outpatient if you're worried about a PE just get a stat CT scan done.

What if you’re an outpatient PCP (which I am not) and NOT worried about a PE, patient low risk by Wells but also histrionic, anxious pressuring you to do SOMETHING to make sure they’re not dying of a PE.

PCP: This is unlikely to be a PE, but to be sure we’ll check this test, and if it’s negative you can rest assured you don’t have one.

::test comes back::

PCP: aww beans…

 

[Rekt]

What if you’re an outpatient PCP (which I am not) and NOT worried about a PE, patient low risk by Wells but also histrionic, anxious pressuring you to do SOMETHING to make sure they’re not dying of a PE.

PCP: This is unlikely to be a PE, but to be sure we’ll check this test, and if it’s negative you can rest assured you don’t have one.

::test comes back::

PCP: aww beans…

Shocking concept of explaining it to the patient.

“By our literature standards and risk stratification, you’re essentially as close to zero percent chance of having a blood clot as we can get. Sometimes ordering unnecessary tests can lead to actual harm.”

 

[RustedFox]

Shocking concept of explaining it to the patient.

“By our literature standards and risk stratification, you’re essentially as close to zero percent chance of having a blood clot as we can get. Sometimes ordering unnecessary tests can lead to actual harm.”

Since when do the muggles listen to anything we have to say?

 

[VA Hopeful Dr]

What if you’re an outpatient PCP (which I am not) and NOT worried about a PE, patient low risk by Wells but also histrionic, anxious pressuring you to do SOMETHING to make sure they’re not dying of a PE.

PCP: This is unlikely to be a PE, but to be sure we’ll check this test, and if it’s negative you can rest assured you don’t have one.

::test comes back::

PCP: aww beans…

Bilateral leg doppler study. Its fairly cheap, no radiation, its a decently involved study so the patient feels like its super cereal, and if negative and zero other risk factors I feel pretty good saying there's no PE.

If I was salaried and patient satisfaction played no role in my compensation I would do what @Rekt described.

But since I'm not and it does, I don't fight patients on much outside of opioids and xanax.

 

[DocEspana]

Did I see "TBD" (total body dolor) creep it's way in there?

That's racist, you're a racist. Cancel BoardingDoc /s.

Also, this needs to be posted to r/Noctor.

Nah. The patient was Haitian, so it was total body doulè.

Very different.

 

[DocEspana]

Ah, yes. The old "Pre-litigation physical"

down in Miami this is so common that people show up with written requests from their attorney that they need CT or MRI of their involved spinal areas (and uninvolved areas too, if you could) and that they will NOT ACCEPT any flat plate imaging.

The attorneys know that a vague un-imaged complaint of "something is wrong since the accident but the doctor never checked" is 100x better than a document in the record stating "No acute pathology on 2-view lumbar spine study." Obviously a study prone to incidentaloma findings is the gold standard.

*These* people make me happy, because they are the ones that I hope have not even read their own letter they bring in to me. I try to convince them (very gently) to get the flat plate imaging just so I can derail the frivolous lawsuit that has a 1:1 relationship with those letters.

 

[DocEspana]

Bilateral leg doppler study. Its fairly cheap, no radiation, its a decently involved study so the patient feels like its super cereal, and if negative and zero other risk factors I feel pretty good saying there's no PE.

If I was salaried and patient satisfaction played no role in my compensation I would do what @Rekt described.

But since I'm not and it does, I don't fight patients on much outside of opioids and xanax.

I was going to suggest benign but convincing tests - I do the same thing in the ED. If a patient comes in with a fully unnecessary test in mind and I cant easily* convince them its not needed, I try to figure out what the cheapest and least irradiating test is that I can do instead and then I hype it the hell up. Often its a random inflammatory marker test that I can easily explain away even if mildly elevated or a bedside echo that I can narrate to them live. Official u/s if I need the CYA element.

* if it takes any effort - they are just trying mentally figure out how to phrase their complaint about me. I've learned that lesson many times. Any good thing you say to a patient will be grossly misquoted and put on a complaint letter entirely out of context.

 

[Brigade4Radiant]

down in Miami this is so common that people show up with written requests from their attorney that they need CT or MRI of their involved spinal areas (and uninvolved areas too, if you could) and that they will NOT ACCEPT any flat plate imaging.

The attorneys know that a vague un-imaged complaint of "something is wrong since the accident but the doctor never checked" is 100x better than a document in the record stating "No acute pathology on 2-view lumbar spine study." Obviously a study prone to incidentaloma findings is the gold standard.

*These* people make me happy, because they are the ones that I hope have not even read their own letter they bring in to me. I try to convince them (very gently) to get the flat plate imaging just so I can derail the frivolous lawsuit that has a 1:1 relationship with those letters.

Isnt the attorney practicing medicine? They don’t determine who needs what imaging

 

[GonnaBeADoc2222]

Shocking concept of explaining it to the patient.

“By our literature standards and risk stratification, you’re essentially as close to zero percent chance of having a blood clot as we can get. Sometimes ordering unnecessary tests can lead to actual harm.”

Bro sometimes you gotta take the path of least resistance in order to preserve sanity.

Things I draw the line on: Narcotics, unnecessary tests / interventions on children, unnecessary consults, unnecessary MRIs, non emergent outpatient procedures (paracentesis, LP for intracranial hypertension)

 

[BoardingDoc]

Bro sometimes you gotta take the path of least resistance in order to preserve sanity.

Things I draw the line on: Narcotics, unnecessary tests / interventions on children, unnecessary consults, unnecessary MRIs, non emergent outpatient procedures (paracentesis, LP for intracranial hypertension)

The number of LPs that I have done on patients who were "sent to the ER for an LP" is almost zero, and it isn't because I don't get several of these referrals a year.

The last few I remember:
LP for pseudotumor rule out. No.
LP for lyme meningitis in a patient with a +lyme test and 4 weeks of HA. No.
LP for vaguely altered mental status in a gomer with dementia. No.

 

[DocEspana]

Isnt the attorney practicing medicine? They don’t determine who needs what imaging

Not at all. They are letting you know that they, as power of attorney (or just an advocate for the patient), have pre-declined any flat plate imaging study I might offer. They're just letting me know the patients preferences so I don't feel tempted to ask the patient and discover the patient may actually express a different opinion.

 

[southerndoc]

down in Miami this is so common that people show up with written requests from their attorney that they need CT or MRI of their involved spinal areas (and uninvolved areas too, if you could) and that they will NOT ACCEPT any flat plate imaging.

The attorneys know that a vague un-imaged complaint of "something is wrong since the accident but the doctor never checked" is 100x better than a document in the record stating "No acute pathology on 2-view lumbar spine study." Obviously a study prone to incidentaloma findings is the gold standard.

*These* people make me happy, because they are the ones that I hope have not even read their own letter they bring in to me. I try to convince them (very gently) to get the flat plate imaging just so I can derail the frivolous lawsuit that has a 1:1 relationship with those letters.

I once had one of these letters from an attorney. I wrote a response on hospital letterhead detailing Canadian head/cervical spine CTs, refused to order any imaging, and sent the patient out.

 

[TooMuchResearch]

Not at all. They are letting you know that they, as power of attorney (or just an advocate for the patient), have pre-declined any flat plate imaging study I might offer. They're just letting me know the patients preferences so I don't feel tempted to ask the patient and discover the patient may actually express a different opinion.

What under developed hole do you live in?
*checks notes*
Florida? Sounds about right.

 

[Fox800]

I once had one of these letters from an attorney. I wrote a response on hospital letterhead detailing Canadian head/cervical spine CTs, refused to order any imaging, and sent the patient out.

Yep. Outpatient non-emergent studies can be ordered by PMD. Discharge.

 

[Fox800]

What if you’re an outpatient PCP (which I am not) and NOT worried about a PE, patient low risk by Wells but also histrionic, anxious pressuring you to do SOMETHING to make sure they’re not dying of a PE.

PCP: This is unlikely to be a PE, but to be sure we’ll check this test, and if it’s negative you can rest assured you don’t have one.

::test comes back::

PCP: aww beans…

YEARS criteria + age-adjusted D-Dimer is reducing the number of CT pulmonary angiograms we have to order. 10/10 would use again.

 

[wareagle726]

I got Jenny'd last night and it really was worse than the usual.

You previously healthy female(adult age) went to UC night before last with headache, nausea, vomiting, neck pain for a week. No fever. Was told "you have meningitis" verbally to the patient. She shows up the the ER the next night...unfortunately my ER. Mom in tow. Mom has bags packed because she's been researching meningitis and thinks her little girl is dying.

I walk in. hi I'm Dr. wareag..."why haven't you started antibiotics yet?!?!? my daughter is dying"

I have to basically pry the tik-tok machine out of the girl's hands. She looks great. Maybe a little sick...like migraine or viral sick...not a week into meningitis sick. Literally no fever ever. I called the urgent care and the NP that saw her wasn't there so I had the secretary read the note to me. Not one mention of meningitis. Diagnosis, headache BUT there was the instruction to go to the ER after leaving. In the exam, RIGHT sided neck tenderness is noted. I suspect he/she just told them verbally she had meningitis.

Now this leads to the 2 hours of getting labs, assuring that all labs don't point toward meningitis, talk about "a needle this big into your spine" and medicate with migraine cocktail until she is smiling and says she wants to go home. Mom kept saying that the doctor last night told her she had meningitis so why are you saying differently. Finally I just broke down and told her that her daughter was seen by a significantly less trained NP who in all likelihood had never seen a case of meningitis and certainly had never done an LP and probably wouldn't even know how to interpret one. A lightbulb actually came on in her mind and she got it.

Just frustrating.

 

[GonnaBeADoc2222]

I got Jenny'd last night and it really was worse than the usual.

You previously healthy female(adult age) went to UC night before last with headache, nausea, vomiting, neck pain for a week. No fever. Was told "you have meningitis" verbally to the patient. She shows up the the ER the next night...unfortunately my ER. Mom in tow. Mom has bags packed because she's been researching meningitis and thinks her little girl is dying.

I walk in. hi I'm Dr. wareag..."why haven't you started antibiotics yet?!?!? my daughter is dying"

I have to basically pry the tik-tok machine out of the girl's hands. She looks great. Maybe a little sick...like migraine or viral sick...not a week into meningitis sick. Literally no fever ever. I called the urgent care and the NP that saw her wasn't there so I had the secretary read the note to me. Not one mention of meningitis. Diagnosis, headache BUT there was the instruction to go to the ER after leaving. In the exam, RIGHT sided neck tenderness is noted. I suspect he/she just told them verbally she had meningitis.

Now this leads to the 2 hours of getting labs, assuring that all labs don't point toward meningitis, talk about "a needle this big into your spine" and medicate with migraine cocktail until she is smiling and says she wants to go home. Mom kept saying that the doctor last night told her she had meningitis so why are you saying differently. Finally I just broke down and told her that her daughter was seen by a significantly less trained NP who in all likelihood had never seen a case of meningitis and certainly had never done an LP and probably wouldn't even know how to interpret one. A lightbulb actually came on in her mind and she got it.

Just frustrating.

Infuriating.

However, the best part is being able to connect with and educate the mother and guide her to realize and agree that the Jennerson is inferior, and is the root cause of her anxiety and ER visit.

I don't hesitate to throw NPs, PAs, and quite frankly incompetent MDs/DOs who are practicing in Urgent Scares and send this dumb **** in

-Cellulitis, not on MRSA coverage, now shockingly worse
-Clavicle fx, seen on UC XR
-Simple lacerations
-Corneal abrasions.
-Uncomplicated I&Ds
-UTI, on Cipro, now shockingly worse
-"Abnormal EKG" in a 22 yo as read by the machine; EKG normal (by MD reading it) in ED

I take care to explain to them that whatever quack saw them in the UC should have been able to handle this easily, apologize for their wasted time and money, and encourage them to seek the care of a qualified PHYSICIAN the next time.

 

[Sushirolls]

I'm doing my own general adult OP private practice for psych.
Half my job some weeks is un-funning midlevels diagnosis or prescribing messes.

I did recently have one of my patients present to my local BFE ED, which is often FM staffed, and one FM told patient, their effexor intolerance was serotonin syndrome - gave ativan - and discharged. I got records. Doc noted clearly doesn't have XYZ symptoms, but yet still diagnosed as serotonin syndrome and discharged. Patient had been freaked out, I get the task of pointing out no, it wasn't SS, and there is a specific criteria, and you did not meet the criteria. We won't be putting this down as an allergy, just a garden variety intolerance... "But the doc said I had SS?!?"

Hard to delicately tell patient, EM can be... less detailed ... but will do great in decision tree, death or no death, and help you discharge alive. The rest is usually less important to them, and remember that's their goal. Get you discharged alive, as fast as possible. Started to sink in a bit at that moment for the patient.

 

[southerndoc]

Get this crap: Local nurse practitioners sue Interior Health over wage disparity with doctors - Kelowna News

NPs in Canada are suing because they aren't paid as much as physicians! What is the world coming to? They claim to be equal to physicians despite numerous studies showing higher readmission rates, higher complications, and more resource utilization (usually imaging), but when they are sued, they claim they can't be held to the standard of a physician. Who in their right mind would pay the same salary for an NP and a physician? Who would choose an NP over a physician? In a way I hope they win so they can all be out of jobs.

 

[JacobMcCandles]

I got Jenny'd last night and it really was worse than the usual.

You previously healthy female(adult age) went to UC night before last with headache, nausea, vomiting, neck pain for a week. No fever. Was told "you have meningitis" verbally to the patient. She shows up the the ER the next night...unfortunately my ER. Mom in tow. Mom has bags packed because she's been researching meningitis and thinks her little girl is dying.

I walk in. hi I'm Dr. wareag..."why haven't you started antibiotics yet?!?!? my daughter is dying"

I have to basically pry the tik-tok machine out of the girl's hands. She looks great. Maybe a little sick...like migraine or viral sick...not a week into meningitis sick. Literally no fever ever. I called the urgent care and the NP that saw her wasn't there so I had the secretary read the note to me. Not one mention of meningitis. Diagnosis, headache BUT there was the instruction to go to the ER after leaving. In the exam, RIGHT sided neck tenderness is noted. I suspect he/she just told them verbally she had meningitis.

Now this leads to the 2 hours of getting labs, assuring that all labs don't point toward meningitis, talk about "a needle this big into your spine" and medicate with migraine cocktail until she is smiling and says she wants to go home. Mom kept saying that the doctor last night told her she had meningitis so why are you saying differently. Finally I just broke down and told her that her daughter was seen by a significantly less trained NP who in all likelihood had never seen a case of meningitis and certainly had never done an LP and probably wouldn't even know how to interpret one. A lightbulb actually came on in her mind and she got it.

Just frustrating.

Most of this is because most of these midlevels (and especially ones working in an urgent care) haven't seen a true case of meningitis as you mention. They don't understand what meningismus is or looks like. Like most everything with them, I blame their training. They probably think this lady had meningitis. They don't know that your concern for meningitis went to 0% after 10 seconds in the room. Frustrating because you have been set up for a negative patient encounter before you've even seen the patient. There's literally no way you can get out from behind the 8 ball with this patient at this point.

 

[thegenius]

Most of this is because most of these midlevels (and especially ones working in an urgent care) haven't seen a true case of meningitis as you mention. They don't understand what meningismus is or looks like. Like most everything with them, I blame their training. They probably think this lady had meningitis. They don't know that your concern for meningitis went to 0% after 10 seconds in the room. Frustrating because you have been set up for a negative patient encounter before you've even seen the patient. There's literally no way you can get out from behind the 8 ball with this patient at this point.

completely agree. I see meningitis like once/year. It's pretty rare. I can't remember the last time I had a confirmed case of meningitis.

Actually I do! It was an 8 day old with a fever 38.5, it was unfortunately a bloody LP but CSF grew enterovirus.

It's so funny how people who look great and are well appearing can be thought by a mildly educated health care professional to have a dangerous and deadly disease causing brain dysfunction.

 

[JacobMcCandles]

It's so funny how people who look great and are well appearing can be thought by a mildly educated health care professional to have a dangerous and deadly disease causing brain dysfunction.

And it doesn’t help that an inordinate amount of people just want to be sick. They seemingly don’t want everything to come back normal.

 

[Fox800]

And it doesn’t help that an inordinate amount of people just want to be sick. They seemingly don’t want everything to come back normal.

Their illness is their identity. It validates their depression/vague somatic symptoms and gives them muh validations.

 

[Birdstrike]

I've had some good referrals from NPs, lately.

 

[bravotwozero]

I've had some good referrals from NPs, lately.

Are you ok?