In some practices, patients with seemingly simple problems are scheduled to be seen by a nurse or medical assistant. Sometimes they can even just drop off a urine sample in case of a suspected urinary tract infection.
This is a dangerous trap. What if the patient rarely gets urinary infections, has back pain and assumes it is a UTI instead of a kidney stone or shingles on their back just where one kidney is located; what if they have lower abdominal pain from an ovarian cyst or an ectopic pregnancy?
Another dangerous type of “nurse visit” is when patients focus on one symptom or parameter, thinking for example that as long as their blood pressure is okay, their vague chest pressure with sweating and shortness of breath isn’t anything serious. It’s one thing if I want a couple of blood pressure checks by my nurse, but a whole different thing when it is the patient’s idea, assumption or self diagnosis.
In many cases, a telephone call with the provider or a triage nurse can be safer and more diagnostic than starting with a nurse visit. Because the symptom history is usually more important when making a diagnosis. And nurse visits tend to be skimpy when it comes to the clinical history, even though the provider assumes responsibility for the diagnosis and treatment of a patient they didn’t talk to or examine.
Seemingly simple things can sometimes be disasters waiting to happen. Nurse visits are not billable, only the dipstick urine test is in my first example. But the malpractice payout could be bigger than for a missed diagnosis made by a thorough clinician in good faith – if there was little clinical history and no physical exam done, not even eye contact between patient and treating physician.
Consider this analogy: How much less is a meal at the takeout window than inside the restaurant? The cost is usually the same and it certainly isn’t free.
A Happy Meal is a Happy Meal, no matter where or how you receive it. Diagnosis and treatment are not defined by their setting or visit charge.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
