An Encounter
I have been in nursing long enough to know that when you encounter a patient or client with multiple unrelated vague issues that there is usually another underlying problem. The issue can be medical, psychological, social or legal and often there are combinations of issues. This leads me to a particular day in my clinic.
On one of my busiest days of the year, I had just finished clearing the waiting area. This young woman walks into my office or clinic within 5 to 10 minutes after I had cleared my waiting area.
I use both words (clinic and office) interchangeably because many retail practitioners believe that an office is related to physicians’ offices and clinics are related to retail practitioners’ clinic. Therefore I will use both words not to split hairs. Back to my encounter:
As she approaches the door, I look up from scanning my backlog of documents into the computer and ask “how can I help you?” She begins by telling me “two days ago I ate something bad and I had nausea and vomiting for about one day.” I asked her if she was still having those symptoms and she says “No.” Then I asked her “if she would like to be seen?”
She then begins to say that she needs to see a doctor because she has not seen one in a while and she has crappy insurance. I explained to her that this clinic is run by nurse practitioners and I would be happy to help her with her problem.
She then sits down in the chair as I ask again, “How can I help you?” She then begins to tell me, “I have had this migraine headache and it will not go away.” I am thinking alright, now I have something that I can help her with. I stated “would you like to be seen for your headaches.” She says “yes.”
I always make sure that my clients knows approximately how much the visit will cost prior to my performing the services. I asked her, “How would you like to pay, prompt pay or insurance?” She hesitated and says, “I don’t know, I have crappy insurance.” I asked if she would like me to check and see if it is one of the insurance that we except at the clinic. She says “Yes.”
While she was removing her insurance card, she goes on to say, “I would like my stomach to be checked out too.” I asked, “What is wrong with your stomach?” She says “well before I had this pain and I just want my stomach checked.” I explained that if this condition has resolved and is not an acute or current issue and we do not have the diagnostic equipment to check her stomach. She then hands me her insurance card.
I look at her insurance card and realized that it is one of the high deductible insurance plans. I explain that she could pay the flat prompt pay rate $$ or she can pay her co-payment $ and we bill insurance but you will be responsible for anything not covered by the insurance. I asked her is she had meet her $$$ deductible and she says “NO.” She sits there going back and forward about what she should do, I explained that if finance is an issue because of the high deductible it would be cost effective for her to pay the prompt pay $$. She agreed.
As I am completing my demographic and history section, she brings up two more issues including how, she is having mild stomach cramps and needs to have her stomach checked. Yes, you are thinking right, I am looking at my backlog of paperwork, the time slipping away, the multiple lists of issues, while maintaining a professional composure.
I then began to realize that these issues are not all medically related and something else is going on in this woman’s life. Because of past experience, I know that poly symptomatic clients often have multiple issues that involve more than medical issues. I must assess this lady’s acute issues and realize that her problems can not be solved in one day or at this clinic.
This really must be her blessed day, because she caught me at a time when the patient volume was low and therefore, I was able to devote a little more time to her and listen to her issues.
During the examination, she divulged that she was going through a divorce, she had lost her job, her husband was cheating on her with multiple women, she did not have any family near, and she does not know what she is going to do. This woman has martial issues, financial issues, social issues, and psychological issues that are manifesting into medical issues.
I listened while doing her examination and focused on addressing her acute issue, which was migraine headache. I treated her migraine headache, gave her 45 minutes of my time and wished that she be well in her life.
I am writing now, because although I know that I did all I could do for this lady in my setting, it still does not stop the feeling that I just placed a band aid on an open sore. However, she was very pleased with my care when she left. After reflecting, I now realized, maybe she just needed someone to talk to.
I call that day her “blessed” day. I know some of you are starting to get critical because I said blessed. I am very religious and if it helps you to say lucky, then substitute lucky. Her visit really placed me behind in my work day; although, I finished the day with seeing over 20 patients, I still finished my day with only 30 minutes overtime. Plus, I now realized that those few minutes may have been what she needed to face another day. No, she was not suicidal at the visit and she was not crying or distorted. I would have never known her problems, if she had not started to confide in me during my examination.
Nurse Practitioners conduct many tasks, such as teaching, counseling, supporting, and comforting, which are just a few that make our position unique. Each day, our responsibilities may change depending of the clients for that day. Although, there are no ICD9 codes or CPT codes to attach to these tasks they are part of the process of helping our clients from a holistic approach.