Ambiguity in Retail Healthcare
During this last month we have been overrun with patients
seeking flu shots and seeing patients with colds, strep throat and flu. I have
seen some folks who are very ill and without doubt have influenza. But mainly I
have seen the worried sick. People who have upper respiratory symptoms and know
they are victims of "swine flu." One little boy who indeed did have influenza
thought he was going to die because he had the "swine flu." Luckily his mom
realized his fear and hopefully we were able to reassure him.
That has been a particularly bad effect of the worry about
H1N1. Getting the vaccine is good; scaring children is not. I have not been to
work in two days, so I don't know much about the distribution of the H1N1
vaccine in our clinics. I hope we find out if we are giving the injections at
least a day before we start.
I personally do not have a choice in getting the seasonal flu
shot or the H1N1 so when I am asked all I have to do is give the company line.
I do have concerns about the use of the H1N1 vaccine but we have to depend on
the CDC and the FDA for assurance that it is a good thing. And that is a very
scary thing since both agencies have been wrong. Also there is a lot of money
involved. And lastly there is my paranoia about vaccines and the government.
I know, rationally, that good people have studied and thought
about this vaccine but I also know that some people will have bad side effects
from the vaccine. This is a conundrum that most providers of healthcare are
aware of and take into consideration every time we prescribe even
acetaminophen. Medicine, while claiming to be science- and evidence-based, is
just as much an art as a science. And art is often in the eye of the beholder.
Every time someone comes to me for an opinion, help or just to be reassured, I
try to keep that in mind.
On another note, I am not sure how every retail clinician works
but I try to triage my patients. I will not see those who are too sick or who
have illnesses that require more than my scope of care in a retail clinic can
provide. Sometimes it can be hard to convince someone we are not set up to meet
his or her needs. Just because we do sport physical exams and are very capable
of doing complete history and physical exams does not mean we can provide what
a regular provider's office can provide. Nor is it in our scope to diagnose and
order antihypertension medications. There is a great difference between our "scope
of practice" as a nurse practitioner and our scope of practice in a retail
clinic. And if sometimes it is difficult for the public to understand, it can
be hard for NPs to understand. I often wish for more clarity in knowing what to
treat. There seems to be a difference between clinicians. I guess it's because
we all are different and have different experiences. And if choose to refer
some things others treat, it may be that I treat what others would refer. It
can be confusing. As the field of convenient care develops, our scope will
become clearer.
The theme for this month's post is ambiguity. We all live
with it and deal with it. And I hope that there is always some ambiguity,
otherwise things become rigid and leave no room for the art of medicine.