When I was a resident, Dena took care of 9 of us, 3 in each year, and every year 3 new ones. I was at her work station and only heard her side of a patient call. “Hi, what’s goin’ on? You’re sick? Oh…You don’t want to smoke even? Is your urine OK? Brown, huh? I think you better come in, it sounds like hepatitis.”
She was right. I was floored. You can ask a few questions and diagnose acute hepatitis on a phone call? Yup. She did. Much later in my career I could do it, too!
10-15 years into practice, Judy, my nurse, is on the phone with Ruby. “Bad back pain on the side, and some blood in the urine, and I think I have a bladder infection. It wasn’t there until I got to work today. It’s a really bad pain!” Judy: “You better come in, and get a urine specimen as soon as you get here. It sounds like a kidney stone.”
Right again! Kidney stone have some distinct characteristics. The back pain is always on one side, it’s quite severe. In fact, in my personal series of women who have had both vaginal childbirth and a kidney stone, labor pain is preferred! Once, a patient in that kind of pain was waiting for an Xray, and writhing, moving, trying to get comfortable. He hurt so bad he wanted to vomit, and went off to the bathroom. When Xray called him, he was gone. We looked all over, couldn’t find him, but I told everyone that no one would leave in pain from a kidney stone, he must be here somewhere. Yup! Lying on the floor in the staff bathroom!
Ruby came in 10 minutes after Judy talked with her, went to the bathroom in pain to give us a urine specimen, and came out with the little cup and a 3mm brown kidney stone in the jar!
Cured!
Miraculous!
I wish the current system worked like this: A doc, a nurse or MA, a patient we both know, a phone call, come in, an easy time, done. Instead, it’s the phone 911 emergency wait disclaimer, IF the patient calls, then the call center nonclinical stranger, then the triage clinician, and likely a referral to the ER at 10 times the expense. Or, a trip to urgent care to see a nurse practitioner, or a doc in the box, and then a referral to the ED at 10 times the cost of an office visit…..and hours of delay.
I remember Judy very fondly. She was a great nurse! I agree how frustrating it is that I can’t see my doctor any sooner than 6 weeks later…