Friday, January 30, 2009

"Now, Dear, we don't really know that yet."

My friend, herself a retired RN, has two stories to tell. The first happened when she was in her third pregnancy, with a past history of rapid labors, and she arrived at the hospital's emergency entrance "with a continuous contraction."

"I need to go to the delivery room," she told the nurse.

"Well, first we need to get your name, address, and name of your insurance." The nurse was proceeding by rote.

"I need to be in the delivery room!" gasped her patient.

"Everyone is in a meeting just now," soothed the nurse. "Now, your name?"

"HERE COMES THE BABY!" That finally focused the nurse's attention.

Fast forward fifty years: My nurse-friend has been referred to a gastroenterologist by her family doctor. A nurse practitioner is taking her history.

"I have upper abdominal pain. My GP found GI bleeding and a low hemoglobin."

The nurse smiled patiently. "Now, dear, we don't know that."

My friend had her family doctor's lab reports, but as often happens, the specialist only accepted reports from his own lab, "to eliminate error."

Before he would treat her, he required a gastroscopy (passing a scope down the throat and into the stomach to take a direct look.) "We're pretty busy," the patient was told, we can schedule you for six weeks from now." No medicine was supplied for the interim.

My friend returned to her family doc who gave a prescription for Prevacid. Taking that for six weeks healed her pain, and the gastroscope showed a stomach that by that time was almost normal.

Were she my patient, I would have just given her the prescription at her first visit and called in the specialist only if she wasn't improving after a week. Tests for blood in the stool, anemia and for Helicobacter (a common cause of duodenal ulcer and bleeding) can be done in the office. A scope should be done to rule out cancer, but the cancer will still be there when the specialist gets around to doing it.

My question to the specialist and his nurse would be, "Why don't you know that? Why didn't you confirm or disprove the family doctor's data at first visit, at least look at his lab reports, and save your patient time, worry, and money?" Sometimes it seems like no one listens to anyone else.