Nurse/doc communication fail

[fireheart]

This is relating more to my sister, but I heard the full story from mum today.

Basically little sister had been having some tummy troubles of late, so she went to the doc. Doc scheduled a blood test for her. Sister went and had blood test no drama. The fun started when she got the results.

Now this particular clinic (like quite a few clinics I've heard of apparently) has a rule that they DO NOT GIVE OUT ANY TEST RESULTS OVER THE PHONE. They will either send a letter or email you if they want a follow-up visit to discuss your test results. NO phone communication is needed AT ALL.

Sister got a phone call from someone who had her results (either the patho nurse or the clinic nurse, not sure which) who basically told her that while she wasn't coeliac, she was borderline coeliac and needed to go gluten-free. So sister did her best to go gluten-free for about 6 months, but did not necessarily adhere to it completely.

Then she went back to the docs and visited a new doc who had just started at the clinic for an ear infection. She brought up the issue and doc had a look at her test results. I believe he ordered a new set of tests.

End result? No, sister WASN'T coeliac, but she had a bug in her gut that needed to be killed off. Doc gave her some strong antibiotics that eventually killed off the bug, but then sister got annoyed.

Why?

Because 1) She'd had to adjust her diet for 6 months for what turned out to be no particular reason (and the merits of a gluten-free diet for NON-COELIAC folks is best left to Fratching) and 2) the "bug" in question is one that could come back in the future.

I'm still left scratching my head over why the clinic bothered ringing in the first place. If it was a medical emergency that required hospitalisation then sure, ring, but there was no need to deliver THAT particular result over the phone!

[raudf]

Ours has the clinic nurse call us with results on certain tests, but only after the test has be verified by the doctor or the nurse practioner who ordered it. Or at least they do in the serious tests. Of course, to get this, you have to sign the HIPPA form with "Allow to leave messages," and, "Can discuss medical issues over phone."

This is done because our doc has a lot of patients who cannot easily get to the office and they want to reassure their patients are in the loop on their health as quickly as possible.

[Sapphire Silk]

Giving medical advice over the phone in regards to lab results without a specific diagnosis and order from the MD/NP/PA is out of the scope of practice for a Registered Nurse, Licensed Practical/Vocational Nurse, or a Certified Medical Assistant (med tech). It's the practice of medicine.

I only do teaching on diets when the doc has made the diagnosis; that's within the scope of my practice. If the doc hasn't written anything in the chart, I don't do the teaching. Too easy to get into trouble.

[Gilhelmi]

Ah, the old "someone trying to be 'helpful' when they do not understand their job yet".

Nursing schools only teach you how to be a nurse, they do not teach you the actual job of being a nurse. (they do not understand why they do not deliver information over the phone and think it is a silly rule).

I suspect that maybe they mixed up the records with someone else. A troubling thought because, if that is the case, someone with borderline-coeliac is not getting the proper treatment.

[AccountingDrone]

Giving medical advice over the phone in regards to lab results without a specific diagnosis and order from the MD/NP/PA is out of the scope of practice for a Registered Nurse, Licensed Practical/Vocational Nurse, or a Certified Medical Assistant (med tech). It's the practice of medicine.

I only do teaching on diets when the doc has made the diagnosis; that's within the scope of my practice. If the doc hasn't written anything in the chart, I don't do the teaching. Too easy to get into trouble.

Makes me happy with my doc, I get the results of the bloodwork sent to me. He knows I am perfectly able to read the numbers, I know more or less all my panel results for the past 7 years [I have them in a folder in my desk.] Makes life easier to get the more or less raw data with no bias - we have agreed that there is no such thing as 'average' when it comes to some of my results, frex my normal body temp runs 94.4-95.1 [my forensic tech sis in law jokes that I have a head start on being dead ]

[fireheart]

Ah, the old "someone trying to be 'helpful' when they do not understand their job yet".

Nursing schools only teach you how to be a nurse, they do not teach you the actual job of being a nurse. (they do not understand why they do not deliver information over the phone and think it is a silly rule).

I suspect that maybe they mixed up the records with someone else. A troubling thought because, if that is the case, someone with borderline-coeliac is not getting the proper treatment.

If you had someone who's "actually" coeliac (let alone borderline) wouldn't emphasis be on getting them to come in and see a dietician/nurse ASAP so a care plan can be written up?
From my understanding, sister just got the phone call and not a visit to the doc/dietician.

Chances are that yes, mixed records do occur. The clinic has been seeing some slightly troubling issues of late, including one lovely instance of patient confidentiality being broken! (This was minor)

In that case, my sister and mum both saw the same doctor, but not at the same time. Mum brought up that my sister had seen him and the doc started talking about sister's ear infection! Mum managed to bring him back around though. (Sister did have an ear infection, mum had something wrong with her jaw)

[Sapphire Silk]

Ah, the old "someone trying to be 'helpful' when they do not understand their job yet".

Nursing schools only teach you how to be a nurse, they do not teach you the actual job of being a nurse. (they do not understand why they do not deliver information over the phone and think it is a silly rule).

I suspect that maybe they mixed up the records with someone else. A troubling thought because, if that is the case, someone with borderline-coeliac is not getting the proper treatment.

I teach my students HOW to be a nurse. They are taught what their scope of practice is, and that the rules are not silly and must be followed lest ye invoke the wrath of the Board of Nursing.

If they choose to ignore them, that's on them and their license. It is not on me or mine.

Mixed records could have happened. Or it was someone too big for their britches. Part of the problem is we don't know if the person was a licensed nurse or a CMA. Probably a CMA since a lot of practices don't even employ nurses anymore.

[Seshat]

My clinic has nurses, but the nurses don't do any reception work. The reception/secretarial area is staffed by people who .. actually, I have no idea if they have any medical training at all.
Actually, they probably do, because they have to be able to look at someone and know whether or not to call for a nurse/doctor Right The Hell Now. And they have to have confidentiality drilled into them, though that requires only a certain code of ethics and not specifically medical teaching.

The nurses' station is down thatta-way --> and the nurses - well, do the nursing things. Wound rebandaging after a doctor has checked the progress, flu shots and other such, presumably diet advice/lifestyle advice, though we've not needed it ourselves.

[fireheart]

Mixed records could have happened. Or it was someone too big for their britches. Part of the problem is we don't know if the person was a licensed nurse or a CMA. Probably a CMA since a lot of practices don't even employ nurses anymore.

The clinic we go to I believe has Registered Nurses on staff.

[Sapphire Silk]

The clinic we go to I believe has Registered Nurses on staff.

Well, every rule has its exceptions

[42_42_42]

Ah, the old "someone trying to be 'helpful' when they do not understand their job yet".

Nursing schools only teach you how to be a nurse, they do not teach you the actual job of being a nurse. (they do not understand why they do not deliver information over the phone and think it is a silly rule).

I suspect that maybe they mixed up the records with someone else. A troubling thought because, if that is the case, someone with borderline-coeliac is not getting the proper treatment.

Depends on the nursing school. I'm starting junior year of my BSN program and I know everyone in my cohort would know not to do what the nurse did in this case.

[jedimaster91]

Pretty sure the only ones allowed to give results over the phone are MDs, NPs, or PAs. I can't do it as an imaging tech even though the report is right in front of me to read word for word. What I can do is print off the report and fax it, or I can hold the phone up to the computer and play the voice clip. And that's really only for other doctors. Patients I think have to go through medical records and sign a bunch of paperwork. Me giving a patient results is way outside of my scope of practice and would be a Very Bad Thing.

[Sapphire Silk]

Pretty sure the only ones allowed to give results over the phone are MDs, NPs, or PAs. Me giving a patient results is way outside of my scope of practice and would be a Very Bad Thing.

I agree completely. However, a lot of doctors offices don't even employ nurses anymore, not even LPNs. They use CMAs. I've gotten the CMA calling me with lab results before, though she didn't give me any medical advice over the phone thank goodness.

[fireheart]

Down here, things like CMAs and LPNs are a foreign concept. We have ENs and RNs pretty much. (I have an EN aunt and an RN aunt. Both work in aged care )

[jedimaster91]

I've gotten the CMA calling me with lab results before, though she didn't give me any medical advice over the phone thank goodness.

There are ways to skirt around that. I can't utter the words "normal" or "abnormal" in the presence of a patient, but I can say here's what we expect to see and here is what we're seeing. Can't tell you what it means, though.