Health care provider, frustrated with patient's or guardian's attitudes

[southernbelle_amy]

I hope I can explain this. I am a PA (physician assistant) at a pediatric practice. Honestly every day I expose myself to various illness, without much hesitation. However, I am close to 6 months pregnant so some illness I try or the nurses try to avoid, but sometimes we are unaware until it is too late.

Well today there was a kid that is about 6 months old whose chief complaint was cold and cough symptoms. Well, I went into the room, and recognized the kid. He has a history of neonatal Herpes Simplex.
Before his grandmother could start I asked, "Is he the one with a history of Herpes?". She immediately got defensive and said, "yes, but that is not what he is here for he has ............ etc". I said well, "I really think it was be best for the doctor to see him because I am currently pregnant, and due to his history". She was still agitated and said how he did not have a current rash, was asking if I had chicken pox before. I again said that I could get the doctor to see him as soon as I could, and finally left the room. And I in no means just ran out of the room.

I told my doctor about this, and then she even recalled that 2-3 month previously, when I had seen this patient before, we had discussed how myself and the other PA who is also pregnant should not see him until after we deliver. We had discussed this with the grandmother and mom.

So the doctor goes in within 5 minutes and sees the patient. She says that GM was "offended" because I acted like he had some "disease". Yet she did remember, that she was suppose to only schedule with the Dr, but had forgot. So my doctor would like me to call her and apologize. Although, she isn't mad at me. (Which doesn't even bother me that much)

What bothers me, is that if I knew I had a serious illness that could negatively effect someone, there is no way I would expect them to see me. Now, would I probably get infected by this kid? Probably not, however, if I did, and the fetus did, it can cause encephalopathy, prematurity, and death. This is serious stuff so why risk it.

I am not even that mad at GM, but I just think it is a sad case of how selfish people can be, when we (Healthcare providers) are doing the best we can. I work where ~80% of the patients are Medicaid, and a lot of them do have a sense of "entitlement", like we are just there to serve them. I also thought about if something were to happen, it's not as though, she is going to pay for it or even care. Although, my tax money is helping paying for his treatment. (of course health care policy, is not what I want to debate). I try for my sanity and my patients to not become cynical, but in these situations it is very hard. Sorry this is so long, but it really just bothered me. Vent over.

[booger73]

I don't think you did anything wrong.. and I certainly wouldn't call and apologize either.

[Mouse House Mama]

I will be honest and I can bet you won't like it.
As a Mother I think the way you handled it was horrible. I would have felt like the parent did as well and would have been very mad. If you don't want to see certain patients then it is up to YOU to make sure you don't see them. I don't need to keep track of your health. You do. I don't know how your practice runs but in every peds office that I have been in the patient file is outside the door of the exam room and the door is usually closed. The doctor grabs the file on the way in and may look at before entering the room. If you are so concerned then you should scan the files before you go into the room and if you don't want to see a certain patient you should pass them off. What you did (while I understand why) was not only insulting but unprofessional imo. In your quest to protect your own child (and again- I completely understand) you made a parent feel as if their own child was a leper. I don't care if you had a prior conversation with them or not. It is up to YOU to make sure you don't see patients that you feel are a risk to you. I would request to never see you again if I was a client at that practice.

I am sorry if this sounds harsh but you asked what people thought and this is how I feel about it.

[mickeyboat]

I would have been offended if my PA came into the room the way you did. You didn't give her a chance to even speak. You didn't show concern for her grandson. You could have handled it a lot better. Just as your main concern is you and your unborn child, hers is her grandson - and you treated him like a leper. Where was your compassion?

A better way to handle it might be to review charts before you enter the room. You could also speak to the nurse before you enter the room. (I actually was under the impression that the provider I am seeing has done). If you don't have a chance to review the chart or speak to the nurse, you could be a little more sympathetic and gentle. You could also apologize. This child will have to face this stereotype his entire life - at least his health care team could show a little kindness.

[mickeyboat]

Originally Posted by southernbelle_amy

I hope I can explain this. I am a PA (physician assistant) at a pediatric practice. Honestly every day I expose myself to various illness, without much hesitation. However, I am close to 6 months pregnant so some illness I try or the nurses try to avoid, but sometimes we are unaware until it is too late.

Well today there was a kid that is about 6 months old whose chief complaint was cold and cough symptoms. Well, I went into the room, and recognized the kid. He has a history of neonatal Herpes Simplex.
Before his grandmother could start I asked, "Is he the one with a history of Herpes?". She immediately got defensive and said, "yes, but that is not what he is here for he has ............ etc". I said well, "I really think it was be best for the doctor to see him because I am currently pregnant, and due to his history". She was still agitated and said how he did not have a current rash, was asking if I had chicken pox before. I again said that I could get the doctor to see him as soon as I could, and finally left the room. And I in no means just ran out of the room.

I told my doctor about this, and then she even recalled that 2-3 month previously, when I had seen this patient before, we had discussed how myself and the other PA who is also pregnant should not see him until after we deliver. We had discussed this with the grandmother and mom.

So the doctor goes in within 5 minutes and sees the patient. She says that GM was "offended" because I acted like he had some "disease". Yet she did remember, that she was suppose to only schedule with the Dr, but had forgot. So my doctor would like me to call her and apologize. Although, she isn't mad at me. (Which doesn't even bother me that much)

What bothers me, is that if I knew I had a serious illness that could negatively effect someone, there is no way I would expect them to see me. Now, would I probably get infected by this kid? Probably not, however, if I did, and the fetus did, it can cause encephalopathy, prematurity, and death. This is serious stuff so why risk it.

I am not even that mad at GM, but I just think it is a sad case of how selfish people can be, when we (Healthcare providers) are doing the best we can. I work where ~80% of the patients are Medicaid, and a lot of them do have a sense of "entitlement", like we are just there to serve them. I also thought about if something were to happen, it's not as though, she is going to pay for it or even care. Although, my tax money is helping paying for his treatment. (of course health care policy, is not what I want to debate). I try for my sanity and my patients to not become cynical, but in these situations it is very hard. Sorry this is so long, but it really just bothered me. Vent over.

New Rule

Eta - I didn't see your last paragraph the first time I read your post. I hope my doctor does not feel the way you do.

[Magic Mom]

Originally Posted by Mouse House Mama

I will be honest and I can bet you won't like it.
As a Mother I think the way you handled it was horrible. I would have felt like the parent did as well and would have been very mad. If you don't want to see certain patients then it is up to YOU to make sure you don't see them. I don't need to keep track of your health. You do. I don't know how your practice runs but in every peds office that I have been in the patient file is outside the door of the exam room and the door is usually closed. The doctor grabs the file on the way in and may look at before entering the room. If you are so concerned then you should scan the files before you go into the room and if you don't want to see a certain patient you should pass them off. What you did (while I understand why) was not only insulting but unprofessional imo. In your quest to protect your own child (and again- I completely understand) you made a parent feel as if their own child was a leper. I don't care if you had a prior conversation with them or not. It is up to YOU to make sure you don't see patients that you feel are a risk to you. I would request to never see you again if I was a client at that practice.

I am sorry if this sounds harsh but you asked what people thought and this is how I feel about it.

I agree. It sounded sort of rude when you asked "Is this the one with the history of Herpes?"

[Liberty Belle]

Originally Posted by Mouse House Mama

I will be honest and I can bet you won't like it.
As a Mother I think the way you handled it was horrible. I would have felt like the parent did as well and would have been very mad. If you don't want to see certain patients then it is up to YOU to make sure you don't see them. I don't need to keep track of your health. You do. I don't know how your practice runs but in every peds office that I have been in the patient file is outside the door of the exam room and the door is usually closed. The doctor grabs the file on the way in and may look at before entering the room. If you are so concerned then you should scan the files before you go into the room and if you don't want to see a certain patient you should pass them off. What you did (while I understand why) was not only insulting but unprofessional imo. In your quest to protect your own child (and again- I completely understand) you made a parent feel as if their own child was a leper. I don't care if you had a prior conversation with them or not. It is up to YOU to make sure you don't see patients that you feel are a risk to you. I would request to never see you again if I was a client at that practice.

I am sorry if this sounds harsh but you asked what people thought and this is how I feel about it.

I agree. Also, as a PA, I'm sure you realize just how many people have Herpes, either Simplex 1 or Simplex 2. I do hope you avoid it, but if you cannot (and I'm pretty sure you have been exposed recently to someone with herpes, if you've been practicing medicine), I wouldn't get too scared about it. Women with herpes give birth to healthy babies all the time.

[southernbelle_amy]

During "swine" flu season as it is right now we are seeing 30+ a day patients. I nor the other providers have time to review every chart, when the complaint is simple such as cold and cough. We have electronic records, but go in with a scrap piece of paper for each new visit. If I had spoke to the nurses concerning this they wouldn't have known either since "rash" was not a complaint at the time.

I realize that saying "Is he the one with..." or something to that effect may sound bad in writing but I did not say it a rude way. I often ask my patient's, does he have a history of heart murmur, asthma, etc...it is a medical history I do have to ask about it. She did get a word in, what I was saying was I didn't want her to tell me his whole cold and cough symptom history, just to tell her at the end, oh now I need to get the doctor so she can explain it again. I in no way treated him like a Leper, but I realize you all were not there.

I did tell her that I was sorry that I couldn't see him while in the room, but thought it was be best if the doctor saw him. I did try and call them, but their number was disconnected.

[lil mermaid]

Originally Posted by Magic Mom

I agree. It sounded sort of rude when you asked "Is this the one with the history of Herpes?"

I agree....is that really what you said? If that is true, it sounded incredibly insensitive.

I agree with the doctor. I think you owe that family an apology - even if they are on Medicaid

[IloveDMB]

So instead of handling it like a professional by going in the room and checking the EMR for the past medical history, and excusing yourself to go speak with the physician, you chose to offend the poor boy and his family?

I'm sure the grandmother won't forget to not request you next time she goes in, but not because of the herpes, but because of how incredibly rude you were to her.

[southernbelle_amy]

The point isn't that they are on Medicaid. I am sure you all think I hate poor people now. I am talking about feelings of "entitlement" which we see a lot in our practice.
We also have people every day playing with games, answering their phones, and going on smoke breaks, leaving their kids in the room. This irritates me, and is not proper etiquette for any medical office to have to deal with.

[southernbelle_amy]

So, when are people suppose to take responsibility for their actions. I as you all keep reminding me tell me it is my responsibility to know the history of every one of my thousands of patients. Yet Grandmother with 1 grandkid, who was explained by me and the doctor previously, that I or the other PA should not see him, while pregnant, can't possibly remember that? How is that fair.

[princess momma]

One of my biggest pet peeves is being seen at the clinic by someone who has no clue what my medical history is.

I don't understand why it's so hard for a health care provider to scan my chart before seeing me.

[DanMedix]

As a fellow healthcare provider, I can certainly sympathize with your handling of that situation. What many people can't remember is that we are of no help to the public if we become ill or injured ourselves while dealing with a problem.


Case in point - and boy, it's a biggie. About a month ago, we were dispatched (at about 2am) to a call for "nausea and vomiting". (Yes, more people than you think call 911 simply because they "threw up". It's YOUR tax dollars hard at work). I disregard the engine (who was also dispatched to the call), and we head to the house. When we arrive, I approach an adult female in the kitchen, with family huddled around her. Nobody's saying too much, so I kneel in front of the woman, to speak with her. Apparently, she's been nauseous lately due to night-time drainage, and vomited during a coughing spell.

...it's at this point when the husband tells me that they and their two children have recently been diagnosed with H1N1.

For a nanosecond, I consider backing away. Terribly fast. Then I realize that I've been in too close contact with her for too long of a time already. If I've got it, I've got it.

After I explain what's going on with her body, we transport her to the hospital. (once again, your tax dollars....) En route, I contact the hospital, to let them know that we're coming. Of course, THEY all have the time to don masks, etc. This woman and her husband did seem a bit taken aback when I asked them why they didn't tell the dispatcher on the phone that there was confirmed H1N1 in the house. The dispatchers could have told us, and we could have donned masks before entering the house, thus minimizing our exposure. But, as it was, I cought a faceful, because all the dispatchers knew was that someone threw up (once) - not criteria for masks.

Think of it this way: If I'd contracted H1N1 that night, and brought it to my children, there was the (minute but present) possiblity that they could have died. My kids could have died all because Mr. and Mrs. H1N1 didn't want to be "offended" or "labled".

Much kudos and hugs to you, Amy! I totally understand where you're coming from! WE have US and OURS to think about, too. Scene (and provider) Safety is our first priority. Without it, we are no good to anyone.


(....and while I'm running with this rant, will people PLEASE stop calling 911 for:

- ingrown toenails
- the common cold
- "burns when I pee" for 4 days
- "I'm drunk"

...I could seriously go on. These are the people who are taking up the time of YOUR LOCAL EMS, while your neighbors or loved ones are having a heart attack or stroke......)


mkay, thread hijack is over. thank you for your time. I'll step off my soapbox now.

[DawnCt1]

Originally Posted by southernbelle_amy

I hope I can explain this. I am a PA (physician assistant) at a pediatric practice. Honestly every day I expose myself to various illness, without much hesitation. However, I am close to 6 months pregnant so some illness I try or the nurses try to avoid, but sometimes we are unaware until it is too late.

Well today there was a kid that is about 6 months old whose chief complaint was cold and cough symptoms. Well, I went into the room, and recognized the kid. He has a history of neonatal Herpes Simplex.
Before his grandmother could start I asked, "Is he the one with a history of Herpes?". She immediately got defensive and said, "yes, but that is not what he is here for he has ............ etc". I said well, "I really think it was be best for the doctor to see him because I am currently pregnant, and due to his history". She was still agitated and said how he did not have a current rash, was asking if I had chicken pox before. I again said that I could get the doctor to see him as soon as I could, and finally left the room. And I in no means just ran out of the room.

I told my doctor about this, and then she even recalled that 2-3 month previously, when I had seen this patient before, we had discussed how myself and the other PA who is also pregnant should not see him until after we deliver. We had discussed this with the grandmother and mom.

So the doctor goes in within 5 minutes and sees the patient. She says that GM was "offended" because I acted like he had some "disease". Yet she did remember, that she was suppose to only schedule with the Dr, but had forgot. So my doctor would like me to call her and apologize. Although, she isn't mad at me. (Which doesn't even bother me that much)

What bothers me, is that if I knew I had a serious illness that could negatively effect someone, there is no way I would expect them to see me. Now, would I probably get infected by this kid? Probably not, however, if I did, and the fetus did, it can cause encephalopathy, prematurity, and death. This is serious stuff so why risk it.

I am not even that mad at GM, but I just think it is a sad case of how selfish people can be, when we (Healthcare providers) are doing the best we can. I work where ~80% of the patients are Medicaid, and a lot of them do have a sense of "entitlement", like we are just there to serve them. I also thought about if something were to happen, it's not as though, she is going to pay for it or even care. Although, my tax money is helping paying for his treatment. (of course health care policy, is not what I want to debate). I try for my sanity and my patients to not become cynical, but in these situations it is very hard. Sorry this is so long, but it really just bothered me. Vent over.

As a PA you should know that herpes simplex is NOT airborne. If you use good technique and wash your hands before and after examining the patient, you will not get herpes. The combined incidence in the general population of herpes simplex I and II exceeds 80%. If you are that anxious about contracting an infectious disease, maybe its time to start your maternity leave.
I covet my tax dollars as much as anyone, but it is NO ONE'S BUSINESS how a patient's bills are paid. I would hope that you would treat the Medicaid patient with every bit of respect that you would treat your self paying, Blue Cross Blue Shield patient as well as your "dead beat" patient. When someone brings their sick child to you for care, you are there to serve them. If you aren't; find another job. Yes, you owe the family an apology. Your attitude conveyed disgust, even if it wasn't your intention.