Client-centered Therapy eTherapy Health care Medicine Seattle Therapy Washington

When Should You Ask An RN

This is the second post in a series on the empowered client. I’m currently working as a private practice psychotherapist and an urgent/emergent care triage nurse. 

I know many of you are computer-savvy clients. You pay attention to articles about health trends, scan articles about Vitamin D, depression screening, and relationship health, and you pay attention when an online news source mentions a new flu strain. The Internet is a portal to a vast amount of relevant medical information, including symptoms and treatments. However, the Internet is a poor source for triage and suggestions for diagnosis. No website would ever promote what I call “bot medicine”, where a bot helps diagnose people on the basis of symtoms. Even with sophisticated telemedicine practices, we still rely heavily on client report, direct observation, and laboratory testing. But there are times when it is appropriate to ask an RN about your healthcare concerns. Hospitals and ambulatory care settings are turning to nurses to help triage your call to your doctor so you get the care you need in a timely manner.

When Should You Ask An RN

So,  you’re sitting at home by yourself, or your spouse is asking you questions from the other room that sound like this:

“Honey, how long have you been complaining about that pain in your side since you fell off the ladder when you were putting up the Christmas lights?”

“You don’t look too good right now. Are you taking medication for that cough?”

“Uh, sweetie, I saw some blood in the toilet after you used it. Did you see that too?”

Nurses help you determine what action to take and when to take it.

While most of us don’t like to take time to see the doctor, the more important question is, “Is what is happening to me serious enough to warrant medical attention, and if so, how soon do I need to be seen?” Many medical centers hire nurses to (wo)man triage phone lines for potentially life-threatening conditions and urgent issues requiring timely medical attention. If your health insurance provider or medical center provides this service, a phone number is provided for you, and if your symptoms are urgent, your call is transferred to a nurse who can triage your symptoms.

What To Say

Accuracy with your symptoms is important. It makes a difference if your symptoms have persisted for a couple of days versus a couple of hours, is severe or mild, or you have serious symptoms such as as a high fever, chest pain or radiating pain, nausea or vomiting, or shortness of breath. While you might be inclined to minimize bothersome symptoms, remember that the triage nurse can help you ONLY if you are committed to the process of being truthful and accurate about your symptoms.

Do share pertinent historical information to the triage nurse. While some of your most recent medical history is available, you may have visited several clinics, physicians, and medical centers outside your normal health care centers. Information between facilities is not shared unless you requested them in writing. By quickly sharing that information over the phone, you can assist the triage nurse to see how the bigger picture of health affects the problem you are facing today.

While urgent/emergent nurses do not treat symptoms, they often can help point you in the direction of appropriate care for stress-related symptoms, anxiety and depression, and feelings of suicide and self-harm.

Here’s a few things NOT to do:

1. Don’t withhold information from a customer representative. These folks forward calls to the nurses, and they are given instructions to not triage your calls while providing HIPAA compliant care.

2. Don’t try to guess your diagnosis unless you are completely certain of the outcome of your symptoms. Just because you read it on the Internet does not mean that your cough and cold is the new flu strain. Remember that the longer you wax on eloquently about all the pieces of information you read on the Internet, the longer it takes for the nurse to gather the most pertinent information to assist you.

3. Don’t downplay your serious symptoms. If the nurse recommends a response, it’s based on those symptoms. If you downplay them, you run the risk of waiting too long for a prudent response to injury.

4. Don’t delay. One of the worst responses to injury or potential life-threatening symptoms is to do nothing or procrastinate. In some case, a situation may be more difficult or impossible to reverse.

Triage RN’s are often available to help clients know when they should see a doctor, seek emergency care, or try home care for conditions that are less severe. By requesting to speak to a nurse, you could not only be saving money, you could be saving your life, limiting serious injury, or shortening recovery time.

Have you tried calling a triage nurse when you’re sick or injured? What was your experience? Did you trust that your most urgent needs were forwarded to your PCP for further review?

eTherapy Health care How to Seattle Uncategorized Washington

Medicine In The Express Lane

I don’t know many professionals who do what I do: hold dual positions as a Triage Nurse and a psychotherapist. For the past eleven years, there’s only been a few seasons where I’ve worn both hats simultaneously. For the most part, Triage Nursing is fast paced, problem centered, and focused on what is happening right now. Psychotherapy is typically slower paced, person centered, and focused on the effect of the past on the present and immediate future. While these descriptions sound diametrical, they actually describe how my training and current work helps me deliver good medicine in the express lane of life.

Busy people need medicine that meets them where they are at.

Modern Life: You Are Too Busy

Most people are too busy to slow down. Their jobs don’t allow them as much leisure time if they are sent home with emails and smartphones. Lunches and breaks often turn into work time relegated for “catch up”. I can’t tell you how many times clients have told me that the only time they can call for help is after hours, when most clinicians have gone home. By the time many call in for help, they are already stressed, fatigued, or ill.

You Need It Now

Getting same-day appointments can be difficult. As a Triage Nurse, it’s my job to assess who needs to be seen by a PCP today versus tomorrow, and who needs education for good home care treatment. Similarly, counseling clients often wonder if their problems are urgent enough to warrant home care (rest, time off, medication), or the attention of a therapist.  For example, if you’ve never been clinically depressed, a few days of feeling down can easily be mistaken for feeling run down, and many clients misdiagnose their own symptoms for something somatic (body) versus emotional/mental.

Regardless, when you feel you need to be seen by someone, you want to know if you can be seen sooner than later.

Is This OK?

Often times, people are simply wanting to know what they should do with a situation. Is that pain in the chest something serious, or is it acid reflux? Can I just take a few antacids for this, or is that tingle in my shoulder worth reporting? I encourage all people to listen to their instinct for survival and health. Something that is new, unusual, painful, and/or persistent is usually NOT something to dismiss. Calling your PCP’s office is a good idea, and many providers have personnel to triage your call so that you know if you should be seen by your physician.

How To Get Medicine In The Express Lane (without getting run over)

If you want to access medical care appropriately, here’s what you should do:

1. For medical emergencies: dial 911. That’s what’s going to happen anyways if you try to call your doctor’s office with your true medical emergency. Trying to walk-in on your PCP office, which runs by appointment, will likely result in a trip to the ED.

2. If you’re not sure you’re having a medical emergency, and your HMO has a triage line, call it. The representative on the other side of your call is trained to ask a few questions that will help direct you to speak to the appropriate person, or help book an appointment for you in a reasonable timeframe. This will often save you time and grief, because delaying vital care is often more expensive than doctor’s visit.

3. Don’t try to call a triage center on a mobile phone while driving. Not only is it distracting and unsafe to you, it is often very difficult to hear because of ambient noise. Pull over, park in a safe area, and make your phone call. Give your full attention to the call and what is being asked of you. Dont’ be afraid to repeat yourself.

4. For mental health issues, it’s imperative that you report any signs of suicidal thinking, changes in medication, and any unusual circumstances, such as exposure to chemicals, a concussion, electrical shock, or a sudden change in your mood that you cannot account for. Many HMO triage lines accept mental health inquiries as well. Behavioral health specialists are there to assist you if you cannot wait to book an appointment with your therapist.

5. Don’t keep asking for what isn’t available. If your doctor isn’t available to see you, your medical record can be seen by a qualified PCP in the same group. It’s more important to be seen by a doctor in the right timing, than to wait too long to see your doctor when your problem may have significantly worsened. If you’re asked to see another clinician, there’s usually a reason.

Since a lot of medical services are being delivered over the phone, fax, and email these days, it’s important to remember that triage isn’t perfect in these formats. However, they allow professionals like myself to help you get the help you need, when you need it most.

What do you think? Is fast medicine just what you do when you ask Siri a question about your health, or Google a question about your medications? Have you ever tried to use a triage telephone number of your HMO when you’ve been sick? What was your experience?