First Stop: ER or Culmore Clinic
Nurse Practitioner, Maura Constance
The following is a real-life patient story told by one of our Nurse Practitioners, Maura Constance, NP. It illuminates the issues we face every day at Culmore Clinic revolving around our patients’ relationships with the Emergency Room. It is common that patients will either visit the ER too often for needs that are not emergencies, or reversely, visit us for items that are emergent in nature because they fear the prohibitive costs of the ER. Thanks to 2019 funding from VAFCC, we were able to start a public health campaign for our patients and our wider community, educating them on how to self-triage.
Are you a provider? Download our “When Should I Go to the ER? A guide for deciding on the right place to go for affordable medical attention.”
Fear the Bill More Than the Symptoms
She was my first patient that Tuesday morning. The face that usually greeted me so cheerfully was twisted in pain. Her teenage daughter was with her - eyes tearing up with fear and concern - to see her mother in such a state. The normally well-controlled blood pressure was very high - likely due to her great discomfort. She stated that she had woken up yesterday with acute abdominal pain and it only got worse as the day wore on. While she had been able to eat small amounts of food yesterday, today she felt extremely nauseous - and even though she had not vomited - she was sure she soon would.
I grew very concerned as I began to examine her: the lower abdominal bowel sounds were very diminished and she jumped in pain as I gently palpated her stomach.
And yet, with all of this going on - she did not want to go to the emergency room as she was afraid that she would end up with a bill that would be prohibitive for her. She felt the pain would pass and wanted me to give her a medicine, instead , to help her bare it.
I tried to convince her that it was dangerous for her to not go to the hospital, and it was the only way we could definitively figure out how to relieve her great discomfort.
But despite my best efforts - she was not convinced. So I asked our Clinical Director to arrange a STAT abdominal ultrasound for her. Also, I ordered a panel of bloodwork (to try and pinpoint the cause of her acute abdominal pain) and instructed her to go to the lab right after her ultrasound. I was hoping that the information from the imaging and lab work would finally convince her to head to the ER.
As it turned out though, the additional testing was not necessary. She said that she thought more about my warnings and decided, after all, to go on to the hospital. In the ER, she was quickly taken back. They diagnosed her with acute appendicitis and took her on to the operating room where she had emergency surgery.