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The NSPA Blog

Frustrating Times At The Physician’s Office

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Posted on June 13th, 2016 by Teri Dreher, under Patient Advocacy, Tips & Resources

A couple of months ago, a friend of ours encountered a situation that we now have permission to share, so that others can benefit. Our friend, a very young, active and vibrant 80 year old, was out shoveling her snow when she had a sudden, excruciating pain in her back. She did like most of us would do and put away the shovel and headed for the house to put an ice pack on it. She is not one to complain, so she kept quiet about her injury and kept trying to treat herself at home, assuming it was a pulled muscle and that it would get better.

Fast forward to 3 days later, with no relief of her pain. She calls her adult children to let them know of her injury. She goes to her physician’s office, who informs her that, due to insurance regulations, the insurance will not cover any testing until she tries several days of pain medicine to get relief.

Two more days pass, and she is still in excruciating pain. Her children have been phoning the doctor’s office regularly, but are informed that nothing more can be done until there are a few days trial of pain medicine. The MRI is scheduled for a few days later. At this point, our friend’s leg has swollen a great deal. Her physician directs her to go to the local emergency room, where they did not even bother to address her back pain, just her swollen leg. They can’t find a cause for her swollen leg, so she is sent home in the same excruciating pain she was in when she arrived.

The end of this story is that the MRI revealed a fracture of one of her lumbar vertebrae, and she is ordered to the hospital as an emergency. She was then treated appropriately, and is recovering on a daily basis.

In this situation, it is impossible to say what would’ve happened, but our friend may have gotten quicker testing and treatment had she gone to the emergency room initially. Insurance companies often view emergency room visits with greater significance than a visit to your physician’s office, and emergency room physicians are trained to “search for the worst diagnosis first”, so more testing may have been ordered from the onset. Most of us are extremely reluctant to go to the emergency room. There are so many reasons for this reluctance–it seems overly dramatic, or there is an enormous co-pay, the wait can be very long, we trust and respect our primary care physician’s opinion more than an unknown emergency room physician, we want to leave room for the “truly ill”, and a variety of other reasons.

Thinking back to how the emergency room did not address our friend’s back pain when she went for the swollen leg, it is likely that they “assumed” that her back pain had already been addressed since an MRI was already on order.

In our opinion, elderly persons in severe pain should not hesitate to utilize the emergency room! We also recommend bringing someone with them to advocate for their rights to relief of their pain and diagnosis of their issues.

With over 36 years of clinical experience in Critical Care nursing, home based health care and expertise as a cardiovascular nurse clinician, Teri is well acquainted with the complexities of the modern healthcare system. She has served as a nursing leader, mentor, educator, and consistent patient advocate throughout her career in some of the best hospitals across the country. Her passion to keep the patient at the center of the model of nursing care led her to incorporate NShore Patient Advocates, LLC in 2011, serving clients throughout the northern suburbs of Chicago.

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