Lessons Learned: Listening when they say “I don’t feel right”

I would have to say, when I graduated and passed my Family Nurse Practitioner certification, I became nervous about diagnosing and treating patients.  I felt like I would be inadequate, make incorrect diagnoses, or not order the correct tests or treatments.  Luckily I started my new career at a family practice in a small rural/urban town that allowed me to work with the retiring nurse practitioner and my collaborating provider for three months while transitioning to see patients on my own.  The transition to practicing on my own was smooth as I started creating my panel of patients.  It is hard to believe it has not been quite a year yet, and I have already learned much more than I could have ever imagined.

There are a few rules I have created for myself that I never compromise on, no matter how far I get behind in my work.  One crucial piece of advice–listen to what your patient is saying.  When my professors at college told us a patient’s history would help determine the diagnosis, this is 100% true.  Listening to the patient’s symptoms and allowing them to talk without interruption assists in making a diagnose and in formulating a treatment plan.  Formulating a treatment plan and deciding on education needed for the patient is easier when the patient provides me information about their symptoms, what they have already tried, and what information they have researched themselves.  Patients are more aware of their body; and even if they do not have a significant amount of medical knowledge, they are mindful of the fact that the symptoms are abnormal.  It does take more time to let the patient talk and not be in charge of asking the questions; but it saves time in the end, and the patient leaves the office satisfied.  The diagnosis tends to be more accurate and the treatment plan tailored individual patient’s needs.

I had a patient come into the office one day stating he was not feeling right.  He had not felt good for several months.  A referral had been placed to see a cardiologist a few months earlier when he had some chest pain, shortness of breath, and fatigue.  The cardiologist did a complete work up with negative results for cardiac disease.  The cardiologist recommended weight loss and exercise.  When the patient returned to my office, he had some new complaints of urinary frequency, nocturia, urgency, and dysuria and the continuation of shortness of breath and fatigue.

The patient had a history of enlarged prostate and hematuria for which he had completed a cystoscopy 12 years earlier.  He saw a nephrologist regularly for chronic kidney disease and an oncologist yearly for a history of leukemia in which he was in remission.  When he said he just did not feel right, I listened.  A urinalysis was completed and even though he had a history of hematuria, I ordered a urine cytology.  The cytology report was positive for cancer cells.  The patient received an urgent appointment with a urologist, had a repeat cystoscopy; and during the cystoscopy procedure, he needed stents placed in both ureters.  Listening to what the patient reported may have found the bladder cancer early enough for a good prognosis.

I always ask questions.  When I have a doubt, I will always ask one of the providers.  I am new so I know I feel like my questions might be stupid, but no question is stupid.  I have learned many new and interesting facts, tidbits, and information by asking a question.  I find that the patient’s do not get upset with me if I say, “Can you hold on a few minutes while I ask one of the providers for their opinion?”  Most of the patients appreciate that I will take the time to ask and not just guess as to what the treatment should be.  The providers I work with have had many years of experience and will often provide the patient with information I did not know or treatments that might be better than just prescribing a medication.

written by Leigh Anne Dries

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