Saturday, November 13, 2010

How to help your healthcare provider help you.

So you've had abdominal pain for 3 days. You decide to go to see a health care provider.

There are 2 ways your visit can go.

Scenerio #1.
NP: Hi, how can I help you today?
Patient: My stomach hurts.
NP: How long has your stomach hurt?
Patient: I don't know. Awhile.
NP: A few hours, a few days, or a few months?
Patient: A few days I guess.
NP: What type of pain is it? Sharp? Dull? Burning? Aching?
Patient: I don't know! It just hurts!
NP: Where is the pain?
Patient: (Points to entire abdomen) All over!!
NP: Is there anything that makes it better or worse?
Patient: I don't know!! It just hurts!!
NP: Any nausea/vomiting/diarrhea/fever?
Patient: I was nauseous yesterday and I felt warm but I didn't have a thermometer.

At this point the NP probably has absolutely no idea what is wrong with the patient because they really haven't given her any information about the pain other than it hurts. There is about 1000 causes of abdominal pain and the NP has not been able to narrow it down at all based on this conversation. So now the NP may continue asking the exasperated patient more questions or just give up and start the exam hoping it will give her more clues how to proceed. NP may decide to order a bunch of tests to help narrow down the causes of abdominal pain and many of them may turn out to be unnecessary.

or consider this

Scenerio #2
NP: Hi, how can I help you today?

Patient: My stomach hurts.
NP: How long has your stomach hurt?
Patient: It's hurt for about 3 days but it seems to be getting worse so I decided to come in. It only hurts really bad after I eat McDonalds food.
NP: What type of pain is it? Sharp? Dull? Burning? Aching?
Patient: It's a really sharp pain, it happens about 20 minutes after I eat then it lasts for several hours then goes away. I really like to eat at McDonalds so I've been there a lot lately.
NP: Where is the pain?
Patient: (Points to right upper quadrant) Right here
NP: Is there anything that makes it better or worse?
Patient: It's really bad after I eat. Nothing makes it better but it gets better by itself then it comes back when I eat again.
NP: Any nausea/vomiting/diarrhea/fever?
Patient: I have been reallly nausous and vomited 2 times yesterday. I haven't had a fever.

Now at this point the NP is strongly suspecting gallbladder disease based on what the patient has said. She examines the patient, determines she is very tender over the right upper quadrant. Then she orders an abdominal ultrasound and the patient has gallstones. The NP calls the surgeon and the gallbladder is removed 3 days later.

What's the difference in this scenerio? The patient thought about the pain and was able to answer the NP's questions. This helped the NP figure out the problem much more quickly and easily. The patient in scenerio #2 probably got their problem taken care of a lot faster because a diagnosis was made sooner.

If you have pain and go to see a health care provider you will likely be asked these questions:
How long have you had the pain?
What type of pain is it?
Where is the pain?
What makes it better?
What makes it worse?
Any associated symptoms?

Think about the answers to these questions. Answer them the best you can. This will help you get a more accurate diagnosis.

Stay tuned for more on this topic.. I welcome questions or comments!




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