I had a very interesting encounter with a patient’s mother the other day and wanted to get some feedback from the Physician Assistant community on what you would have done? I am curious, how you would handle this situation?
This 25 year old Asian female presents to the clinic with a chief complaint of vaginal odor and some discharge for the last 3 days. I walk into the room, introduce myself and begin gathering some history from her. She is a sexually active female with multiple partners. She does not “need” to use condoms for protection because she takes birth control pills. She denies any other symptoms other than the “fishy odor” and mild discharge. I hope this is sounding like bacterial vaginosis to you, because it sure did to me. Our clinic is not the fanciest, we don’t have slides available to confirm with KOH or look for clue cells. We generally make this diagnosis clinically. I do like to do a urinalysis, pregnancy test, and STD screening. If the patient does not respond well to treatment, then we will work this up a little further with a vaginal swab. I explained to the patient a plan of treatment that included a few labs and a prescription for Flagyl to treat bacterial vaginosis. She asked me if it was ok to go get her mom from the lobby. Mom apparently is a certified nursing assistant and the daughter likes to run things by her.
“Sure, no problem. Bring her in.” (Stupid mistake)
Mom comes in and she is giving me the stink eye before I even say one word. (Click here to see how I managed to piss off another Asian Mom.) I start explaining to the mother the problem that her daughter seems to be having and that I would suggest that we do a urinalysis, pregnancy test and an STD…. (This is where she jumps in).
Her, “My daughter is not pregnant! She has a UTI.”
Me, “I understand that she takes birth control pills, but they are not 100% effective. I want to make sure she is not pregnant before we start dumping antibiotics on her.”
Her, “she is not pregnant! And she does not have any STB’s. (This is not a typo, she said STB’s)”
Me, “Do to the fact that your daughter has unprotected sex with multiple partners, I want to make sure she does not need to be treated for an STDeee as well as a bacterial infection.”
Her, “She has safe sex with birth control pills, she does not have an STBeee and she does not have a bacterial infection. She has a UTI.”
Me, (In my head. Oh god, what have I done? Why am I here? Please, take me now. Heart attack, stroke, pulmonary embolism; your choice.) “Ms. Smith (that’s a HIPPA name change), I have seen this many times in my career and your daughter seems to have bacterial vaginosis. It is easily treated with antibiotics. The tests are to rule out some more serious conditions that may require additional medicines.”
Her, “I have seen this many times in my career too. She does not have a bacterial infection, she has a UTI.”
Me, (I bite the hook) “What do you do Ms. Smith (HIPPA) that you have seen this many times?” (I damn well know what she does, her daughter told me already that she was a CNA.)
Her, “I am a CNA at Rest in Peace (Another HIPPA name change) retirement center. All the residents get this, and it is a UTI. None of the doctors at Rest in Peace (HIPPA) order all those tests. They treat a UTI with Levaquin 500 mg once a day for 7 days. My daughter needs Levaquin.”
Me, “Ms. Smith (HIPPA), those residents are probably not as sexually active as your daughter, and I am certain that none of them are pregnant. I don’t think that…. (Again with the interrupting!)
Her, “I don’t think either. I don’t think you know what you are doing.”
(I’m stopping this torrid tale here because I want you to really pay attention to the next sentence that came out of her mouth. This is the thing I am curious to find out about from other Physician Assistants. I will tell you how I responded and hopefully you will comment and let me know how you would have responded.)
She continues, “Are you even a real doctor or are you JUST a PA?”
“JUST” a PA. Is she F’n serious. “JUST” a PA. I mean, what the fu@^ does this lady know about becoming a Physician Assistant? Does she even have a clue what it takes to become a licensed Physician Assistant? My guess is probably not. I was freakin pissed off. All I wanted to do was rip into this lady, but I simply stopped talking. Wrote out the prescription for Flagyl, handed it to the daughter and walked out. I told reception to schedule this patient to see my supervising physician, took a few deep breaths and moved on to my next patient. I just didn’t want to waste my time with somebody like this. That was the last contact I had with the patient or her mother, but I keep asking myself; did I handle this correctly?
From an office perspective I did what I should have. I treated her problem, got the patient a visit with my supervising doctor, and did not start any static. On a personal level I am not exactly satisfied with how I dealt with this. It feels like something is missing. Kind of like eating a burger that is made with a tofu patty, turkey bacon, low calorie cheese, and light mayo. Sure it provides a sense of satiety, but somehow it just feels incomplete.
I really should have spent some time with this lady explaining exactly what it is I do. What a missed opportunity to educate the public about the Physician Assistant profession.
What I really felt like doing was asking this lady how in the hell does she know anything about what is going on here? How does her being a CNA at Rest in Peace (HIPPA) have anything to do with her daughter’s condition? I am “JUST” confused about how a woman who takes a 12 week correspondence course online to become a CNA can know anything about this? I am “JUST” wondering how her job changing diapers and wiping wrinkled asses makes her qualified to understand anything that I do? I “JUST” want to know what role cleaning soiled bed linens plays in her ability to diagnose a UTI, from an STBeee, from BV, from a runny nose? This lady needs some serious ad”JUST”ment in her un”JUST” thinking. Her daughter would be better off if she would “JUST” stick to cleaning bed-pans and leave the diagnosis and treatment to someone that was trained for it.
I’m not saying that because she has fewer letters following her name than I do that she is incompetent or ignorant. What I am saying is that her level of education and expertise fall well below mine in this particular situation. She is only harming her daughter’s health by trying to be something she is not. I am not trying to belittle the woman for what she does for a living. In health care, every role is vital to overall patient care. I have a very healthy respect for the CNAs and MAs. At my clinic the MAs are extremely skillful at their job and I will freely inform patients that ask me to draw blood that the MAs are much more skilled than I am at venipuncture. It has been years since I drew blood for a patient, the girls at my clinic do it 20-25 times a day. I can tell you without reservation, that I would not want me to draw blood on me.
So I go back to the original question that I proposed to you. How would you have handled this situation? Would you have “JUST” ignored the lady as I did or would you have something more to say to her?