Some of our urgent care referrals are getting so stupid that i have messaged them in Epic but sometimes it's like talking to a wall.
On a recent ED shift at FSED.
1. Patient checking in and transfer note pops up. Transfer center note: "Right shoulder injury 2 weeks ago. having pain with sleeping, Rating pain 10/10, taking meloxicam with no relief. Needing higher level of care." I see patient has had an outpatient xray without fractures, and then an outpatient MRI which showed partial-thickness supraspinatus tear, and follow up with the ortho in a few days. His chief complaint at urgent care was wanting something to help him sleep with the shoulder pain.
I messaged the NP, "so what exactly did you want me to do for this patient?"
"Well, he says his pain is 10/10 and he is already on meloxicam."
His exam is benign, surprisingly like someone with a rotator cuff issue and he is quite comfortable. I prescribed him some pain medication that obviously could not be prescribed from an urgent care.
2. Another patient checking in and a transfer center note pop up (different urgent care). Transfer note: "severe back pain, loss of bladder and bowel, not able to urinate, concern for cauda equina"
I message the MD "Hey, for patients you are worried about cauda equina, the modality of choice is going to be an MRI."
"Yes I know, but she just wanted to go there (FSED)."
"Again, you know we don't have MRI here."
Radio silence.
I go see the patient just to get ready for another transfer for MRI. Patient doesn't actually have symptoms of cauda equina. She has a history of sciatica and she has her typical unilateral right sided sciatica with your typical radicular exam. No incontinence or saddle anesthesia. I asked why the other doctor was saying she has loss of bladder (and decided to write loss of bladder and bowel function all over her chart). She says she never said anything like that, she hasn't gone to the bathroom yet because her back hurts to sit on the toilet. After some pain medication, walked around, went to the bathroom without issue and was happy. Such terrible whiplash of medical decisions that ultimately just cancelled itself out I guess.
3. Pilonidal abscess. 20s F with pilonidal abscess. Patient being transferred because her temperature was 99.9 even though she had taken tylenol earlier in the day so concern for sepsis. Patient needs labs and CT imaging.
Patient with obvious pilonidal abscess. Talked her and family off the ledge about the labs and imaging, drained the abscess. Got tired of messaging, just routed my note documenting inappropraiteness of labs and imaging for typical pilonidal abscess to the referring provider.
