Thanks jimmie. Today, I saw two kids who were exposed to strep a week ago. The symptoms the kids with strep had were sore throat and abdominal pain. Classic. Supposedly, none of their RSAs came back positive the first day, but they did the second day. So, the mother (very reasonable) was convinced that even though are RSAs were negative with a NPV of about 97%, she knew that tomorrow they would be possible. I wasn't going to argue with her, so I compromised. I sent the culture, which I rarely do, and wrote a prescription for $50 mLs of amoxicillin. I don't like using amox when I am not certain of the diagnosis given the mono/red disease, but I didn't want to write for anything else given penicillin tastes awful. This way they could take the 40 mLs while I waited on the culture.
Flash back 10 years ago. Message to MA. Please give two samples of Cefzil to these patients. Done. No going to the pharmacy. No calculating dosages and explaining what I was doing. Did it drive costs up? Maybe. Did it improve patient care and satisfaction? Yes.
4 year old boy in waiting room for 45 minutes. Crazy day. I can relate jimmie. CC: Conjunctivitis. While my MA put a patient back, I asked them to come back to triage. Eyes red. Vigamox sample given. Patient does not have to go to pharmacy. Patient did not have to wait to be triaged. Now, they are happy, and I have gained ten minutes. Was my care great? Not particularly. H flu runs with conjunctivitis. Didn't look at the ears. But, no ear pain.
Just some positives.
