A stepdad brings in his 15 year old stepdaughter after she suddenly started having “excruciating” lower abdominal pain. She is doubled over when walking into the emergency department and is crying.
The mother is finishing up her night shift and comes to the emergency department to meet her daughter and husband. When she arrives, she takes the patient to the bathroom and reports that girl is starting her period.
After using the bathroom, the patient’s pain decreases to 6 of 10 intensity.
Because the patient just started her period, I ordered a catheterized urine specimen so that there was no urine contamination from menses. The patient’s nurse refused, saying I was being “unreasonable.” She went in and talked to the family, then came out and said that the family also refused. Instead, she obtained a “clean catch” urine that showed 1+ bacteria and 10-20 WBCs per HPF.
I told the nurse that we needed to get a catheterized specimen. She yelled at me stating that she’s “not going to put a 15 year old through that.” “You know damn well that the pain is just from her period,” she said.
“Explain to me why there are bacteria and white blood cells in her menses, then.” I demanded.
“I don’t know.” She replied.
“OK, then why are you giving me such a hard time when you’re ignoring information sitting right in front of your nose?”
“I’m still not doing the catheter. You can do it yourself.”
“If the family doesn’t want it done, they can sign out against medical advice.”
“They won’t do it because insurance won’t pay for the visit.”
I handed her the chart and said “Then you can write the discharge orders, because the ED is full and I’m not arguing about it with you any more.”
“Well …” she started.
“We’re DONE discussing this patient.”
Eventually obtained catheterized urinalysis that showed some bacteria and a few WBCs. I treated the symptoms as a UTI, even though I wasn’t entirely convinced that the patient had a UTI and would ideally have done a pelvic exam.
I told the family that the patient had a mandatory follow up the following day for re-evaluation. The patient said “like hell” as she walked out the door.
You all give me a good reality check.
Was I being unreasonable?