Million Dollar Questions that Make Diagnosis and Treatment a Sinch

I've been a nurse practitioner for more than eight years now. My face has a few more wrinkles than when I began practicing, however time has brought a few positive changes to my nurse practitioner life. Fortunately, over the years, I have gained valuable practice experience. Unlike my new grad years, my work is not accompanied by a feeling of being utterly stressed out or overwhelmed. Rather, I feel quite comfortable interacting with patients (new grads, you'll get there, too!). 

While I have had significant NP experience at this point, there are still times when I'm not quite sure how to treat a patient's illness or what diagnosis to make. My experience has taught me, however, a few tricks to use to find the answers to my questions in times of uncertainty. One of my favorite go-to resources is, well, the patient. 

If you find yourself in a situation where you aren't quite sure about the next steps, see if these million dollar questions help in making your diagnosis or determining your plan of care. Better yet, your patient won't even notice that you aren't sure what to do!

Have you ever had anything like this before?

There are times I can't decide if a patient has a run of the mill infection, or something more serious like a complication of acute illness. There are other times when it's just plain unclear what diagnosis I should make. If you are uncertain about what is going on with your patient, ask "Have you ever had anything like this before?". Often, this will lead the patient to make the diagnosis for you. "Oh, yes. I get strep throat every year and it feels exactly like this", the patient might say. Or, "This is what is feels like when my asthma flares up" may save you from working your patient up for a cardiac condition when they present with shortness of breath. A word of caution with this approach - use your patient's reply as a guide. You may still need to do some investigating to rule out a more serious or new diagnosis

What usually helps you the most when this happens?

This question helps in two different situations. First, if you aren't sure how to proceed with treating your patient, asking "What usually helps you the most when this happens?" clues you in to treatments that have worked in the past. Often, patients struggle with the same health problems repeatedly, and can lead you to the appropriate next steps. This question is genius because patients don't realize you aren't sure how to proceed, and come away with a sense that you are genuinely interested in learning about their medical history (not that you aren't, but you're in stealth mode here). It's a much better reply than "I don't know". 

The second situation where this question comes in handy is when you aren't sure what the patient wants from you. Perhaps they have an untreatable chronic condition. Or, maybe they've nearly exhausted their options for treatment so you aren't sure how to proceed. The patient may feel that repeat imaging is in order. Or, for example, they may request a refill of their pain medication. Sometimes, the patient may even just want to vent! Understanding what the patient hopes to accomplish with their visit to see you helps you know know where to go next. Even if you don't grant their request, you can at least address the issues most important to them by explaining the 'why' behind your decision. 

What million dollar questions do you ask patients as a nurse practitioner?

 

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