I work in a family practice clinic in a suburb of Nashville, TN treating patients of all ages. Working in a primary care clinic I enjoy a regular 8-5 schedule that some of my fellow nurse practitioners friends do not. I work four days a week and take Thursdays off. I do work one weekend a month, half-days both Saturday and Sunday treating patients who walk-in for acute illnesses. My appointments are scheduled in 15 minute increments for routine follow-up visits and illnesses and 30 minute increments for routine physicals and GYN exams. Empty appointment slots will typically be filled by patients calling in for “sick visits”. In an average day, I see anywhere from 20-26 patients.
On a typical work day, I arrive at work about 30 minutes early to get ready for the day. I go through any lab results that have come back and mark any abnormalities that will require the patient to be called back for follow up or further discussion. By the time I have completed this task, my first patient has usually arrived. Today is no different.
My first patient is a 46 year old woman who presents for a follow up of hypertension. She has been on two blood pressure medications, hydrochlorothiazide and lisinopril, for the past three years and has recently began walking and trying to eat healthier. She hopes to ultimately lose enough weight to get off of at least one of her blood pressure medications. At her last visit, I was able to decrease her lisinopril dosage from 40mg to 20mg. She has been regularly monitoring her blood pressure at home and shows me her readings. On average, her blood pressure has been about 122/82. She has also lost 4 lbs. since her last visit. I tell her I am proud of her for her continued weight loss but do not think we should decrease her blood pressure medication dosage at this visit as her blood pressure is currently properly controlled. I encourage her to continue her weight loss plan and return in three months for a follow-up.
Next, I see a 56 year old male patient. I know him well as he follows up regularly for management of diabetes, hypertension and hyperlipidemia. He is on multiple medications and has no plans for lifestyle change. As a result, I closely manage his blood pressure, blood sugar and cholesterol levels to keep him as healthy as possible. Today he presents for an acute gout attack in his left MTP joint. He has had gout once before, about four months ago. I examen the joint and determine its appearance to be consistent with gout. I prescribe him pain medication, colchicine and indocin and tell him to follow up in three days for a recheck. I also let him know that if he continues to have acute gout attacks, we can consider putting him on allopurinol to prevent further attacks but this will be another medication he needs to take on a daily basis.
My third patient is a 5 year old girl with a fever, sore throat and rash on her abdomen. She started kindergarden last week and could have had exposure to illness. I examen her throat and note her tonsils to be swollen with exudate. Her temperature is 102.1 and she had a fine, erythematous rash on her chest and abdomen. I do a strep test which comes back positive and treat her with a prescription for amoxicillin.
Next, I see a 32 year old woman who presents for a routine physical including her yearly GYN exam. She has no health concerns today, but would like to be sure to get her cholesterol and blood sugar checked as diabetes and heart disease run in her family. I order a CBC, BMP and lipid panel. I complete a full physical exam including a GYN and breast exam. I inform her she has gained five pounds in the last year and recommend that she begin a daily walking routine to prevent further weight gain. I write her a prescription for a refill on her birth control and let her know I will contact her later this week with her lab results.
I love my job in family practice as I really get to know my patients. I see multiple patients from the same family and treat patients of all ages. Patient’s visits are more enjoyable with this relationship as they are comfortable with me and the clinic. I enjoy managing chronic illness and encouraging my patients to make lifestyle changes in order to be healthier. This can be discouraging, as many of my patients seem not to care about their health and rely on medication for chronic management but the few success stories are very encouraging. I highly recommend the FNP career!