"I am confused, what should I dx the patient with?"
We're confused by the fact that midlevels like these are allowed near real patients.
Today we have another gem from our perennial favorite of all nurse practitioner groups, "NP Guidance Group". This particular specimen comes to us courtesy of a family nurse practitioner by the name of Mari Abdishoo, who hails from the
online for-profit diploma mill Harvard-caliber institution known as Chamberlain University and now appears to be working at an urgent care. We've covered the esteemed Chamberlain and its curriculum before, which offers its customers students a total of 625 clinical training hours. Of course, 625 hours is a joke compared to the estimated total of 15,000 training hours accrued by a MD/DO resident physician in an ACGME-accredited family medicine residency.
Nevertheless, NP Abdishoo apparently liked Chamberlain enough that she's in the process of
purchasing earning her "Doctor" of Nursing Practice degree from there, too. Of course, we highly doubt that the DNP will remediate her apparent inability to interpret a urinalysis.
As is typically the case with these midlevel Facebook consults, we are presented with a grossly inadequate picture of the patient's medical history, history of present illness, and workup so far, further muddled by shit-tier grammar and spelling. We have absolutely no fucking idea how long this "male pt in early 20's" "flanks /. Sides back pain specially at nights" has been going for. Does this patient have any history of kidney disease or other genitourinary problems? "All other labs WNL" - what other labs, exactly? In any case, it's kinda fucking impossible to figure out how to answer the question "What should I diagnose the patient with" when you don't have anything resembling a differential diagnosis. Any half-competent medicine physician, let alone an intern or even a fourth-year medical student, could rattle off a comprehensive list of differential diagnoses for a patient presenting with flank pain and positive leukocyte esterase on urinalysis, even with a negative urine culture. Hell, we just went through that mental exercise and came up with a list of five things in the time it took to write this paragraph. Not that we particularly care to share them here, of course, because we're not in the business of giving free handouts to incompetent midlevels. Instead, we found this handy-dandy ICD-10 code for NP Abdishoo to use: Z71.1 - Person with feared health complaint in whom no diagnosis is made.
Really, what NP Abdishoo needs to do is get the hell off Facebook and stop asking total strangers for "advise". Instead, she should be asking her supervising physician for help. If this Facebook post is any indication, she's already in well over her head trying to figure out what's going on with this poor patient. That's assuming a supervising physician even exists, of course, as Massachusetts is one of states that recently enacted full practice authority for midlevel nurse practitioners. If not, it looks like the patient above will be paying the price!