Urgent care NP missed the diagnosis on myself, a pharmacist
A midlevel nurse practitioner's failure to recognize a classic textbook diagnosis results in unnecessary suffering for a patient.
Originally posted on Reddit. Reposted with permission. Lightly edited for grammar and clarity.
So this story actually takes place before I was a pharmacist. I was in my last year of school still at the time.
For several days, I developed symptoms of urinary frequency with significant difficulty urinating. This progressed to a severe level, and I started to have some flank pain. I decided it was time to see a doctor, but it was the weekend, so only urgent cares were open.
I was seen by a nurse practitioner inside the clinic. After asking about my symptoms, she began to shift her questions toward my sexual history. "You're in your twenties, sexually transmitted diseases (STDs) are a very common cause of this in people your age." I responded that this would be unlikely for me - "I've been in a long-term relationship for the past 5 years." I mentioned to the NP that it could be a kidney stone, as I've started having flank pain the last day. She seemed to ignore that and continue to say things like, "Even if you're in a long-term relationship, it's still possible to acquire an STD." Yeah, I don't think I'm getting cheated on, but OK? In addition, I also denied any evidence of infectious symptoms such as discharge or burning.
The nurse practitioner decided that the best course of action was to take a urine sample and await the results. She offered to treat me pre-emptively with an IM antibiotic injection (editor's note: likely ceftriaxone), but I declined because I was pretty sure it wasn't chlamydia or gonorrhea.
I went home with no idea what was going on and continued to suffer throughout the weekend. Luckily, I was able to see my MD primary care physician first thing in the morning on Monday. After quickly reviewing the nurse practitioner's note (both clinics were in the same health system) he said, "This makes no sense - they only did a urine culture and chlamydia/gonorrhea nucleic acid amplification test (NAAT)." He did a quick urinalysis and sure enough, protein and blood were present, with no indicators of a bacterial infection.
He was very confident that I indeed had a kidney stone, so he sent me on my way with a script for Flomax and naproxen. In addition, he scheduled an ultrasound for later that day. Sure enough, the ultrasound revealed a 4 mm stone.
Why in the world the nurse practitioner jumped straight to a urine culture and STD testing without first starting with a rapid urinalysis, I have no idea. Also, Flomax is an absolute godsend - within hours, I was transformed from a Chinese water torture device to an 8500 psi power washer.