“I can’t diagnose you by phone, but…”

Phones ring continuously in most ERs. I’ve learned to block the racket, but every so often I overhear nurses or clerks trapped in conversations that end with “I’m sorry, but I can’t diagnose you over the phone. If you feel you need to be seen you’ll have to come to the ER.”

This makes me cringe, because I know both parties feel stuck. The nurse or clerk doesn’t want to make a mistake over the phone that leads to a “bad outcome,” while the patient just wants a bit of guidance without having to run the full gauntlet, lose a night’s sleep, incur a massive bill.

Anyone who does telemedicine faces the same challenge, but here’s my work-around. On the phone I take the generic complaint and list “red flags” and “happy words” and then let the patient choose their path. I rarely diagnose or instruct about which way to go. Patients typically seem grateful for the time spent.

For dysuria (painful urination), here they are:
Red flags: Fever, back pain, vomiting, diabetes, pregnant, IV drug use, frail, history of kidney stones, history of frequent UTIs, STDs, or hospital admissions.
Happy words: Eating/drinking easily, “feels like past UTIs”, “on my honeymoon”, short duration, no recently treated UTIs.

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