Women's Health NP is "at a lost" on urinalysis and cultures
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If you have no idea how to interpret a female patient's urinalysis or urine culture and decide whether or not she needs treatment, you have no business working in Women's Health.
You can tell a lot about a person's fund of knowledge and level of training/experience by not only how the answer a question, but by the questions they ask and how they ask them. Case in point: this Facebook consult by nurse practitioner Shaina Rosenwasser.
Shaina, who works for a large multi-specialty group called New York Health, is a family NP with an additional piece of toilet paper certification in Women's Health (or currently in the process of doing so). In any case, that post-master's program must have been pretty low-yield for NP Shaina, since by her own admission she is new in her role and "at a lost (sic) on UA [urinalysis] and cultures." Apparently, she has no idea if this bacterium called P. bivia needs to be treated. We count ten ACOG/ACOOG board-certified OB/GYN physicians in her group, along with a physician assistant. Can you imagine a resident, let alone a seasoned, board-certified OB/GYN not knowing how to perform the mundane task of interpreting a urinalysis and urine culture? Did Shaina even bother for one fucking second to ask one of her clinical colleagues for help? Â We suspect not, and subsequently, she finds herself at the mercy of the Facebook peanut gallery as well as Midlevel.WTF.
Of course, NP Shaina completely and utterly fails to provide any useful information or context that might help to answer her clinical question and appropriately manage her poor patient. Without any clinical details like the patient's age, medical history, pregnancy and sexual activity status, symptoms, the complete urinalysis results, and the indication for obtaining a urinalysis in the first place, we're at a complete fucking loss too.
Finally, someone who was able to muster up more than one neuron started asking some pertinent questions in an effort to prod Shaina into coughing up some more details. We learn that the patient is asymptomatic and that there is some degree of pyuria present. But amazingly, it isn't until we're four comments deep that Shaina finally decides that it's important to mention that the patient is fucking pregnant. Did she not think that was relevant the first time around when posting about a urinalysis in a women's healthcare group? Are we the only crazy ones in here? Jesus fucking Christ. To make matters worse, judging by Shaina's question "So you're saying it's more a vaginal infection then (sic) a UTI", it's not even clear that she even considered or entertained the possibility of an asymptomatic sexually transmitted infection such as bacterial vaginosis, which can be caused by P. bivia.
KY Loh
In any case, while not treating a UTI or STI in a nulliparous female may not cause any issues - in fact, asymptomatic bacteriuria is generally not treated in this population - missing a genitourinary infection in a pregnant patient can be a big fucking deal, potentially leading to all sorts of unpleasant complications including but not limited to preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine growth retardation, and fetal death. Most medical malpractice lawyers we know would be chomping at the bit to take a case like this. Of course, if that happened, any midlevel nurse practitioners involved could simply claim that they were practicing "advanced nursing", not medicine, and dump all of the liability on the physician foolish enough to be supervising them. It's a win-win for everyone except the poor physician, grieving mother, and the dead baby!
