Health Care Through the Back Door: The Dangers of Nurse Visits

In some practices, patients with seemingly simple problems are scheduled to be seen by a nurse or medical assistant. Sometimes they can even just drop off a urine sample in case of a suspected urinary tract infection.

This is a dangerous trap. What if the patient rarely gets urinary infections, has back pain and assumes it is a UTI instead of a kidney stone or shingles on their back just where one kidney is located; what if they have lower abdominal pain from an ovarian cyst or an ectopic pregnancy?

Another dangerous type of “nurse visit” is when patients focus on one symptom or parameter, thinking for example that as long as their blood pressure is okay, their vague chest pressure with sweating and shortness of breath isn’t anything serious. It’s one thing if I want a couple of blood pressure checks by my nurse, but a whole different thing when it is the patient’s idea, assumption or self diagnosis.

In many cases, a telephone call with the provider or a triage nurse can be safer and more diagnostic than starting with a nurse visit. Because the symptom history is usually more important when making a diagnosis. And nurse visits tend to be skimpy when it comes to the clinical history, even though the provider assumes responsibility for the diagnosis and treatment of a patient they didn’t talk to or examine.

Seemingly simple things can sometimes be disasters waiting to happen. Nurse visits are not billable, only the dipstick urine test is in my first example. But the malpractice payout could be bigger than for a missed diagnosis made by a thorough clinician in good faith – if there was little clinical history and no physical exam done, not even eye contact between patient and treating physician.

Consider this analogy: How much less is a meal at the takeout window than inside the restaurant? The cost is usually the same and it certainly isn’t free.

A Happy Meal is a Happy Meal, no matter where or how you receive it. Diagnosis and treatment are not defined by their setting or visit charge.

3 Responses to “Health Care Through the Back Door: The Dangers of Nurse Visits”


  1. 1 Kelley Stanley March 30, 2022 at 11:42 am

    Well said Hans
    I couldn’t agree more !
    These visits are dangerous

    Happy doctors Day !

    Kelley

  2. 2 Cathy H. April 3, 2022 at 12:54 pm

    Amen! I am a Nurse Practitioner in a large Family Practice clinic. While our RNs, LPNs, and MAs are overall very good, they are limited to doing just the BP check or urine dip or whatever. I am not sure if that is due to institutional policies, lack of time, or just not realizing they can and should ask questions appropriate to their level of training. Often they do engage in discussion with the patient about the visit purpose, but it isn’t documented OR the information is forwarded to the provider, but just quietly filed away. Very dangerous for all involved and a waste of the education and talent of our ancillary staff. I am a very hands-on provider and hate nurse visits for all of the reasons Dr. Hans listed and my own. The greatest healing powers providers have are their ears, eyes, and hands. A great provider taught me early on that the patient will tell you what is wrong with him. Listen to your patients. Use the lab as a tool, but listen to and touch your patients. That is the best advice I have ever received about life in general and I try to apply it to every interaction with my patients and with most interactions in life.


  1. 1 The Dangers of Nurse Visits – The Health Care Blog – Healthcare News Hubb Trackback on May 12, 2022 at 1:04 pm

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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