Question

José Menendez is an elderly patient of Dr. Juárez, a board-certified urologist. José has a history of recurrent UTIs dating back more than 10 years. When he becomes symptomatic, he has been instructed to call Dr. Juárez’s office and schedule a urinalysis. Dr. Juárez’s receptionist has just received a call from Mr. Menendez. He says he knows he is supposed to come in for a urine test but that he just wants a prescription phoned in to his pharmacy instead. The receptionist asks Emilia, Dr. Juárez’s medical assistant, to take the call from Mr. Menendez. Emilia listens as Mr. Menendez recounts that he is experiencing dysuria—painful, burning urination. She asks him to come in for a urinalysis, explaining that, as per standing orders, a clean-catch midstream specimen needs to be collected. Mr. Menendez repeats to Emilia that he does not want to come in to the office. “Why can’t you call in a prescription for Bactrim? That is what I took last time, and it helped.”

Provide detailed answers for each of the following questions. Your response should be one (1) page in length.

• What is your response?
• Should the responsibility for this call have fallen on Emilia, or should the receptionist have either handled the call herself or passed it on to Dr. Juárez?
• What, if anything, could or should Emilia say to Mr. Menendez to persuade him to come in for the urinalysis?
• Might the cost of the procedure be a factor in the reason why Mr. Menendez does not want to have a urinalysis, and, if so, what, if anything, can Emilia do or say about the cost?
• Is it appropriate in this case, given the patient’s extensive history, to indeed call in a prescription for Bactrim?
• If not, how should Emilia handle Mr. Menendez’s request for his prescription?
• If so, what procedure should Emilia follow to arrange for a prescription?
• How should this telephone call be charted?
• What, if anything, should Dr. Juárez be told about the conversation with Mr. Menendez?

Answer 1

Mr. Menendez is an elderly patient suffering from frequent urinary tract infections since 10 years. He calls in the Dr. Juarez office, the receptionist connects the call to doctor's medical assistant, Emilia wherein she explains about the urine culture and sensitivity test to be taken before starting the bacterim. But Mr. Menendez refuses to come and instead asks for the prescription of the bacterim.

The response would be -

I would explain as to why the mid stream clean catch urine analysis is important. Here, Mr. Menendez explains that he had taken bacterim previously without the test and it worked and wants the same now.

I would explain as to knowing the causative organism is necessary to prescribe the type of antibiotic being prescribed and also the test reveals the extent of infection by measuring the colony forming units per mL of urine. This gives in idea of infection as well as the type of antibiotic that works for that particular organism. The test has to be taken before starting of antibiotics as the urine test result may alter after taking antibiotic. By following all these we can prevent the recurrent urinary tract infections you are experiencing.

Well, this would be my response to Mr. Menendez.

I feel the receptionist made a good choice to connect it to Emilia, medical assistant of Dr. Juàrez .

Emilia should say regarding the positive effects of test which would prevent him from frequent urinary tract infections he is experiencing.

Yes, the cost of the test may be a reason for Mr. Menendez rejecting the test as usually culture tests are bit costly. Emilia should inform about the cost of the test and reason for Mr. Menendez to refuse the test.

Mr. Menendez being experiencing UTI frequently, it is not appropriate for him to call and ask for Bacterim.

I feel it is better that Emilia inform this case to Dr. Juarez as the doctor is aware of his case as he being the patient since 10 years . Doctor would decide based on his previous reports. This is how Emilia should handle the case and chart it down in the patient profile regarding the symptoms and his refusal for the test.

Thank you.