Telephone Triage

It is in the telephone communication with patients that the IBD nurse advocate functions most in the capacity of liaison between patient and physician. The nurse must be able to quickly determine the severity of the issue prompting the call in order to prioritize the urgency. Frequent issues or requests per the phone range from new onset of symptoms, failed response to therapy, adverse events, need for refills, test results, insurance coverage problems, disability paperwork, or referral to other specialists. Often patients are asked to call the nurse for guidance in adjusting medication dosages. This is particularly important when the physician has been tapering the patient off of steroids or adjusting the dose of newly prescribed azathioprine. Documentation of the content of the calls is important for legal reasons as well as for continuity of care. Before changes in therapy or plan of care are implemented the physician approves them.

Calls that are made because of an increase in disease activity (diarrhea, cramping, urgency, etc) require an investigation that includes asking about any changes in overall health, medication compliance (nonsteroidal anti-inflammatory drug use aggravates IBD), diet, and stress level, as well as asking about the presence of other symptoms (bleeding, opening of fistulas, fevers, extra-intestinal manifestations). Even the most articulate and insightful patients can leave out important data needed to appropriately assess the situation. Conversely, patients that are known to go on and on with copious and various complaints can be under-evaluated when they have real medical needs. Good advice from Dr. Theodore Bayless: "Neurotics are not immortal." Some calls simply require an empathetic ear.

Communication with outpatients via email can be effective and timesaving in some instances. However, it does not replace the need to actually talk with patients who are experiencing a flare of disease symptoms. It is often a subtle statement made by the patient that gives a clue as to degree of disease activity or maladaptive coping.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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