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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #11

Have a patient with acute diarrhea? Here is a reasonable strategy:

If there is no significant fever, abdominal pain, signs of dehydration or bloody/mucoid stools, you can implement a watchful waiting period for 3-5 days with the patient. Most cases of acute diarrhea are viral in nature. Even if there is a bacterial food poisoning present, it will usually self-resolve within 5-7 days.

Instruct the patient to return by day 5 for stool studies if symptoms are failing to improve or worsening. Usually the patient never returns because the diarrhea resolves by itself. Occasionally though, they will return and you will pick up salmonella, campylobacter, cryptosporidium , etc…

As always, use your own clinical judgement in any type of acute presentation.

6 Responses

  1. I’m a fan. You have good honest pearls of wisdom because you’ve walked these paths already. Thank you for sharing your hard earned knowledge!
    God bless you abundantly in 2020!!

  2. My only issue in practice is that stool studies (unless PCR which can be very expensive depending on insurance) the result takes forever. So by day 5…you do the study…wait 5 more days and see its something that complicated or needs treatment the pt is typically annoyed you didnt test earlier. Especially in pediatrics where pt “need to know” the final dx.

    1. I agree, typical stool studies can take a while, but your lab should have a “film assay study.” It is a rapid stool antigen study and results are back within 24 hours. It works fantastic.

  3. I have recently launched a NP Mobile HouseCall business and want to add IV hydration, DOT certification, and podiatry. It is going slow, but 2020 I am praying for ways to attract more patients & to get lucrative ways to continue to help my business to serve others. Your story gives me hope, but I want to make more than peanuts.

    1. Stick with it Andrea. You might want to narrow down your service list and focus just on that. To many services confuse patients and deviates from the Elite NP Model. Remember, this should be a small NICHED side practice. Focus just on IV hydration and market in bars for people with hangovers, that kind of thing. Market the mobile DOT certifications in all the truck stops within 100 miles to your home. You must narrow down your service line.

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