I chose this GoHealth location partly because it has thousands of excellent reviews. Unfortunately,…read moremy experience was remarkably poor. The facility itself used artificial fragrance, which is a significant accessibility problem for chemically sensitive patients. More importantly, the NP did not take an adequate history. She repeatedly interrupted me, failed to ask systematically about relevant respiratory symptoms, made assumptions about symptoms I had never reported, and then forgot information I had already given her. I had to ask her approximately four times to stop and listen. Examples: after I had specifically reported a productive cough with green sputum, she later told me what to do "if you develop a cough." She proposed treatment for postnasal drip, which I had never reported. She repeatedly offered cough medication after I had clearly declined symptomatic treatment. After I told her I'd recently had E. coli urosepsis, she asked, "How did you get the sepsis?" I had to explain, "It was urosepsis. You get that from a UTI." She also assumed features of that illness rather than asking what had actually occurred. I also had to interrupt the encounter to make sure my chronic kidney disease/nephrogenic diabetes insipidus/recent acute kidney injury and eGFR of 34 were actually considered. She was unfamiliar with the 2021 CKD-EPI equation and showed little interest in the laboratory data I had available.
During the visit, the nurse practitioner demonstrated noticeably poor recall of information I had already provided. She did not take notes or use an AI scribe or any other visible documentation method to capture the clinical history. Given the memory difficulties I observed, I was concerned about how accurately she could retain the information, integrate it into her clinical assessment, and document the encounter afterward. This was particularly troubling because accurate history-taking and retention of clinical details are essential to making sound treatment decisions, **creating a reliable medical record that other providers can review and use to guide subsequent care**, and, frankly, **developing the clinical reasoning skills that make someone a better practitioner over time.**
There were two other exchanges that particularly undermined my confidence in the assessment.
At one point she apparently assumed that I had auscultated my own lungs. I'm not sure how she imagined I had adequately auscultated my own posterior lung fields, but more importantly, I had already told her that I practice psychiatry. I have essentially no current physical-assessment skill set and certainly was not presenting my own lung exam as clinical evidence.
She was also dismissive when I described the prolonged respiratory symptoms I experienced after my E. coli urosepsis two months ago. She told me, categorically, that sepsis does not lead to bronchitis/ongoing respiratory problems. I disagreed and told her to look at the literature: persistent respiratory symptoms--including cough, sputum, dyspnea, and impaired pulmonary function--are well described after severe infection/sepsis. My own post-sepsis respiratory syndrome lasted about a month before resolving.
Her response was to tell me that she had been "practicing medicine for 15 years." As a fellow nurse practitioner, I found that an especially strange appeal to authority. We practice as advanced-practice nurses; we are not physicians. Fifteen years of experience also does not make a categorical assertion correct or substitute for engaging with a patient's actual history and the evidence.
That exchange captures my problem with the visit: when information conflicted with her initial formulation, she did not become more curious. She became more certain. I am a nurse practitioner myself, and this is not a criticism of NPs. I have enormous respect for excellent advanced-practice clinicians. My criticism concerns this clinician and this encounter.
She may ultimately be correct that my current respiratory illness is viral and will resolve without antibiotics. That is not my complaint. A conservative treatment decision reached after a careful history, differential, examination, and patient education would have been completely acceptable to me. My complaint is that she reached her conclusion through inadequate history-taking, repeated interruption, unsupported assumptions, and failure to retain information I had just provided. I came for an assessment. I left without confidence that I had actually received one.
