CVS review: Health hub nurse practitioner

To whom it may concern:

I made an appointment for my 15-year-old son at the Minute Clinic at 21 Mile and Card Road in Macomb Twp, MI at 10 am on 1/7/2024. He woke up very congested on 1/7/2024.

He initially had a sore throat that started on 1/3/2024 with some nausea. He had no congestion, just a bad sore throat. I took him to Summit Urgent Care at 23 Mile and Card Road in Macomb Twp on 1/4/2024 where he tested negative for influenza and COVID. Based on these findings, the Physician’s Assistant did a negative rapid strep test. The PA who saw my son at this urgent care gave me a script for amoxicillin and said to start giving it to him in 5 days if his sore throat was not better as the rapid strep tests often can give false negatives.

His throat did not improve much over the next 4 days, yet he had no additional symptoms. On 1/6/2024, I made an appointment at CVS for the following day, on 1/7/2024, to be re-tested for strep. Since he has Crohn’s, I did not want to administer the Amoxicillin. I wanted to try to confirm the DX by having him re-tested before giving the antibiotic.

As I mentioned, my son has Crohn’s disease. He receives IV infusions every 8 weeks for this, but they cause immunosuppression. We must make every effort to test him for COVID/influenza/Strep whenever he has symptoms so we can get ahead of it and possibly place him on Paxlovid/Tamiflu/Antibiotics if strep when indicated.

On day 5, 1/7/2024, the day of the CVS appointment, his throat was still very sore. In addition, he developed significant congestion with some chills that morning. I gave him one Coricidin tablet about 1.5 hours before the appointment to alleviate some of his symptoms. In addition to re-testing him for step, I now wanted him to be re-tested for COVID as his brother was sick and had just tested positive for COVID.

When we arrived for the appointment at CVS, I explained all of this to the Medical Assistant. The MA told us that she would be swabbing my son for COVID, but that the NP would be doing the strep swab when we saw her. When the technician was done with us, she told us to go back and wait in the waiting room. I asked her if she was going to do the COVID test like she initially said she was going to. She said that the NP would decide if he needed one.

When we finally got into the room with the NP, I tried to reiterate our reasons for the appointment. That he had a stand-alone sore throat that had not gotten better after 4-5 days but then the morning of the CVS appointment, he woke up with significant congestion. My other son had just tested positive for COVID. The NP talked to my son a little bit about how he was feeling and then proceeded to ask him if he had planned on going to school the next day. I explained that in his current state, the school would not want him to be there as we didn’t know if this was COVID, strep, both, or neither and that is why we made the appointment.

The NP began to examine my son and noted that he had significant mucus. She said this was the cause of his sore throat. She said he should do saline rinses for the congestion and use Flonase for the inflammation. I explained again that he had no congestion, runny nose, or postnasal drip for the past 5 days so his sore throat could not be caused by the mucous. The congestion just started that morning.

I again asked her if she was going to do a strep test and a COVID test and she responded “I am the practitioner today.” She told me that her assessment did not indicate any need to test him for COVID, that he did not have a fever, and that just because we have COVID in the home, does not mean he has COVID. As far as the strep swab, she said that I could just follow what the PA told us and begin to administer the amoxicillin since his throat was still sore. I told her again that I did not want to give the antibiotic without swabbing him for strep given his Crohn’s history. She seemed unphased and essentially ignored my request again.

I explained that like her, I am also a Registered Nurse with a master’s degree in nursing administration. I do not normally find it necessary to announce this during medical appointments of my own or my children unless the situation calls for it and this one did. I politely reminded her that a patient can present with no fever and still have COVID. I reminded her that he had taken a Coricidin tablet, which has antihistamine and acetaminophen in it if he had been running a low-grade temperature, the Coricidin may have brought the temperature to a normal range. As a healthcare provider, she must know this.

I felt like I was fighting her to test him, and she was not going to do it. Finally, she said, okay we can test him for COVID if you want. She unwrapped the swab and handed it to my son to swab his nose. He had a horrified look on his face. I said to my son, “We are done here, let’s go.” We got up and she said, “Wait you need to get your paperwork.” As we were standing there, my son got pale, said he felt like he was going to vomit, and then proceeded to do so in the sink. When he was done, she handed him the swab again to swab his nose. I took it from him and swabbed him myself. Since the COVID test was not done by the MA, we now had to go back into the waiting room to wait for the results, tying the exam room up and delaying other patients’ scheduled appointments. Lo and behold, we were called back in with the results which were positive just as I expected.

I am still not sure why we were treated this way. I called my sister-in-law right after the appointment, who is also a family practice NP, to ask a few questions I wanted to know if this is standard protocol to have children swab their noses and to reject reasonable requests by parents for swabs like strep and COVID. She responded with “This is outrageous. You need to report this.” In addition, my sister-in-law has a family member who also works as an NP at CVS in Royal Oak, MI. She could not believe it either.

This NP did not do her due diligence. She put my son at risk. She also put the health of others at risk by indicating that he did not need to be swabbed, even though she knew his symptoms and history of being immunosuppressed, and went on to say he could go back to school the next day if he felt like it. Aren’t we trying to control the spread of these communicable diseases or am I missing something here? I am a nurse. I knew better. Some people who are not medical, do not. Had I been one of these people who listened to her and sent my son to school, he would have exposed 100-200 other students and teachers to COVID for no reason.

From the moment we walked through the exam room door, there seemed to be an attitude before even one word was spoken. It felt personal to me, and I am not sure why.

One other thing I would like to mention is that I see on my receipt that she billed the insurance company for a new patient’s extended visit. She is the reason that the visit was extended, not my son. She chose to advise the MA not to swab him and then argued with me about it until she finally let me test him myself. The insurance company/I should not have to pay for her mistake.

I am sorry to say that we will not be coming back or referring anyone to this CVS for any type of health care issues if these are the types of health care providers you employ.