Diagnosing Headache in Primary Care: Red Flags

Jun 7

Listen

Watch

Show notes:

Patients who come into primary care for a headache are often worried that it’s something very serious – and it’s your job to know whether it is or not. Many headaches are nothing overly serious, but as a new grad, it can be hard to know just how concerned to be and what to do with your concern.

Diagnosing Headache Red Flags in Primary Care

Let’s build your confidence and demystify some of the grey areas of headaches. In this video, we’ll cover:

✅ A simple tool that you can use to guide your visit, assessment, and plan

✅ Specific headache red flags, and what to do if you encounter them

✅ When to worry and what to worry about

✅ When to refer patients out

Headaches in a primary care setting can be confusing when you are getting started, but the more you see and the more you manage, the more clarity that you will gain. Use these tips to prepare for your next headache patient and be confident in your assessment, treatment, and referral.

SNOOP10 acronym:

Systemic symptoms including fever
Neoplasm history
Neurologic deficit (including decreased consciousness)
Onset is sudden or abrupt
Older age (onset after age 50 years)
Pattern change or recent onset of new headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema
Progressive headache and atypical presentations
Pregnancy or puerperium
Painful eye with autonomic features
Post-traumatic onset of headache
Pathology of the immune system such as HIV
Painkiller (analgesic) overuse (eg, medication overuse headache) or new drug at onset of headache

Resources mentioned in this episode:

Link to headache diary

WEBVTT
1
00:00:08.580 --> 00:00:12.760
Hey there, welcome to the Real World NP podcast.
2
00:00:13.140 --> 00:00:20.400
I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
3
00:00:20.400 --> 00:00:23.160
company for nurse practitioners in primary care.
4
00:00:24.360 --> 00:00:29.420
I'm on a mission to equip and guide new nurse practitioners so that they can feel
5
00:00:29.980 --> 00:00:33.040
capable and take the best care of their patients.
6
00:00:33.520 --> 00:00:38.260
If you're looking for clinical pearls and practice tips without the fluff, you're in
7
00:00:38.260 --> 00:00:39.040
the right place.
8
00:00:39.240 --> 00:00:42.960
Make sure you subscribe and leave a review so you won't miss an episode.
9
00:00:43.300 --> 00:00:49.260
Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
10
00:00:49.260 --> 00:00:50.140
podcast.
11
00:00:55.240 --> 00:01:01.440
So we are going to talk today about red flags of headaches.
12
00:01:02.100 --> 00:01:07.720
So headaches are a doozy of a chief complaint because there's such a broad differential,
13
00:01:07.900 --> 00:01:12.680
like so many of the topics I've talked about an episode so far.
14
00:01:13.420 --> 00:01:16.020
Headaches are really our tricky one.
15
00:01:16.360 --> 00:01:22.700
So the reason I want to focus on red flags in this episode is because the way that
16
00:01:22.700 --> 00:01:27.160
we get to that confident place of like, you know what, this is what I think this
17
00:01:27.160 --> 00:01:28.040
headache is from.
18
00:01:28.340 --> 00:01:29.600
Here are the differentials.
19
00:01:29.700 --> 00:01:31.300
I'm pretty confident going forward.
20
00:01:31.440 --> 00:01:36.380
The way that we get there is it's just a gradual process like most of the really
21
00:01:36.380 --> 00:01:37.400
tricky chief complaints.
22
00:01:37.500 --> 00:01:42.660
We have to start with the kind of basics, the old cart, onset location, duration,
23
00:01:42.780 --> 00:01:44.260
all those history questions.
24
00:01:44.940 --> 00:01:49.420
And then understanding the red flags of headaches keeps us safe.
25
00:01:49.720 --> 00:01:53.120
And then as we build out our knowledge, we can be like, oh, okay.
26
00:01:53.440 --> 00:01:58.080
So like spontaneous, you know, intercranial hypotension.
27
00:01:58.220 --> 00:01:59.820
I know all about that, right?
28
00:02:00.040 --> 00:02:00.760
Like, come on.
29
00:02:00.760 --> 00:02:03.340
We're going to learn about that as we go, right?
30
00:02:03.400 --> 00:02:07.360
And so the red flags are like those kind of anchoring pieces of like, okay,
31
00:02:07.620 --> 00:02:12.940
maybe I don't know all the things about spontaneous intercranial hypotension,
32
00:02:12.940 --> 00:02:13.460
right?
33
00:02:13.660 --> 00:02:16.080
But like, you know what, we're going to, we're just going to watch out
34
00:02:16.080 --> 00:02:16.800
for it, right?
35
00:02:17.440 --> 00:02:19.760
So anyway, I want to talk about some red flags.
36
00:02:20.260 --> 00:02:23.920
So specifically what I want to focus on is an acronym, which you may or
37
00:02:23.920 --> 00:02:25.100
may not be familiar with.
38
00:02:25.780 --> 00:02:29.080
It's called, it's had a lot of names, but it's like the snoop acronym.
39
00:02:29.080 --> 00:02:32.300
So snoop 10, I think is the most updated one.
40
00:02:32.480 --> 00:02:35.920
And I want to walk through that and kind of give some examples of context.
41
00:02:37.880 --> 00:02:39.100
So snoop, right?
42
00:02:39.100 --> 00:02:39.940
S is the first one.
43
00:02:40.300 --> 00:02:43.440
So the first thing you want to watch out for when it comes to a headache is,
44
00:02:43.600 --> 00:02:45.400
do they have any systemic symptoms?
45
00:02:45.820 --> 00:02:48.360
Do they have other things going on in their body, right?
46
00:02:48.440 --> 00:02:50.980
Even if you aren't, you know what, you're not like,
47
00:02:51.000 --> 00:02:53.940
like listing off all of those differentials, right?
48
00:02:54.220 --> 00:02:55.960
Is there anything systemic going on?
49
00:02:56.000 --> 00:02:57.860
Do they have a fever or chills?
50
00:02:57.860 --> 00:02:59.460
Most specifically, right?
51
00:02:59.480 --> 00:03:00.220
Do they have a rash?
52
00:03:00.260 --> 00:03:02.020
Do they have like other things going on?
53
00:03:02.220 --> 00:03:05.400
And that can be tied into things like meningitis, for example.
54
00:03:05.920 --> 00:03:08.100
So first things first, start with the S.
55
00:03:08.800 --> 00:03:10.260
I got my little notes over here.
56
00:03:11.100 --> 00:03:12.060
There's two ends.
57
00:03:12.500 --> 00:03:16.040
The first most important end, they kind of like, these are some hopefully like
58
00:03:16.040 --> 00:03:20.020
helpful hack pathways that you can be like, at least even if I don't know all of the
59
00:03:20.020 --> 00:03:21.860
differentials, I know these red flags, right?
60
00:03:22.200 --> 00:03:26.200
The next one is neurologic symptoms, neurologic deficits.
61
00:03:26.200 --> 00:03:29.320
So whenever I was a new grad, and even to this day,
62
00:03:29.420 --> 00:03:32.780
when I have a patient with a headache and I'm not quite sure what to do with them,
63
00:03:33.040 --> 00:03:35.120
the first question is, how is their neuro exam?
64
00:03:35.500 --> 00:03:37.940
If I didn't present that information to the person already.
65
00:03:38.520 --> 00:03:40.900
So neurologic exam is going to be so, so important.
66
00:03:41.060 --> 00:03:45.320
Anybody with a headache, we really want to be mindful of their neurologic status.
67
00:03:45.400 --> 00:03:47.240
Do they have any focal deficits?
68
00:03:48.320 --> 00:03:51.440
The next one is a history of neoplasm.
69
00:03:51.520 --> 00:03:55.160
So we want to be mindful of, do they have a history of cancer?
70
00:03:55.160 --> 00:03:56.860
Could this be a brain tumor?
71
00:03:57.780 --> 00:04:00.640
And I want to pause there and say that pretty much every patient that comes in
72
00:04:00.640 --> 00:04:02.180
is worried about something that severe.
73
00:04:02.500 --> 00:04:04.460
It's our job to be worried about it.
74
00:04:04.460 --> 00:04:08.800
It is not a common reason, but it is an important history question to ask
75
00:04:08.800 --> 00:04:11.140
in the context of a person with a headache.
76
00:04:12.220 --> 00:04:14.860
So with O's, there's two O's, so snoop.
77
00:04:14.980 --> 00:04:16.500
So two ends, two O's.
78
00:04:16.680 --> 00:04:21.079
So one of them is older age, which older is subjective, right?
79
00:04:21.200 --> 00:04:24.560
But basically it's referring to any patient over the age of 50.
80
00:04:24.560 --> 00:04:29.940
And a new onset of a headache over the age of 50 just has another level,
81
00:04:30.140 --> 00:04:33.600
another layer of differentials that could be more severe.
82
00:04:33.980 --> 00:04:37.800
And so it's just one piece to keep in mind with a red flag.
83
00:04:38.400 --> 00:04:41.000
Somebody who is the age of 50 or older with a headache
84
00:04:41.000 --> 00:04:43.520
does not necessarily mean that this is a red flag.
85
00:04:43.600 --> 00:04:44.540
They need urgent imaging.
86
00:04:44.620 --> 00:04:45.940
You have to send them to the ED.
87
00:04:46.340 --> 00:04:49.140
It's just one piece of information to keep in mind.
88
00:04:51.480 --> 00:04:53.280
Oh, the other O is really important.
89
00:04:53.280 --> 00:04:55.700
So these are all important, obviously.
90
00:04:56.840 --> 00:04:58.380
But maybe I'll keep saying they're all important.
91
00:04:58.420 --> 00:04:59.140
I don't know.
92
00:04:59.740 --> 00:05:03.220
So this second O though has to do with onset.
93
00:05:04.160 --> 00:05:07.400
So abrupt onset is very concerning with a headache.
94
00:05:08.340 --> 00:05:10.480
So that's what you've probably learned about
95
00:05:10.480 --> 00:05:14.320
or maybe even seen in real life so far of a thunderclap headache.
96
00:05:14.340 --> 00:05:17.220
So something that happened immediately, quick onset,
97
00:05:17.700 --> 00:05:21.380
especially in the context of somebody who was like exercising
98
00:05:21.380 --> 00:05:24.080
or doing some sort of exertion and then had this sudden,
99
00:05:24.080 --> 00:05:25.460
severe onset of a headache,
100
00:05:25.740 --> 00:05:27.760
that could be some sort of vascular condition.
101
00:05:28.080 --> 00:05:32.800
So it's really important to be mindful of the abrupt onset patients.
102
00:05:33.440 --> 00:05:35.420
Okay, so the rest of them are P's.
103
00:05:35.500 --> 00:05:36.660
There are 10 P's.
104
00:05:36.720 --> 00:05:37.940
There used to be a couple of P's
105
00:05:37.940 --> 00:05:39.360
and it feels like they just keep adding them.
106
00:05:39.360 --> 00:05:41.540
But it's nice at least that they're the same letter, right?
107
00:05:42.500 --> 00:05:47.360
So pattern change or a recent new onset.
108
00:05:47.360 --> 00:05:53.680
So this is again, this in and of itself is not necessarily an emergency.
109
00:05:54.460 --> 00:05:56.420
It's just a helpful context of like,
110
00:05:56.480 --> 00:05:58.000
when you're talking to somebody who has a headache,
111
00:05:58.820 --> 00:06:01.520
is this a headache that you've had before?
112
00:06:02.000 --> 00:06:03.720
Do you have headaches like this?
113
00:06:04.060 --> 00:06:06.580
Or is this drastically different than what you've had before?
114
00:06:07.580 --> 00:06:09.680
Because when there is a changing pattern,
115
00:06:09.700 --> 00:06:11.160
especially if it's progressive,
116
00:06:11.460 --> 00:06:15.660
that is more concerning for something more organically dangerous.
117
00:06:16.780 --> 00:06:17.660
Positional headache.
118
00:06:18.720 --> 00:06:21.180
So this one, I feel like I would get this when I was a new grad.
119
00:06:21.260 --> 00:06:23.940
I would present my case and then my colleague would be like,
120
00:06:23.960 --> 00:06:25.060
well, was it positional?
121
00:06:25.100 --> 00:06:26.380
I'd be like, what are you talking about?
122
00:06:26.760 --> 00:06:30.600
So this is referring to somebody who's laying flat or standing up.
123
00:06:30.900 --> 00:06:32.460
It's worse when they stand up
124
00:06:32.460 --> 00:06:33.960
and then better when they're laying flat
125
00:06:33.960 --> 00:06:36.860
is typically the scenario that we're talking about.
126
00:06:36.860 --> 00:06:39.480
And this has to do with the zebra that I mentioned
127
00:06:39.480 --> 00:06:43.400
of spontaneous intercranial hypotension or CSF leak
128
00:06:43.400 --> 00:06:47.060
or some sort of more concerning acute process.
129
00:06:47.800 --> 00:06:50.300
So even if you're not comfortable with all the differentials
130
00:06:50.300 --> 00:06:52.640
of like what positional could mean,
131
00:06:53.580 --> 00:06:55.860
just keeping that in mind as part of your history taking.
132
00:06:56.520 --> 00:06:59.980
The other context I want to make that I want to set around that,
133
00:07:00.000 --> 00:07:02.940
and I'm going to be making another video about migraines specifically,
134
00:07:03.400 --> 00:07:07.220
it's not necessarily that like the movement around is troublesome
135
00:07:07.220 --> 00:07:10.280
because there are patients who have migraines, for example,
136
00:07:10.500 --> 00:07:12.820
and exertion makes it worse because they just,
137
00:07:12.820 --> 00:07:15.560
it's just a throbbing headache that if they're going for a walk,
138
00:07:15.580 --> 00:07:16.520
it's going to make it worse.
139
00:07:16.880 --> 00:07:19.240
So that's not necessarily what I mean by positional
140
00:07:19.240 --> 00:07:20.800
or what's meant by positional.
141
00:07:21.020 --> 00:07:22.320
It has to do with position changes.
142
00:07:22.360 --> 00:07:24.840
There's a distinct difference between the position change
143
00:07:24.840 --> 00:07:27.560
that causes some sort of difference in their symptoms.
144
00:07:28.540 --> 00:07:29.740
Let's go for another P.
145
00:07:29.840 --> 00:07:33.340
So this is precipitated by sneezing, coughing, or exercise.
146
00:07:33.580 --> 00:07:35.700
I've already kind of mentioned this already,
147
00:07:35.700 --> 00:07:39.440
but when you have somebody who has a very sudden onset,
148
00:07:39.440 --> 00:07:43.380
especially in the context of that sort of exertional episode,
149
00:07:43.400 --> 00:07:45.220
that could be a vascular cause.
150
00:07:46.000 --> 00:07:47.580
Another P, papillodema.
151
00:07:48.140 --> 00:07:50.740
So this is a very challenging one
152
00:07:51.260 --> 00:07:53.340
where pretty much anybody who has a headache,
153
00:07:53.680 --> 00:07:57.020
you're going to do a focal neuro exam, full head to toe,
154
00:07:57.360 --> 00:07:59.420
probably in terms of your neurologic exam
155
00:07:59.420 --> 00:08:01.220
that you're going to be focused on.
156
00:08:01.720 --> 00:08:04.120
Papillodema is important to take a look
157
00:08:04.120 --> 00:08:05.900
at the intracranial pressure and all that.
158
00:08:06.100 --> 00:08:08.160
It is a very challenging exam to master.
159
00:08:08.160 --> 00:08:10.860
Just do your very best to keep on practicing
160
00:08:10.860 --> 00:08:12.540
and always ask for help if you need it.
161
00:08:13.300 --> 00:08:17.340
Another P, progressive history or atypical presentations.
162
00:08:17.860 --> 00:08:19.520
It's sort of similar to what I've already said,
163
00:08:19.600 --> 00:08:22.060
but the context of people is that they...
164
00:08:23.880 --> 00:08:26.360
Like most of the time, patients who have headaches
165
00:08:26.360 --> 00:08:28.740
can tell you what their history is,
166
00:08:28.920 --> 00:08:30.600
versus if this is like a brand new,
167
00:08:30.640 --> 00:08:32.360
they've never had this type of headache before,
168
00:08:32.840 --> 00:08:33.980
definitely tread cautiously.
169
00:08:36.120 --> 00:08:37.000
Pregnancy, 100%.
170
00:08:37.000 --> 00:08:39.659
Anytime I have a patient who is pregnant with a headache,
171
00:08:39.700 --> 00:08:41.380
I'm getting somebody else involved
172
00:08:41.380 --> 00:08:44.780
because there are more other things to be considered
173
00:08:44.780 --> 00:08:46.260
for a patient who is pregnant,
174
00:08:46.260 --> 00:08:47.560
and it could be a lot more serious.
175
00:08:48.760 --> 00:08:50.860
Post-traumatic onset, another P.
176
00:08:50.940 --> 00:08:52.860
So if somebody has some sort of head injury
177
00:08:52.860 --> 00:08:54.160
or some sort of trauma,
178
00:08:54.220 --> 00:08:55.520
and then they get the severe headache,
179
00:08:55.560 --> 00:08:57.180
that is much more concerning.
180
00:08:58.260 --> 00:08:59.140
Painful eye.
181
00:08:59.480 --> 00:09:00.680
If somebody has a painful eye,
182
00:09:00.720 --> 00:09:02.200
it could be more associated
183
00:09:02.200 --> 00:09:04.600
with like another sort of underlying condition.
184
00:09:05.340 --> 00:09:06.400
So two more P's.
185
00:09:06.400 --> 00:09:08.380
So pathology of the immune system.
186
00:09:08.580 --> 00:09:10.420
So if somebody has something like HIV
187
00:09:10.420 --> 00:09:13.360
or something underlying with their immune system going on,
188
00:09:13.420 --> 00:09:14.640
and they have a severe headache,
189
00:09:14.960 --> 00:09:17.500
they just have a lot more medical complexity
190
00:09:17.500 --> 00:09:18.740
to keep in mind,
191
00:09:18.840 --> 00:09:21.260
and it really broadens the differential diagnosis.
192
00:09:21.640 --> 00:09:24.260
So again, it's not that the patient has, for example, HIV,
193
00:09:24.500 --> 00:09:26.800
it's just that it's introducing a broader differential
194
00:09:26.800 --> 00:09:28.240
that could be a higher risk.
195
00:09:28.560 --> 00:09:31.220
So the last P is painkiller overuse.
196
00:09:31.620 --> 00:09:33.460
And I don't know, I don't...
197
00:09:33.460 --> 00:09:35.260
This is not necessarily a red flag,
198
00:09:35.260 --> 00:09:36.740
but I'm sure you are familiar
199
00:09:36.740 --> 00:09:38.500
with medication overuse headaches.
200
00:09:39.180 --> 00:09:42.560
So it's just one extra thing to kind of keep in mind
201
00:09:43.620 --> 00:09:46.240
that we just want to be mindful of,
202
00:09:46.280 --> 00:09:47.660
but it's not necessarily you need to send them
203
00:09:47.660 --> 00:09:48.840
to the ED right now.
204
00:09:49.400 --> 00:09:52.280
So of those snoop tens,
205
00:09:53.160 --> 00:09:54.560
who needs urgent evaluation?
206
00:09:55.660 --> 00:09:57.680
Pretty much, there's a couple...
207
00:09:57.680 --> 00:09:59.520
We can kind of siphon it down a little bit more.
208
00:09:59.720 --> 00:10:01.300
So sudden thunderclap headaches
209
00:10:01.300 --> 00:10:03.000
where it's like a rapid onset.
210
00:10:03.680 --> 00:10:05.380
I know it's a difficult decision
211
00:10:05.380 --> 00:10:06.760
to make to send somebody to the ER,
212
00:10:06.980 --> 00:10:08.000
but most of the time,
213
00:10:09.220 --> 00:10:10.460
I mean, those patients need to go.
214
00:10:11.300 --> 00:10:13.820
The other one is like a first or worst headache
215
00:10:13.820 --> 00:10:14.560
of their life.
216
00:10:14.900 --> 00:10:16.560
You really want to tread cautiously.
217
00:10:16.980 --> 00:10:18.860
I've been in that uncomfortable situation
218
00:10:18.860 --> 00:10:20.060
of like, do I send them?
219
00:10:20.120 --> 00:10:21.280
Do I not send them?
220
00:10:22.660 --> 00:10:24.900
That is one potential area to consider.
221
00:10:25.980 --> 00:10:28.460
The deciding factor in those types of situations
222
00:10:28.460 --> 00:10:30.360
is typically their neurologic exam.
223
00:10:30.580 --> 00:10:32.720
So if you have any focal neurodeficits,
224
00:10:32.720 --> 00:10:35.960
those patients definitely need emergent care and imaging.
225
00:10:36.760 --> 00:10:38.200
The other context that you want to think
226
00:10:38.200 --> 00:10:40.420
about emergent care for patients are
227
00:10:40.420 --> 00:10:41.300
when they have things like
228
00:10:41.300 --> 00:10:42.860
if you're worried about a meningitis
229
00:10:42.860 --> 00:10:43.860
or encephalitis,
230
00:10:44.140 --> 00:10:45.160
they have a neck pain,
231
00:10:45.300 --> 00:10:46.500
they have systemic symptoms,
232
00:10:46.600 --> 00:10:49.500
especially with focal neurologic deficits.
233
00:10:50.140 --> 00:10:54.120
And if you also have any periorbital symptoms as well,
234
00:10:54.320 --> 00:10:54.920
like we just,
235
00:10:54.980 --> 00:10:56.660
we don't want to mess around in that area.
236
00:10:56.880 --> 00:10:58.520
And then the last thing is,
237
00:10:58.780 --> 00:11:00.340
this is a pretty rare one,
238
00:11:00.340 --> 00:11:02.720
but is there any possible carbon monoxide poisoning?
239
00:11:03.220 --> 00:11:04.880
Hopefully you've gotten that in your history
240
00:11:04.880 --> 00:11:06.980
in terms of the context of what's going on
241
00:11:06.980 --> 00:11:08.300
for their evaluation.
242
00:11:08.800 --> 00:11:10.340
But those are for the most part,
243
00:11:10.560 --> 00:11:12.000
the reasons that those patients
244
00:11:12.000 --> 00:11:13.580
would need emergency evaluation.
245
00:11:14.240 --> 00:11:15.100
So down below,
246
00:11:15.100 --> 00:11:16.180
I'm going to write a little list
247
00:11:16.180 --> 00:11:17.620
of all of the SNOOP acronyms.
248
00:11:17.640 --> 00:11:19.340
So you can just kind of copy and paste that,
249
00:11:19.340 --> 00:11:21.520
and you can put that into your HPI.
250
00:11:21.520 --> 00:11:23.320
And then hopefully that will kind of help you
251
00:11:23.320 --> 00:11:25.360
trigger those types of questions.
252
00:11:25.840 --> 00:11:26.980
And hopefully in this video,
253
00:11:26.980 --> 00:11:28.820
I've kind of fleshed out that acronym
254
00:11:28.820 --> 00:11:30.340
a little bit more for context
255
00:11:30.340 --> 00:11:32.780
so that you can apply it more comfortably.
256
00:11:33.660 --> 00:11:35.640
And again, you have to do your due diligence
257
00:11:35.640 --> 00:11:38.360
of assessing the underlying reason for the headaches.
258
00:11:38.740 --> 00:11:39.780
But if you can incorporate
259
00:11:39.780 --> 00:11:41.880
or start incorporating that acronym
260
00:11:41.880 --> 00:11:43.140
in terms of your red flags,
261
00:11:43.400 --> 00:11:44.700
you can at least comfortably say,
262
00:11:44.900 --> 00:11:46.000
hey, we can take a pause.
263
00:11:46.300 --> 00:11:47.340
We can evaluate further.
264
00:11:47.440 --> 00:11:48.680
We can try some medications.
265
00:11:48.780 --> 00:11:49.880
We can do more assessment.
266
00:11:50.260 --> 00:11:52.100
We don't have to do anything emergent
267
00:11:52.100 --> 00:11:53.780
in terms of imaging or referrals
268
00:11:53.780 --> 00:11:54.860
or anything like that.
269
00:11:55.300 --> 00:11:57.560
So if you haven't grabbed the ultimate resource guide,
270
00:11:57.560 --> 00:12:00.220
head over to realworldnp.com slash guide.
271
00:12:00.540 --> 00:12:02.520
You'll get these episodes sent straight to your inbox
272
00:12:02.520 --> 00:12:03.860
every week with notes from me,
273
00:12:04.080 --> 00:12:05.120
patient stories and bonuses
274
00:12:05.120 --> 00:12:07.080
I really just don't share anywhere else.
275
00:12:07.120 --> 00:12:08.820
Thank you so much for tuning in.
276
00:12:09.140 --> 00:12:09.920
We'll talk to you soon.
277
00:12:12.400 --> 00:12:13.940
That's our episode for today.
278
00:12:14.100 --> 00:12:15.880
Thank you so much for listening.
279
00:12:16.280 --> 00:12:17.620
Make sure you subscribe,
280
00:12:17.960 --> 00:12:18.580
leave a review,
281
00:12:18.740 --> 00:12:20.480
and tell all your NP friends
282
00:12:20.480 --> 00:12:21.940
so together we can help
283
00:12:21.940 --> 00:12:24.260
as many nurse practitioners as possible
284
00:12:24.260 --> 00:12:26.200
give the best care to their patients.
285
00:12:26.420 --> 00:12:28.080
If you haven't gotten your copy
286
00:12:28.080 --> 00:12:30.680
of the ultimate resource guide for the new NP,
287
00:12:31.100 --> 00:12:34.220
head over to realworldnp.com slash guide.
288
00:12:34.640 --> 00:12:35.960
You'll get these episodes
289
00:12:35.960 --> 00:12:37.840
sent straight to your inbox every week
290
00:12:37.840 --> 00:12:39.240
with notes from me,
291
00:12:39.620 --> 00:12:40.140
patient stories,
292
00:12:40.320 --> 00:12:41.320
and extra bonuses
293
00:12:41.320 --> 00:12:43.440
I really just don't share anywhere else.
294
00:12:43.860 --> 00:12:45.420
Thank you so much again for listening.
295
00:12:45.580 --> 00:12:46.800
Take care and talk soon.

Podcast

Liz Rohr