My demeanor is too dependent on the patient..

[Birdstrike]

Nothing makes me more angry, more likely to yell at the patient, more likely to throw furniture, then when you go see a patient who is usually in the ED for some bull**** complaint like vaginal discharge at 3am, but they cannot be bothered to open their eyes to talk to you. They simply don't want to wake up. You are disturbing them by waking them up and attempting to ask about why you're here. Last night I have one for 3am vaginal discharge X 2 days who when I tried to talk to her took a blanket and pulled it over her head. I come back with the nurse to do the pelvic, and the same ****. She does not want to wake up. We tell her (loudly) that she needs to wake up and participate in the exam or we are not going to treat her. Still with eyes closed she just spreads her legs and lifts them up wide in the air.

I'm disgusted with humanity.

Yes. I know. You have to admit the average level of psychopathology and interpersonal dysfunction in the ED population is glorious, isn't it. It makes for colorful (and wonderfully odiferous) stories, doesn't it?

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[herewego]

Thanks to everyone who contributed to my topic. I really appreciate it. As you can tell, I'm an intern. I'm no stranger to customer service, I've been a bank teller, I' ve been a door greeter etc.

That night where I wrote that post was just a particularly bad night...but I'm starting to understand that it happens, and that I'll have to deal with people like for the rest of my career.

The post about the anger being poison and bitterness particularly resonated with me, as I think I've actually used that word to describe it.

I've got alot to learn so bear with me =)

 

[EM4life]

I'm probably a minority opinion on this but I think it's fine for the OP to get frustrated and show it.

We validate far to much absolutely horrible behavior from patients. Refusing to answer simple questions from a doctor who you came in to see is awful. If you are in too much pain to talk, I understand that, but most of these patients are not.

I have ejected multiple patients for failing to cooperate with the history and physical. Obviously you have to select your candidates pretty carefully here but recently I had a 21 f come in for "syncope" by EMS who wouldn't talk at all. Just sat on bed and stared at us. Asked her several times, verified she spoke english, etc. Then I said very clearly: "you can either answer my next question or I am going to removed by security and document that you are attempting to defraud the hospital and the EMS system so that your insurance will not pay for this visit. The other option is that I can have you committed to a psych facility. There is no 3rd option. Now why are you here?" All of a sudden her ability to talk returned.

If patients will not fully participate then I just leave the room and wait a minimum of an hour before going back it. When teh family comes out saying they need pain medicine/juice/sammich I say, "sorry, your mother hasn't allowed us to evaluate her so we can't treat her yet."

I don't think we have a duty to haul information out of people. We have a duty to provide care but if the patient isn't on board there isn't much we can do.

I worked with a guy at one of my ML gigs who takes it a step further. He tells a lot of patients, "you made a really bad decision today to come to the ER." He gets lots of complaints but he also gets tons of compliments and is probably the staff's #1 favorite doc.

This made me smile and cannot tell you how often I have felt this way, however I cannot imagine having that conversation with a patient. Do you ever get a patient complaint for doing that or how do you document how this interaction goes? I have very little trust that hospital admin would ever side with our docs if we had interactions like this with our patients. Having said that though, I agree with if not fully participating in my assessment and otherwise well appearing and not in need of any intervention I do exactly what you do because I have patients who actually want to talk to me and seek my help. In my experience though, showing annoyance/irritation in general will make things more difficult, especially with a sick patient who actually does need some sort of intervention and is completely counter productive. But yes, for the 20 yo who cannot bother to look up at me while texting, they can wait or leave without being seen.

 

[AmoryBlaine]

I happen to work in a hospital that doesn't really care about patient complaints.

In the rare circumstances some troll of a patient has managed to get an administrator down I just calmly lay out the situation and 9/10 times the admin says, "well, sounds like they're being pretty unreasonable."

I fully realize not everyone has this luxury.

I also think that you can get away with more if you are a) productive, b) develop relationships with the medical staff, and c) make an effort to get to know the administrators. If you're the random quirky dude who shows up for 3 moonlighting shifts a month and people have to ask you your name no one is going to give you the benefit of the doubt. If you sent a nurse on a coffee run at 3am with a wad of your money and called the nursing sup to ask what they wanted.....

 

[Hair Police]

...If you sent a nurse on a coffee run at 3am with a wad of your money and called the nursing sup to ask what they wanted.....

I am going to have to steal this idea...

 

[deleted109597]

It might feel like making conversation, if you were born in the US, and have a different regional accent. If you are an immigrant, it can feel (or even be) discriminating.

So please don't tell me to calm down.

You do realize that we are required by law ensure effective communication? Not only that, we have to pay for an interpreter if one is needed. A doc in New York was sued for not paying for a sign language interpreter. http://www.amednews.com/article/20090420/profession/304209975/4/
So no, I don't care if you get offended when I ask where you're from and if you want an interpreter. I'm covering my ass.

 

[Promethean]

I also think that you can get away with more if you are a) productive, b) develop relationships with the medical staff, and c) make an effort to get to know the administrators. If you're the random quirky dude who shows up for 3 moonlighting shifts a month and people have to ask you your name no one is going to give you the benefit of the doubt. If you sent a nurse on a coffee run at 3am with a wad of your money and called the nursing sup to ask what they wanted.....

Since the thread got necrobumped anyhow, I'm just going to take this opportunity to confirm that a cup of coffee can buy a LOT of goodwill. It isn't the $1-3 you spend that matters, but that you thought enough of the person to do them the kindness. I remember every single time a doc even offered me a cup of coffee or a soda, even the ones that I declined. And I know that my interactions with those docs were forever improved by those offers. They showed me respect and, sometimes, a bit of compassion, and I subsequently bent over backward to make sure that I helped them in any way that I ever could. You need particular sutures from the OR brought down to the ED at 4 in the morning? I'll deliver them personally. Would you like to borrow a good set of needle drivers, too?

That brings me back to the topic. Small gestures of thoughtfulness work on everyone, including frustrating patients. It is almost too easy to get along with pleasant people. I consider difficult people to be interesting challenges. I treat it like a game, enjoying the process of finding a way past their defenses, to make them like me in spite of themselves. Bringing a blanket without having to be asked for it can make all the difference.

 

[deleted171991]

You do realize that we are required by law ensure effective communication? Not only that, we have to pay for an interpreter if one is needed. A doc in New York was sued for not paying for a sign language interpreter. http://www.amednews.com/article/20090420/profession/304209975/4/
So no, I don't care if you get offended when I ask where you're from and if you want an interpreter. I'm covering my ass.

The way to ask that politely is in reverse order: Do you want an interpreter? (Yes.) Where are you from?