Ungrateful patients?

[agranulocytosis]

Today I went in to check in on a new patient and write up a progress note. Right as I introduced myself as agranulocytosis, 3rd year med studet, the guy blows up at me and says, "You're the 5th doctor to come see me today! I'm sick of all these people coming in and bothering me! Why can't you guys just leave me alone?"

OK, I thought. If you don't want the doctors' help then just leave AMA to let yourself rot out on the streets. I told the guy, "Well, sir, lots of people sure would be happy to even have one doc take care of them, let alone 5. Let me just find out what's wrong and we can get you better and out of here, OK?"

Stupid ungrateful prick.

Anyone else have any stories about dealing with these kind of patients?

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[smq123]

Today I went in to check in on a new patient and write up a progress note. Right as I introduced myself as agranulocytosis, 3rd year med studet, the guy blows up at me and says, "You're the 5th doctor to come see me today! I'm sick of all these people coming in and bothering me! Why can't you guys just leave me alone?"

OK, I thought. If you don't want the doctors' help then just leave AMA to let yourself rot out on the streets. I told the guy, "Well, sir, lots of people sure would be happy to even have one doc take care of them, let alone 5. Let me just find out what's wrong and we can get you better and out of here, OK?"

Stupid ungrateful prick.

Anyone else have any stories about dealing with these kind of patients?

I think your reaction is a little excessive.

Sure, it's always unpleasant to get yelled at, especially by patients. But it's equally annoying to have 5 people come in, have to repeat your story FIVE times (at least - usually more, because the nurse needs to know the CC and HPI), get poked, prodded, and poked some more. He might be anxious, and taking it out on you. Maybe none of those five doctors actually took the time to sit down and TELL him what to anticipate, what is wrong, etc. Maybe he's really worried about how much this hospital stay will cost him.

My boyfriend ended up in the ER, and eventually required emergent surgery. If I hadn't been a medical student, and aware of what it's like to be a student/resident, I probably would have been extremely annoyed. There is an endless stream of people just when you want to sit and collect your thoughts - nurse after nurse after nurse after med student after ER resident after ER attending....it's endless. You have to repeat your story to the ED clerk, to the ED nurse, to the med student on the ED rotation, to the resident, to the ED attending, to the trauma surgery intern, to the trauma surgery resident, and to the trauma surgery attending. Over, and over, and over again....

And then, despite the over half-dozen people "taking care" of you, you don't really know what's going on, when you can expect something definitive to happen, etc. My boyfriend probably would have been more irritated than I was, but he had a nice morphine chaser to keep him happy.

Sorry to hear you got yelled at by your patient. But it doesn't mean he's ungrateful, and it doesn't mean that he's a prick, either. Being a patient sucks, too.

 

[agranulocytosis]

You make excellent points. He did say that the other doctor just left his room not 5 minutes prior to my arrival, so if I had walked into his room a little earlier or later perhaps his reaction to me would have been a bit better.

I'm not upset that he yelled at me. I've been yelled at for being a "know-nothing student" plenty of times. It's understandable that patients wouldn't want to be used as a learning tool for medical students, but nothing really hits my nerve like the patient I saw today. His reaction to me was more along the lines of feeling inconvenienced somehow by my presence. In fact, he kept calling me "doc" throughout our discussion, which makes me think he really wasn't upset that I was a student checking him out for learning purposes.

I guess it's the whole person-standing-over-you-with-a-white-coat that can seem a little nerve-racking. You're most probably right about the other doctors not telling him what to expect and giving him the whole picture. It goes both ways, however. A little respect from the doctors as well as a little appreciation from the patients makes for a far better hospital stay, imho.

 

[smq123]

His reaction to me was more along the lines of feeling inconvenienced somehow by my presence.

That's probably what it was - he was just tired of having people come in and ask him a bunch of silly questions. I doubt it was personal.

 

[bjackrian]

I think your reaction is a little excessive.

Depending on how it was said, I'm not sure the OP's reaction was inappropriate. The goal is to defuse the situation and redirect the patient's energy toward giving you the information you need, and if delivered properly, I think the OP's response could have done that.

 

[smq123]

Depending on how it was said, I'm not sure the OP's reaction was inappropriate. The goal is to defuse the situation and redirect the patient's energy toward giving you the information you need, and if delivered properly, I think the OP's response could have done that.

Well, I meant more along the lines of calling him a "stupid ungrateful prick"....

 

[JeffLebowski]

Well, I meant more along the lines of calling him a "stupid ungrateful prick"....

This is an interesting phenomenon - medical students on SDN "calling out" other medical students for venting frustrations in dealing with patients. I seem to recall other threads where this has happened.

A medical student voices a very realistic frustration with a very common scenario, one that we all have probably faced at some point, and a very normal response to that scenario, and some other student, who isn't happening to have a rough day today comes in and throws around a holier-than-thou chastisement of his vent. Sure, it'd be inappropriate if we were to sit around and have a trash-talking fest all day and we should probably be careful, and yeah, "stupid ungrateful prick" is a little harsh, but I don't think the OP should get scolded with a "those poor patients are vulnerable and special and scared and helpless how dare you criticize them" lecture. The OP knows this, we all know this, give us the benefit of the doubt that we all take it seriously, and I'll wager he handled it totally professionally, let the guy vent a little jeez.

Especially when sometimes, it's just not the case. Sometimes patients are just jerks. Again, we always give them the benefit of the doubt and handle them professionally, but behind closed doors let him vent.

 

[smq123]

This is an interesting phenomenon - medical students on SDN "calling out" other medical students for venting frustrations in dealing with patients. I seem to recall other threads where this has happened.

A medical student voices a very realistic frustration with a very common scenario, one that we all have probably faced at some point, and a very normal response to that scenario, and some other student, who isn't happening to have a rough day today comes in and throws around a holier-than-thou chastisement of his vent. Sure, it'd be inappropriate if we were to sit around and have a trash-talking fest all day and we should probably be careful, and yeah, "stupid ungrateful prick" is a little harsh, but I'll be damned if I'll let the OP get reamed out with a "those poor patients are vulnerable and special and scared and helpless how dare you criticize them" lecture. The OP knows this, we all know this, give us the benefit of the doubt that we all take it seriously, and I'll wager he handled it totally professionally, let the guy vent a little jeez.

Especially when sometimes, it's just not the case. Sometimes patients are just jerks. Again, we always give them the benefit of the doubt and handle them professionally, but behind closed doors let him vent.

It wasn't meant to be a call-out. Nor did I mean it to be a "holier than thou chastisement." Sorry if that's the way it came across to you.

It just seemed like he was taking it way more personally than it was meant. And if that's how reacts to every single patient that says "I'm tired of all these people coming in to talk to me!" then he's in trouble. His reaction seemed way too harsh and out of proportion to the incident, and I was just trying to get him to calm down about it a bit.

But thanks for assuming that I wasn't having a rough day. Really. I actually kind of was, but that's okay, too. Maybe YOU were having a rough day?

 

[JeffLebowski]

It wasn't meant to be a call-out. Nor did I mean it to be a "holier than thou chastisement." Sorry if that's the way it came across to you.

It just seemed like he was taking it way more personally than it was meant. And if that's how reacts to every single patient that says "I'm tired of all these people coming in to talk to me!" then he's in trouble. His reaction seemed way too harsh and out of proportion to the incident, and I was just trying to get him to calm down about it a bit.

But thanks for assuming that I wasn't having a rough day. Really. I actually kind of was, but that's okay, too. Maybe YOU were having a rough day?

Yes. Sorry for biting your head off. But still.

 

[smq123]

Yes. Sorry for biting your head off. But still.

Dude, we've all been there. We've all had patients who yell at you, curse at you, call you names, question the legitimacy of your birth, hurl racial insults at you if you are a minority. Or (always my personal favorite) insist on calling the female med student as "nurse," and calling the male CNA a "doctor".

And I'm all in favor of venting. But there's venting, and there's stuff that goes beyond venting.

Sorry you had a rough day, though. Hopefully tomorrow will be better.

 

[agranulocytosis]

Let me reiterate: I'm not offended that I was yelled at. The thing that bothered me about this patient was the ungrateful attitude he displayed. If my intern related to me the attitude such a patient displayed to him, I would have reacted the very same way - "ungrateful prick".

I actually enjoy interacting with people that seem bothered by my lack of credentials. I find that by the time I'm done doing my thing, the people I'm seeing are somewhat relieved that I'm not an ass and actually try to communicate with them. Human interaction is a funny thing.

He was a stupid ungrateful prick.

 

[agranulocytosis]

and I'll wager he handled it totally professionally, let the guy vent a little jeez.

At least I hope so...

 

[bigDinLV]

This is nothing.. I was a paramedic for a while before med school. Imagine having patients try to assault you when you are just there to do your job because they called 911.

How about when you go pick up the wife that got beat senseless.. she cusses you up and down the entire time (you can almost imagine why she got beat up) calls you the white devil, cracker, and every other name in the book for the entire time you are with her.

Or the drunks that you have to wake up in an alley because of the "man down" call. Sometimes they just come up swinging...

Wait, how about the guy that had knives hidden all around his house. He managed to pull one out from the couch and raises the knife up. After you put him on his butt and have a little struggle, you take the knife away and ask what he was going to do with it. He said he was going to cut his own throat with it so we could watch. Should have let him, would have been a more interesting call that way.

 

[bjackrian]

Well, I meant more along the lines of calling him a "stupid ungrateful prick"....

Right, but as far as I can tell he didn't say that to the patient--he said it to someone completely removed from the situation, which is totally the right response IMHO.

 

[LadyWolverine]

Let me reiterate: I'm not offended that I was yelled at. The thing that bothered me about this patient was the ungrateful attitude he displayed.

I'm struggling with this as a 3rd year as well. The sense of entitlement and sheer disrespect for the people trying to help you that I encounter on a regular basis just floors me. Many of the patients that we treat do not pay a dime for their medical services - the "system" absorbs the cost, which is then distributed to the people (myself included) who do actually pay for their medical care in the form of higher premiums, etc. My political/economical leanings aside, I've seen my residents and attendings bend over backwards to make sure that these people get everything they need - make phone calls for them, find them transfers to other hospitals that can accomodate them if we can't, find them ways to get free care from the system, get social work involved to find them even more free stuff, etc. It shouldn't be their job to have to procure these things for these patients, but they do it out of the goodness of their hearts and their belief that everyone deserves to be healthy and have a chance to get better. Yet I've watched countless times as these exact same people disrespect my attendings, call them all sorts of names to their faces because they don't "appreciate" the doctor telling them to discontinue their bad habits, demand more medicine/services for free, argue with the plan of care that someone has slaved over for the past two days to try to make it work...all while they lie in their hospital bed, make/recieve phone calls all day (usually when you are trying to interview/examine them), yell at the nurses, complain when the teams round on them in the mornings, refuse to cooperate with PT/OT/getting OOB/etc, sneak outside to smoke after you've asked them not to leave the floor and offered them alternatives, etc. It makes me so angry.

I'm not saying that patients should kiss our feet for going out of our way for them - as a matter of fact, no showing of gratitude is expected. But why is it so excessive to expect to be treated with the same respect that you have granted them? Why is it an overreaction to think that that person is out of line? That kind of behavior shouldn't be defended. I doesn't matter how many people have to take your history, or wake you up in the morning, or listen to your heartbeat - if you are getting something for nothing, you should be grateful for it. You come to a hospital to be examined and to get treated, until you are well enough to continue recovering at home. You need to both cooperate and participate in your care, which means you need to actively work to get better. It's not a free hotel stay where people wait on you hand and foot, and cater to your every emotional whim. End of story.

 

[smq123]

I'm struggling with this as a 3rd year as well. The sense of entitlement and sheer disrespect for the people trying to help you that I encounter on a regular basis just floors me.

I've seen my residents and attendings bend over backwards to make sure that these people get everything they need - make phone calls for them, find them transfers to other hospitals that can accomodate them if we can't, find them ways to get free care from the system, get social work involved to find them even more free stuff, etc. It shouldn't be their job to have to procure these things for these patients, but they do it out of the goodness of their hearts and their belief that everyone deserves to be healthy and have a chance to get better. Yet I've watched countless times as these exact same people disrespect my attendings, call them all sorts of names to their faces because they don't "appreciate" the doctor telling them to discontinue their bad habits, demand more medicine/services for free, argue with the plan of care that someone has slaved over for the past two days to try to make it work...all while they lie in their hospital bed, make/recieve phone calls all day (usually when you are trying to interview/examine them), yell at the nurses, complain when the teams round on them in the mornings, refuse to cooperate with PT/OT/getting OOB/etc, sneak outside to smoke after you've asked them not to leave the floor and offered them alternatives, etc. It makes me so angry.

<sigh> I know. It IS frustrating.

I had an HIV+ pt. when I was on IM. He was homeless, and hadn't been taking his HAART. So, to prepare for his discharge, I had to call every single free HIV/AIDS clinic in the city, to find someplace where he could go and get his meds. It took several hours, but I finally found one.

When I told him that he could go to this place for his HAART, he said, "UGH! I'm not going THERE! The only people who go there are fags, fairies, drag queens! NO WAY! They creep me out. And if I go there, everyone will think that I'm a *** too! You'll have to find someplace else."

<sigh>

Trying to shame him into being grateful, reminding him how much he legitimately had to be grateful for, and yelling at him, doesn't accomplish anything. Nor does doing another 4 hours of calling every single HIV clinic in the county, just to find him one that he would deem "acceptable." At some point, you just start to accept that people take ****ty care of their health, and make bad decisions, regardless of your best efforts.

In my opinion, it's not wrong or medically negligent to say to him, "Well, that's fine. But you have to understand that, at this point, your only options are going to this particular HIV clinic, or letting your HIV get worse and progress to AIDS. But the decision is up to you." And then, leave the decision up to him. If he wants to die of AIDS, then, well...that's up to him.

I think part of the stress comes from the fact that most of us were taught, at some point, that refusing to bend over backward for your patients, letting your patients walk away without giving them 110% of your effort, etc. makes you a bad physician. Really, I don't think it does, though. You're not going to save everyone. Nor do I think you necessarily need to kill yourself to try.

I'm not saying that patients should kiss our feet for going out of our way for them - as a matter of fact, no showing of gratitude is expected. But why is it so excessive to expect to be treated with the same respect that you have granted them? Why is it an overreaction to think that that person is out of line? That kind of behavior shouldn't be defended. I doesn't matter how many people have to take your history, or wake you up in the morning, or listen to your heartbeat - if you are getting something for nothing, you should be grateful for it. You come to a hospital to be examined and to get treated, until you are well enough to continue recovering at home. You need to both cooperate and participate in your care, which means you need to actively work to get better.

That's the part I disagree with.

For one, I don't think that patients "should" be grateful for much. It's always nice if they are, obviously, but nothing besides common courtesy dictates that they should be grateful.

Second of all, there are limits. I don't think that someone saying, "You're the fifth person in this room; I'm tired of all these people!" makes him an ungrateful prick. Yelling at the FIRST person who walks into the room, sure - that's ungrateful. Spitting blood at the ENT resident who is coming in to repair your face lacs is ungrateful. (Saw that a few months ago.) But it is genuinely irritating to have a parade of people come in. And I think part of "dealing" with ungrateful patients is recognizing when they're truly rude ingrates, and just cranky people who have a legitimate complaint.

Yeah, I know, these people are tough to work with. They don't care if their health sucks, and that's frustrating to watch.

 

[QofQuimica]

Anyone else have any stories about dealing with these kind of patients?

Oh, yeah, of course. We all have difficult patients sometimes. That is the kind of patient where you pull up a chair, sit next to their bed, and agree with them that it sucks to have a parade of perfect strangers coming in and out of your room. Then they vent to you for five or ten minutes, and afterward they let you do your H & P. Like someone else already said, it's not personal when a patient yells at you. If you show them some empathy (or fake it if you have to) instead of fighting them, things will go more smoothly, and you'll be able to get your job done. At least, that's been my experience.

Basically, it comes down to this: there are some people in this world whom you are going to like better than others. Some of your classmates are nicer than others. Some of your attendings and residents are nicer than others. Some of your patients are nicer than others. But you have to work with all of them, and you have to get along with them well enough to get your work done. You won't like them all, but they don't have to know how you feel, though.

 

[aphistis]

nothing besides common courtesy dictates that they should be grateful.

When, exactly, did this become such an unreasonable expectation of behavior from a grown human being? I work in a county hospital, and the volume of resources we waste enabling people's bad habits and poor decisions leaves me with steam out of my ears some days.

The waste of hospital personnel time and money offends me much less than the implicit resignation that "these losers are never going to make a good decision about themselves, so we might as well just help them make bad ones to shut them up and get them out of our hair." Does anyone remember the expression "soft tyranny of low expectations"?

 

[smq123]

When, exactly, did this become such an unreasonable expectation of behavior from a grown human being? I work in a county hospital, and the volume of resources we waste enabling people's bad habits and poor decisions leaves me with steam out of my ears some days.

The waste of hospital personnel time and money offends me much less than the implicit resignation that "these losers are never going to make a good decision about themselves, so we might as well just help them make bad ones to shut them up and get them out of our hair." Does anyone remember the expression "soft tyranny of low expectations"?

I'm not sure how this is related to ungrateful patients.

I've had patients who were exceedingly kind and gracious...but were horribly (and blithely) non-compliant. One lovely 95 year old lady who was gentle, kind, and courteous....but hadn't taken her blood pressure meds in a month. Didn't really seem to care that her blood pressure was 210/100. Seemed more interested in her lemon meringue pie than my carefully prepared spiel on the importance of good blood pressure control. Then again, she was 95. I might be like that too, if I make it to that age.

And there are the REALLY compliant patients who are rude to everyone. There's no correlation.

 

[aphistis]

I'm not sure how this is related to ungrateful patients.

My last comment was directed toward providers attitudes toward troublesome patients, rather than the reverse perspective prevailing through the rest of the thread.

 

[smq123]

The waste of hospital personnel time and money offends me much less than the implicit resignation that "these losers are never going to make a good decision about themselves, so we might as well just help them make bad ones to shut them up and get them out of our hair." Does anyone remember the expression "soft tyranny of low expectations"?

It's not an implicit resignation that "these losers are never going to make a good decision about themselves, so let them do whatever to get them out of our hair." It's a realization that a) there are limitations to what you can do, and b) recognizing that, hey, there are 4 other people on this service who need your attention.

I don't know what they do in dental school, but in med school, during our first two years, they inflict ethics and "touchy-feely" classes on us. The biggest contention that most med students have against these types of classes is, "You can lecture us all you want, but if you're a fundamentally unethical and immoral person, you're going to become an unethical and immoral physician, no matter how many ethics lectures they throw at your head." Does that mean that they shouldn't try to influence us, and should discontinue these classes. No, of course not. But, honestly, not every student is going to listen to/derive any benefit from these types of lectures. Ultimately, it is up to the STUDENT to make those changes needed to become a better, more ethical physician.

It's the same thing with patients. Do I talk to every patient about the dangers of smoking? Sure. Do I recognize that not every patient is going to listen to/derive any benefit from this info? Sure! I'm not that unrealistic or optimistic. Does that mean I'm not going to try? No, I still will. But will I beat myself up if not every patient quits smoking? No. And I'm not going to bend over backwards to try and make them, either. Ultimately, it is up to the PATIENT to make those changes needed to become a better, healthier person.

Patients will always make their own decisions. I'm not always going to agree with those decisions, and that is one of the challenges that I've had to face over the course of 3rd and 4th year - and will continue to face, I suspect, as a resident. But, honestly, I don't feel that it is the physician's duty to change everyone's mind. It's their duty to take care of the patient, to do what is medically necessary for the patient, and to do their best within those parameters, but it's not my duty to take charge of every aspect of that patient's life.

The waste of hospital personnel time and money offends me much less than the implicit resignation that "these losers are never going to make a good decision about themselves, so we might as well just help them make bad ones to shut them up and get them out of our hair."

Aphistis - recognizing that patient's ability to make their own decisions (good or bad) does NOT always get them out of our hair. If you think it does, you must have had a very narrow experience with patients.

Especially in the ICU, patients make bad decisions that actually create MORE work for the hospital staff. I can talk to a patient and his family about his poor prognosis until I'm blue in the face....but if they still insist on being Full Code (instead of DNR/DNI), then there's not a lot I can do except honor that decision.

There was an elderly patient that came in with a ruptured AAA. The surgeons made it very clear that he was a poor candidate for repair, and that, maybe, he should just be allowed to die peacefully. The family, however, refused to listen to this, and insisted that he be operated on. So they did.

The guy ended up requiring 33 units PRBCs, 20 units of platelets and (I think) 20 of FFP. He literally cleaned out the blood bank. Too bad all those blood products didn't do any good - he died less than 4 hours after he left the OR.

It's not an implicit resignation to do anything to get the patients out of our hair. It's recognizing that patients have the right to make their own decisions, whether it is to stop taking their insulin, continue to smoke 4 packs a day, or get an operation that is likely to kill them (or bankrupt the hospital). All you can do is give them your opinion, and let them figure it out for themselves.

 

[SoCuteMD]

Let me reiterate: I'm not offended that I was yelled at. The thing that bothered me about this patient was the ungrateful attitude he displayed. If my intern related to me the attitude such a patient displayed to him, I would have reacted the very same way - "ungrateful prick".

I actually enjoy interacting with people that seem bothered by my lack of credentials. I find that by the time I'm done doing my thing, the people I'm seeing are somewhat relieved that I'm not an ass and actually try to communicate with them. Human interaction is a funny thing.

He was a stupid ungrateful prick.

I have to say that I'm a little confused as to why you think the patient is ungrateful. As medical students, we pretty much take more than we give to patients. We are another voice waking them at 630 AM, another pair of hands palpating their tender abdomen, and when they ask us for something we look at them, stammer, and say, "Um, I'll have to speak to my senior about that." Patients ABSOLUTELY have the right to refuse to be teaching cases.

The patient does not have FIVE doctors, especially if he was counting you (a medical student) as one of them. And the choice is not "5 doctors or nothing" - patients have the right to determine who can and can't be involved in their medical care.

Clearly you have never been an inpatient in a hospital and seen what it's like to get your vitals every 4 hours, your meds every 4 hours (staggered from vitals) and to be awakened constantly by troops of people passing through your room (half of them to see your roommate).

 

[aphistis]

I have to say that I'm a little confused as to why you think the patient is ungrateful. As medical students, we pretty much take more than we give to patients. We are another voice waking them at 630 AM, another pair of hands palpating their tender abdomen, and when they ask us for something we look at them, stammer, and say, "Um, I'll have to speak to my senior about that." Patients ABSOLUTELY have the right to refuse to be teaching cases.

The patient does not have FIVE doctors, especially if he was counting you (a medical student) as one of them. And the choice is not "5 doctors or nothing" - patients have the right to determine who can and can't be involved in their medical care.

Clearly you have never been an inpatient in a hospital and seen what it's like to get your vitals every 4 hours, your meds every 4 hours (staggered from vitals) and to be awakened constantly by troops of people passing through your room (half of them to see your roommate).

I agree completely. I applaud these courageous heroes, bravely struggling on against the wicked inconveniences of modern inpatient health care.
After all, who could possibly concern themselves with something as trifling as the prospect of imminent death, when weighed against such momentous obstacles to care as asking your mother to call back in ten minutes or being awakened periodically for the care that is, frequently, keeping you alive?

This is another perfect example of the enabling attitude I referred to earlier.

 

[SoCuteMD]

I agree completely. I applaud these courageous heroes, bravely struggling on against the wicked inconveniences of modern inpatient health care.
After all, who could possibly concern themselves with something as trifling as the prospect of imminent death, when weighed against such momentous obstacles to care as asking your mother to call back in ten minutes or being awakened periodically for the care that is, frequently, keeping you alive?

This is another perfect example of the enabling attitude I referred to earlier.

This patient was clearly not facing "imminent death." And there was no mention of him being on the phone either. He simply did not want to be poked, prodded, and questioned by yet another person. I can't blame him. Did I LOVE being the medical student thrown out of the room when it happened? No. Did I understand? Yes. Did I applaud my mother when, as a patient, she threw the gyn onc fellow out of her room when he breezed in with his entourage and without introducing himself lifted her gown to examine her wound? You bet I did!

I'm sorry, but if they didn't teach you empathy for patients in dental school, there's very little I can do for you here. But it's fine - I'll treat my patients with empathy and caring, you treat yours with your attitude. We'll see who ends up in court for malpractice first !

 

[aphistis]

This patient was clearly not facing "imminent death." And there was no mention of him being on the phone either. He simply did not want to be poked, prodded, and questioned by yet another person. I can't blame him. Did I LOVE being the medical student thrown out of the room when it happened? No. Did I understand? Yes. Did I applaud my mother when, as a patient, she threw the gyn onc fellow out of her room when he breezed in with his entourage and without introducing himself lifted her gown to examine her wound? You bet I did!

I'm sorry, but if they didn't teach you empathy for patients in dental school, there's very little I can do for you here. But it's fine - I'll treat my patients with empathy and caring, you treat yours with your attitude. We'll see who ends up in court for malpractice first !

Your passive-aggressive, middle-school demeanor isn't doing you any favors. If you're going to disagree with someone, stand on your feet and disagree with them instead of hiding behind fake smilies and insincere sympathy.

Back on topic, since you don't seem to be catching on, I'll point out to you that I'm generalizing the OP's specific example to highlight the broader points it illustrates. I wasn't there to know whether the OP deserved the treatment s/he received, but your insistence on belaboring the details of the incident tells me that either 1) you were there yourself and can therefore speak intelligently about the details of the encounter, or 2) you don't share my reservations about leaping headfirst into arguments whose contexts I know very little about.

I obviously agree that bedside manner is an important component of medical care. Just as obvious, however, is this: if you don't want lots of people asking you about being sick, don't go to a hospital.

 

[JeffLebowski]

This patient was clearly not facing "imminent death." And there was no mention of him being on the phone either. He simply did not want to be poked, prodded, and questioned by yet another person. I can't blame him. Did I LOVE being the medical student thrown out of the room when it happened? No. Did I understand? Yes. Did I applaud my mother when, as a patient, she threw the gyn onc fellow out of her room when he breezed in with his entourage and without introducing himself lifted her gown to examine her wound? You bet I did!

I'm sorry, but if they didn't teach you empathy for patients in dental school, there's very little I can do for you here. But it's fine - I'll treat my patients with empathy and caring, you treat yours with your attitude. We'll see who ends up in court for malpractice first !

Whoa, it kind of sounds like you're going off the deep end.

Of course some doctors are in the wrong here. We all agree that we should be sensitive to our patients' struggles to some extent. But you can't argue with the fact that SOME PATIENTS ARE JUST RUDE. Come on, let's acknowledge that and acknowledge that patients cause us LEGITIMATE frustration sometimes, that we should always handle it professionally, and that it's not unhealthy to express that frustration in this kind of forum with people who (should) be able to relate.

...and for the record, it sounds like you're an M4. You can still talk about medical school in the present tense, you're still a medical student like the rest of us.

 

[SoCuteMD]

Whoa, it kind of sounds like you're going off the deep end.

Of course some doctors are in the wrong here. We all agree that we should be sensitive to our patients' struggles to some extent. But you can't argue with the fact that SOME PATIENTS ARE JUST RUDE. Come on, let's acknowledge that and acknowledge that patients cause us LEGITIMATE frustration sometimes, that we should always handle it professionally, and that it's not unhealthy to express that frustration in this kind of forum with people who (should) be able to relate.

...and for the record, it sounds like you're an M4. You can still talk about medical school in the present tense, you're still a medical student like the rest of us.

I actually referred to being thrown out of the room in the past tense, simply because it happened in the past and has not happened in over a year. If you read my first post you'll see that I wrote "As medical students, we..." which I think pretty accurately conveys the status of my undergraduate medical education as "in progress." And actually, if you read the original post you'll see that it was the OP who categorized him/herself as a doctor.

As for patients being rude, I agree. Rude patients are frustrating. A patient who is frustrated with the number of people coming in to see him isn't necessarily rude in my book, however. I remind myself that the patient is sick, tired, and has now answered questions regarding farting and pooping approximately 47x in the last 24 hours. You can not deny that this patient would have had fewer "doctors" visiting him if he weren't in an academic hospital.

FWIW, if greeted with something like the above, I probably would have put on my best "I'm sorry" face and said, "I'm really sorry, I know being in the hospital is tough when you don't feel well and want to rest. Can you tell me if what we've done so far has made you any more comfortable?" and then listen (if you shut up and listen, almost no patient will ever ramble for more than 2 minutes). They'll vent regarding whatever's bothering them, I'll respond appropriately, and then I'll ask the questions I need to write my progress note and promise to discuss any issues with my senior. I also poke my head in to "tuck my patient in" when I do chart-checks in the afternoon. Since most patients don't see a provider later in the day, it's a good chance to establish rapport with the patient by updating them on the status of various tests and results.

I don't know, maybe I do give patients too much of a "free pass" on bad behavior. But I'm not a psychiatrist and it's not my job to babysit them. Everyone regresses when ill, and the hospital environment is enough to drive pretty much anyone insane. I don't necessarily assume that someone who seems rude and ungrateful while hospitalized actually IS rude and ungrateful.

 

[SoCuteMD]

Your passive-aggressive, middle-school demeanor isn't doing you any favors. If you're going to disagree with someone, stand on your feet and disagree with them instead of hiding behind fake smilies and insincere sympathy.

Back on topic, since you don't seem to be catching on, I'll point out to you that I'm generalizing the OP's specific example to highlight the broader points it illustrates. I wasn't there to know whether the OP deserved the treatment s/he received, but your insistence on belaboring the details of the incident tells me that either 1) you were there yourself and can therefore speak intelligently about the details of the encounter, or 2) you don't share my reservations about leaping headfirst into arguments whose contexts I know very little about.

I obviously agree that bedside manner is an important component of medical care. Just as obvious, however, is this: if you don't want lots of people asking you about being sick, don't go to a hospital.

I think we can probably both be reasonable and agree that if you are in a teaching facility (which is not a giant leap, considering the OP is a medical student) you will be asked more questions more often and by more people than if you were in a private facility. Patients are perfectly within their rights to refuse the involvement of residents and students in their care - which doesn't exactly endear them to the staff but certainly does cut down on the number of questions they are asked in any given day.

As for your last statement, I have to say that I find it fairly silly. Just because people are hospitalized doesn't meant they lose the right to voice their opinion regarding their living conditions.

 

[JeffLebowski]

FWIW, if greeted with something like the above, I probably would have put on my best "I'm sorry" face and said, "I'm really sorry, I know being in the hospital is tough when you don't feel well and want to rest. Can you tell me if what we've done so far has made you any more comfortable?" and then listen (if you shut up and listen, almost no patient will ever ramble for more than 2 minutes). They'll vent regarding whatever's bothering them, I'll respond appropriately, and then I'll ask the questions I need to write my progress note and promise to discuss any issues with my senior. I also poke my head in to "tuck my patient in" when I do chart-checks in the afternoon. Since most patients don't see a provider later in the day, it's a good chance to establish rapport with the patient by updating them on the status of various tests and results.

Yeah, I do the same thing and I agree that it works well.

 

[PeepshowJohnny]

I think we can probably both be reasonable and agree that if you are in a teaching facility (which is not a giant leap, considering the OP is a medical student) you will be asked more questions more often and by more people than if you were in a private facility. Patients are perfectly within their rights to refuse the involvement of residents and students in their care - which doesn't exactly endear them to the staff but certainly does cut down on the number of questions they are asked in any given day.

Not always. I believe if you're admitted to one of the resident run services at our hospital, you waive your right to refuse medical students or residents (Unless they're preforming an invasive procedure). Most of these patients tend to be without insurance so the implication is that if you're receiving the hospital's charity, you should help educate the next generation of doctors.

 

[aphistis]

I think we can probably both be reasonable and agree that if you are in a teaching facility (which is not a giant leap, considering the OP is a medical student) you will be asked more questions more often and by more people than if you were in a private facility. Patients are perfectly within their rights to refuse the involvement of residents and students in their care - which doesn't exactly endear them to the staff but certainly does cut down on the number of questions they are asked in any given day.

As for your last statement, I have to say that I find it fairly silly. Just because people are hospitalized doesn't meant they lose the right to voice their opinion regarding their living conditions.

You may find it silly, but it's still self-evident. Otherwise, fair enough. There's plenty of room for different personalities in medicine; the bedside manner I've developed in two years of residency is probably quite different from the one you've developed in school, but the important thing is that they both get the job done.

 

[SoCuteMD]

Not always. I believe if you're admitted to one of the resident run services at our hospital, you waive your right to refuse medical students or residents (Unless they're preforming an invasive procedure). Most of these patients tend to be without insurance so the implication is that if you're receiving the hospital's charity, you should help educate the next generation of doctors.

I'll be the first to admit that I'm not educated on the laws of all 50 states. I do know that by law in Massachusetts, any patient at a clinic or hospital can refuse the involvement of a medical student or a resident. Under the NY State patient bill of rights is included the right to "Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation" which essentially states the same thing.

I'm not sure of the legal/ethical implications of requiring someone to waive their right to refuse someone's participation in their care - sounds kind of shady and unethical (if not illegal) to me.

 

[dragonfly99]

I'll be the first to admit that I'm not educated on the laws of all 50 states. I do know that by law in Massachusetts, any patient at a clinic or hospital can refuse the involvement of a medical student or a resident. Under the NY State patient bill of rights is included the right to "Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation" which essentially states the same thing.

I'm not sure of the legal/ethical implications of requiring someone to waive their right to refuse someone's participation in their care - sounds kind of shady and unethical (if not illegal) to me.

I believe patients ARE within their legal rights to refuse treatment by house staff and students. However, if large numbers of patients started doing this, it would be a MAJOR problem, not just for the learning environment but for the hospital itself. For example, when I was on my MICU rotation we (house staff) were the only ones really there at night, so if a patient had refused our care, a fellow or attending would have had to have been brought in/called in from home. If this happened every night, I'm honestly not sure how the hospital would continue to function, as the fellows/attendings would never get any sleep. The learning of the students and house staff would also be irreparably damaged. I guess this scenario is very unlikely to ever happen, but I would not be surprised if the frequency of patients refusing nursing and med students' involvement in their care goes up in the future, since we now have a "customer is always right" philosophy that pervades medical care. Sometimes this actually works to the detriment of patients, particularly those who are very demanding but don't know what is good for them medically (i.e. those who pressure docs to give them excess narcotics, antibiotics and CT scans).

OP, if you don't like abuse from patients, you may want to stay out of specialties like ER and perhaps psych and ENT (high frequency of abusive patients).

 

[aphistis]

since we now have a "customer is always right" philosophy that pervades medical care. Sometimes this actually works to the detriment of patients, particularly those who are very demanding but don't know what is good for them medically (i.e. those who pressure docs to give them excess narcotics, antibiotics and CT scans).

Amen, amen, a thousand times amen.

 

[turkeyjerky]

This patient was clearly not facing "imminent death." And there was no mention of him being on the phone either. He simply did not want to be poked, prodded, and questioned by yet another person. I can't blame him. Did I LOVE being the medical student thrown out of the room when it happened? No. Did I understand? Yes. Did I applaud my mother when, as a patient, she threw the gyn onc fellow out of her room when he breezed in with his entourage and without introducing himself lifted her gown to examine her wound? You bet I did!

I'm sorry, but if they didn't teach you empathy for patients in dental school, there's very little I can do for you here. But it's fine - I'll treat my patients with empathy and caring, you treat yours with your attitude. We'll see who ends up in court for malpractice first !

I actually agree with the point you've been making in this thread, but after that statement--you belong in Tool Academy.

 

[bjackrian]

I don't know about the law, but from an ethical point of view, there's some literature out there to suggest that patients are ethically obligated to participate in medical education activities. All patients benefit from medical education (there are trained doctors, nurses, etc. to treat them). To have some patients decline to participate effectively shifts the burden to other people. Those burdens include the inconvenience/annoyance that the OP's patient was expressing as well as the more tangible risks of a trainee making a mistake and causing physical injury. To benefit from the risks that other people are taking by refusing to be seen by a trainee is unethical.

There's also a fair amount of debate over whether there are substitutions you can make. People have asked if it would be ethical for a patient to refuse medical trainee care during a hospitalization but then to volunteer as a standardized patient at a later date. My answer is no, but different people have come to different conclusions on that issue.

 

[KidDr]

OP, if you don't like abuse from patients, you may want to stay out of specialties like ER and perhaps psych and ENT (high frequency of abusive patients).

Psych and ER I get. but ENT? I'd never heard this being a big issue in ENT before. I'm curious...why do ENTs see more abusive patients than other specialties?

 

[DrWBD]

To the original poster:
Be glad you haven't yet been cursed out by an irate drug-seeker's wife in the middle of a packed ER waiting room when offering to contact a social worker to help her with cab fare. Because that's what happened to me during my residency. I still get mad thinking about it, years later.

 

[45408]

To the original poster:
Be glad you haven't yet been cursed out by an irate drug-seeker's wife in the middle of a packed ER waiting room when offering to contact a social worker to help her with cab fare. Because that's what happened to me during my residency. I still get mad thinking about it, years later.

that merits an eye roll to their face.

 

[MILK07]

Psych and ER I get. but ENT? I'd never heard this being a big issue in ENT before. I'm curious...why do ENTs see more abusive patients than other specialties?

Just an uneducated guess, but I thought a lot of head and neck cancers were caused by the combo of excessive smoking and excessive drinking. I know patients have shown up for their free flaps still drunk, and then have to detox in the ICU after surgery. I doubt they are very nice!

 

[dilated]

I do know that by law in Massachusetts, any patient at a clinic or hospital can refuse the involvement of a medical student or a resident. Under the NY State patient bill of rights is included the right to "Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation" which essentially states the same thing.

I'm not sure why this is news. Did you think there was a law that people would be held down and forced to undergo med student exams?

The question is not whether people can decline to be examined by a ms or resident. The question is whether the attending can dump them to a private hospital if they won't allow trainees to be involved with them. And the answer is yes, because I've seen it happen - a guy demanding that only the ortho attending be allowed to do any part of his spine surgery was told point blank it was a teaching hospital, love it or leave it.

 

[SoCuteMD]

I'm not sure why this is news. Did you think there was a law that people would be held down and forced to undergo med student exams?

The question is not whether people can decline to be examined by a ms or resident. The question is whether the attending can dump them to a private hospital if they won't allow trainees to be involved with them. And the answer is yes, because I've seen it happen - a guy demanding that only the ortho attending be allowed to do any part of his spine surgery was told point blank it was a teaching hospital, love it or leave it.

This is not permitted in Massachusetts or New York. You can be a non-teaching patient in a teaching facility.

 

[PeepshowJohnny]

Here's my understanding of how the system works at my hospital (which may be incorrect because I've never looked into my state law, but this is how it was explained to me).

We'll do a medicine example. You're a 41 year old who comes in with pneumonia. You've been laid off work, you have no insurance, no PCP. Our hospital will typically admit these patients to the resident service. If you apply and you meet criteria, you can apply for the institution's program and you may receive discounted/free care for your stay (as well as they try to set you up with a resident for outpatient follow up). However, you WILL be seen by residents, medical students, nursing students, etc.

If you refuse this, you will be admitted and placed on the hospital's "private" inpatient service staffed by attendings. However, you are much more likely to end up with a hefty bill for your hospital stay.

So, the choice is yours. Take the cheap/free care or get saddled with a big bill?

Now, two caveats. There are a fair number of chronic/difficult patients who wind up on the resident service who "refuse" students/residents. This is because they are a HUGE PITA and the private inpatient service does not want to deal with them. Usually at the end of the stay, they're amenable to one resident seeing them, but then they end up yelling at the resident to get out when they come to round on them in the morning or shrieking in a temper tantrum at the top of their lungs when they don't get the Dilaudid they want and demanding to see a real doctor. In those cases, the attendings overseeing the service have been known to step in and ease the situation just to make the they GTFO of the hospital. No one ever really stresses about these because there's usually no educational value in dealing with these people and it's just a bad deal for the attendings.

The other caveat is I'm not sure what happens when you have a service like Trauma surgery where essentially, there's really only the one service.

 

[JeffLebowski]

This is not permitted in Massachusetts or New York. You can be a non-teaching patient in a teaching facility.

Of course you can refuse treatment. You can refuse treatment from anyone for any reason. dilated is saying that doctors have the same right to refuse treatment to a patient who is refusing to receive it the way a doctor's team operates.

 

[SoCuteMD]

Of course you can refuse treatment. You can refuse treatment from anyone for any reason. dilated is saying that doctors have the same right to refuse treatment to a patient who is refusing to receive it the way a doctor's team operates.

I get what he was saying and I'm actually fairly certain that it's also not permitted in the states I have previously mentioned. In any case, physicians can not discharge the care of a patient without arranging continuity of care for them. They have to find another physician willing to accept the patient. Does it happen? Sure. Is it legal? No.

Also, once an inpatient, what are they going to do - transfer the patient to a non-teaching facility? Transferring patients can only be done for some very specific reasons (higher level of care). Many teaching facilities ARE the highest level of care available in their area, and I doubt you'll find a non-teaching facility that is a higher level of care that would accept the patient (especially if they have no insurance). The only exception I'm aware of is for a neonate who previously required a high level of NICU care but is now a feeder-grower - they can occasionally be transferred to a NICU closer to home.

 

[bjackrian]

Also, once an inpatient, what are they going to do - transfer the patient to a non-teaching facility? Transferring patients can only be done for some very specific reasons (higher level of care). Many teaching facilities ARE the highest level of care available in their area, and I doubt you'll find a non-teaching facility that is a higher level of care that would accept the patient (especially if they have no insurance). The only exception I'm aware of is for a neonate who previously required a high level of NICU care but is now a feeder-grower - they can occasionally be transferred to a NICU closer to home.

They can also be transferred per patient request. So if an attending tells a patient that in this hospital we have residents and student who see all the patients but at Private Hospital down the road, there are no residents or students, the patient is likely to want to go there. Then the paperwork says the reason for transfer is a patient request which is a legal reason under EMTALA.

 

[tkim]

They can also be transferred per patient request. So if an attending tells a patient that in this hospital we have residents and student who see all the patients but at Private Hospital down the road, there are no residents or students, the patient is likely to want to go there. Then the paperwork says the reason for transfer is a patient request which is a legal reason under EMTALA.

Yup - have had to fill out these forms for patients who want to be transferred to a private hosp - inpatient and ED-to-ED.

 

[SoCuteMD]

They can also be transferred per patient request. So if an attending tells a patient that in this hospital we have residents and student who see all the patients but at Private Hospital down the road, there are no residents or students, the patient is likely to want to go there. Then the paperwork says the reason for transfer is a patient request which is a legal reason under EMTALA.

You STILL have to have an accepting physician - which extremely unlikely to happen if the patient isn't insured. Certainly patients can CHOOSE to go elsewhere - that wasn't really the discussion at hand, though. The issue (which is far departed from the original topic) is whether patients in a teaching hospital who refuse the involvement of residents/students can be forced to go elsewhere. My point was that if the patient is an inpatient, this involves a transfer which can NOT be forced upon a patient.

 

[SouthernSurgeon]

I have to say that I'm a little confused as to why you think the patient is ungrateful. As medical students, we pretty much take more than we give to patients. We are another voice waking them at 630 AM, another pair of hands palpating their tender abdomen, and when they ask us for something we look at them, stammer, and say, "Um, I'll have to speak to my senior about that." Patients ABSOLUTELY have the right to refuse to be teaching cases.

The patient does not have FIVE doctors, especially if he was counting you (a medical student) as one of them. And the choice is not "5 doctors or nothing" - patients have the right to determine who can and can't be involved in their medical care.

Glad to see you've joined the ranks of people that view med students as worthless piles of dung before you've even graduated.

 

[njbmd]

A couple of points:

• The patient is NOT LIKELY in the hospital by choice but you are and you pay for the privilege. Sick people can be rude, crude and disgusting but they are sick and I am not. I give them the benefit of the doubt and move on. As an attending, I HAVE to find another physician who is willing to treat them or I can be sued for abandonment unless they sign out against medical advice.
• Any patient at any time can refuse to be seen by any person who walks in their room. Just because you happen to be a patient in a teaching hospital does not mean that your rights are somehow less.
• Even if the patient previously gave permission for you to treat them, they can refuse your presence at any time.
• Just because the patient is indigent does not mean that they have less rights. They can refuse your care. If you don't grant their wishes, the attending, whose license your practice under, can be sued for battery.

While this doesn't make your job (or your learning experience) easier, it is a learning experience nevertheless. Move on and find another patient. Being sick is not fun for the patient either and prudence would dictate that you (the patient) would accept help to make you feel better but this isn't always the case.