"Brain-dead" patients

[qw098]

I am on a rural rotation for two weeks... patients here are EXTREMELY "brain-dead"... as in having trouble understanding basic things like "what is your age?". Not "brain-dead" in the sense as having problems with their brain.. but in the sense of being extremely stupid..

Is this normal? How do you guys cope with this?

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[cabinbuilder]

Yep, it's everywhere. The degradation of our society. Nobody has parents anymore and all are on welfare. It's like lemmings. The population will crash eventually. Long live Darwin.

All day I see "cough, cold, congestion". So, "what have you tried OTC?" Nothing. Or I get "I don't know what to pick". Okaayyy, so you read the back of the box and match your symptoms to what the box says. I guess people don't know how to read anymore either. All in a day.

 

[qw098]

Yep, it's everywhere. The degradation of our society. Nobody has parents anymore and all are on welfare. It's like lemmings. The population will crash eventually. Long live Darwin.

All day I see "cough, cold, congestion". So, "what have you tried OTC?" Nothing. Or I get "I don't know what to pick". Okaayyy, so you read the back of the box and match your symptoms to what the box says. I guess people don't know how to read anymore either. All in a day.

Thanks for the share cabinbuilder. Do you have any other anecdotal stories?

 

[evilbooyaa]

Oh. Thought your focus was going to be different.

You do the best you can. They won't get as much out of it compared to those with a brain, but you'll still be helping them, even if it is what OTC decongestant to use for symptomatic relief of their cold. Just grit your teeth at their stupidity, smile (while thinking how thankful you are you don't come to the doctor's with a cold, especially as an adult), and do the best you can.

 

[cabinbuilder]

Thanks for the share cabinbuilder. Do you have any other anecdotal stories?

Honestly there are more stories than I have time to write. It's all day everyday.

 

[22031 Alum]

The world is a lot tougher to navigate for many people, than it is for someone with the mental chops to become a healthcare professional. I realize this every day.

 

[cabinbuilder]

The world is a lot tougher to navigate for many people, than it is for someone with the mental chops to become a healthcare professional. I realize this every day.

So true. You wonder how some of these people survive every day. Hold a job, pay their bills.

 

[FutureInternist]

The answer to a bunch of my Qs is..."Look it up in the computer"

Infuriating

 

[Psai]

The answer to a bunch of my Qs is..."Look it up in the computer"

Infuriating

lol i hate that
they say it like you're wasting their time

i think it's due to the fact that we're very smart and have usually been around smart people so that when we come into contact with the general population, they just seem incredibly stupid by comparison
at least i hope that this is true and we're not moving towards idiocracy although these new "doctors" at hospitals are getting very stupid, very quickly

 

[cabinbuilder]

So I had a girl (age 24) the other day come into urgent care for subconjunctival hemorrhage. She wanted me to tell her how to wipe the blood off her eye. Hmm. I said that the bleeding is like any other bruise in your skin. You have to wait for it to absorb.

 

[solitarius]

So true. You wonder how some of these people survive every day. Hold a job, pay their bills.

Or raise the kids they spawn. #shudder.

 

[Kaustikos]

I am on a rural rotation for two weeks... patients here are EXTREMELY "brain-dead"... as in having trouble understanding basic things like "what is your age?". Not "brain-dead" in the sense as having problems with their brain.. but in the sense of being extremely stupid..

Is this normal? How do you guys cope with this?

I don't understand the question. These people are entertaining. Enjoyable. Even a challenge, if you will. I've never been annoyed or hindered by them. I actually like them. Yes, they make your work difficult, but I find it that they are better options than the entitled patients who demand the best.
Don't take offense to the situation. Don't lose your patience. You'll become more comfortable as you deal with it more. They're not being intentionally dense, which makes it easier for me to deal with them.
Also, don't call them brain dead. They deserve better. Not everyone is born intelligent. God forbid you have to deal with a patient with CP or Downs. Then get back to me about difficulty in communication.

 

[22031 Alum]

I don't understand the question. These people are entertaining. Enjoyable. Even a challenge, if you will. I've never been annoyed or hindered by them. I actually like them. Yes, they make your work difficult, but I find it that they are better options than the entitled patients who demand the best.
Don't take offense to the situation. Don't lose your patience. You'll become more comfortable as you deal with it more. They're not being intentionally dense, which makes it easier for me to deal with them.
Also, don't call them brain dead. They deserve better. Not everyone is born intelligent. God forbid you have to deal with a patient with CP or Downs. Then get back to me about difficulty in communication.

Bolded is what I was trying to get at with my post. Hanging around in the medicine bubble can lead to an extremely warped perception of what "average" intelligence is.

 

[efex101]

well unfortunately some folks are getting dumber and dumber - nobody expects anyone not in healthcare to know medical facts but jeez how about taking 100 tylenol tabs for a headache that is just well, stupid

 

[cabinbuilder]

well unfortunately some folks are getting dumber and dumber - nobody expects anyone not in healthcare to know medical facts but jeez how about taking 100 tylenol tabs for a headache that is just well, stupid

Or coming into urgent care for 1 day of diarrhea and not taking any pepto or Imodium. 1 day of head cold and haven't tried anything? I always get, " I don't like to take medicines. Okaaayyy, but you will take a medication that I give an Rx for?

 

[Psyche Estrelle]

I work in the heart of south central LA, but I feel like I can relate to the stories on this thread. Every single day I wonder how certain patients I see have made it this far in life. I find life incredibly difficult. I can't even imagine what it's like for someone who
1) asks me why he needs to go to a dentist for a toothache - "what would a dentist do for me?"
2) tells me her kid's dad smokes, but "only in the bathroom," as if that makes it okay. What do you think your kid breathes every time you bathe him???
3) doesn't bat an eyelash at her third diagnosis of chlamydia. Life circumstances notwithstanding, I still can't help but wonder if she's waiting for something worse.
4) can't answer simple questions, in person or on a form. On a TB screening form: "Is your child sick today?" Answer: "I don't know, she talk to herself"

 

[Kaustikos]

well unfortunately some folks are getting dumber and dumber - nobody expects anyone not in healthcare to know medical facts but jeez how about taking 100 tylenol tabs for a headache that is just well, stupid

Right. But it doesn't give you any right to condescend. You chose this profession knowing full well you'd be dealing with this kind of thing. Not every patient is a usmle format question. People make mistakes, do bad things. Some are suicidal, psychotic, etc. I don't find a problem with calling the decisions bad, but don't deliberately insult them like this or develop this attitude. Especially if you're a medical student because god forbid you continue this as a resident or physician you might find this career miserable.

Or coming into urgent care for 1 day of diarrhea and not taking any pepto or Imodium. 1 day of head cold and haven't tried anything? I always get, " I don't like to take medicines. Okaaayyy, but you will take a medication that I give an Rx for?

Okay,
Take the above quoted about 100 pills and read what you said. Which is worse? The person who would rather seek medical advice before doing anything or trying things their own way?
How would you enjoy seeing a patient who cut his leg on a barbwire fence and decided to "suture" it themselves with needle and thread from their cabinet and subsequently became infected and necrotic. There are worse things.

 

[cabinbuilder]

How would you enjoy seeing a patient who cut his leg on a barbwire fence and decided to "suture" it themselves with needle and thread from their cabinet and subsequently became infected and necrotic. There are worse things.

This happens more often than you think. I'm out here with the miners, the cattleman, the trappers, fishermen, etc. All treat themselves first and then come in when things get bad. I probably get 2-3 patient a week with infected limbs from self sutures. Not to mention the farmers who take cattle antibiotics for themselves because they can get them OTC at the feed store.

 

[efex101]

kaustikos chill, I was not trying to be condescending just stating that some people are well, stupid. Sorry but it is what it is.

 

[Kaustikos]

This happens more often than you think. I'm out here with the miners, the cattleman, the trappers, fishermen, etc. All treat themselves first and then come in when things get bad. I probably get 2-3 patient a week with infected limbs from self sutures. Not to mention the farmers who take cattle antibiotics for themselves because they can get them OTC at the feed store.

It's kind of funny if it's not so serious. The one that was hilarious is the kid who tried doing it but his mom caught him and dragged him to the hospital and told him what he tried doing. Or, wait, not even clinically related; the time I was in the bathroom and saw these two kids by the sink with one kid trying to remove one of his nail beds. I just didn't even say anything, shook my head, and left. I only left because each time he pulled he cringed with pain. Like... yeah.

kaustikos chill, I was not trying to be condescending just stating that some people are well, stupid. Sorry but it is what it is.

True. Sorry, I didn't mean to be rude. The internet makes it hard to communicate intentions sometimes. I'm more saying it's easier to take things in stride/enjoy it for what it is rather than the tone of the OP.

 

[Armadillos]

While Im never suprised by the limits of human stupidity, you also have to realize your in a profession that historically was the gatekeeper of highly specialized information and cut everyone a break. When my car breaks down and I take it to the mechanic I have no idea WTF they are even talking about and Im just trusting their reputation to not rip me off. When I applied for my mortgage and looked for houses I similarly felt like a fish out of water, my accountant might as well be speaking a foriegn language, etc.

 

[colbgw02]

nm

 

[Kaustikos]

While Im never suprised by the limits of human stupidity, you also have to realize your in a profession that historically was the gatekeeper of highly specialized information and cut everyone a break. When my car breaks down and I take it to the mechanic I have no idea WTF they are even talking about and Im just trusting their reputation to not rip me off. When I applied for my mortgage and looked for houses I similarly felt like a fish out of water, my accountant might as well be speaking a foriegn language, etc.

Hence why I'm glad I know cars. And also why I have taken an interest in housing. I don't want to be an expert... But mechanics don't have to worry as much about liability. Especially when people don't know what they're talking about and lawyers aren't behind their backs.

 

[cabinbuilder]

While Im never suprised by the limits of human stupidity, you also have to realize your in a profession that historically was the gatekeeper of highly specialized information and cut everyone a break. When my car breaks down and I take it to the mechanic I have no idea WTF they are even talking about and Im just trusting their reputation to not rip me off. When I applied for my mortgage and looked for houses I similarly felt like a fish out of water, my accountant might as well be speaking a foriegn language, etc.

That may be true but how hard is it to know ( everybody watches TV) that you can go to Wal-Mart and get some cold medication?!!! At least try mucinex: the commericials are on every 15 minutes!!!!!!

 

[YankeeCandle1141]

If everyone was as smart as doctors, we wouldn't have jobs.

Your patients health care literacy is your job. You dont get to blame them. They didnt go to medical school, you did...so when they come in and they dont understand basic medical concepts, it is YOUR fault. Part of being a doctor is being a good teacher.

 

[cabinbuilder]

If everyone was as smart as doctors, we wouldn't have jobs.

Your patients health care literacy is your job. You dont get to blame them. They didnt go to medical school, you did...so when they come in and they dont understand basic medical concepts, it is YOUR fault. Part of being a doctor is being a good teacher.

How true this is. Of course most of what I write is what I'm thinking in my head and not what is coming out of my mouth. You smile and explain for the umpteenth time how a Z-pak doesn't fix a viral infection and how I know the difference between viral and bacterial, etc. with the 25th sinus infection that comes through the door in a single day.

 

[Promethean]

That may be true but how hard is it to know ( everybody watches TV) that you can go to Wal-Mart and get some cold medication?!!! At least try mucinex: the commericials are on every 15 minutes!!!!!!

So are commercials for endless prescription pharmaceuticals. Do you really want people taking television advice for treating their symptoms?

Most of these people aren't actually stupid. Some of them are profoundly uneducated, and they are giving us an opportunity to help them change that, in some small way. Maybe by teaching them a little, they go out of the clinic a little less dumb for the next time, and maybe can give a little better advice to a friend. The kind of education that they need is best provided through forming a relationship with a PCP who has the opportunity to get to know them over time, and who has more than 10 minutes per encounter to spend. That is a luxury these days, and lacking it leads to ignorant patients and frustrated physicians.

Don't blame the patients for not knowing when they haven't had any guidance. Do what you can to teach them what they are willing to learn in the time you have with them. That is at least as important as treating their immediate complaints.

I'm not criticizing you, cabinbuilder! If anyone has the right to vent about your experiences with patients in far flung locations, that would be you. But for someone who is a couple weeks into rural rotations, maybe reframing the situation a little can help them cope and be more helpful to the patients, at the same time.

 

[giantswing]

I don't have a problem with uneducated or even stupid, but I take issue with those that refuse to learn.

Oh, you won't give me abx for my viral uri? Fine, I'll go find one who will.

 

[cabinbuilder]

S
I'm not criticizing you, cabinbuilder! If anyone has the right to vent about your experiences with patients in far flung locations, that would be you. But for someone who is a couple weeks into rural rotations, maybe reframing the situation a little can help them cope and be more helpful to the patients, at the same time.

I should say that just because you are a rural person, doesn't automatically put you in that ignorant category. I grew up more rural than most (80 miles out of town in the middle of Alaska, but we did have a road). I will have to say that some of THE MOST BRILLIANT people are rural - my mom included in that group. I mean she build the cabin that is my avatar from library books by herself!! As with every place you get the full rainbow of intelligence.

 

[cabinbuilder]

Not just rural people who are "different". This is a doctor I worked along side for 9 months. Gave me the creeps every day. http://www.facebook.com/l.php?u=htt...ted-in-louisiana-on-rape-charges/&h=tAQGL6NB8

 

[Kaustikos]

If everyone was as smart as doctors, we wouldn't have jobs.

Your patients health care literacy is your job. You dont get to blame them. They didnt go to medical school, you did...so when they come in and they dont understand basic medical concepts, it is YOUR fault. Part of being a doctor is being a good teacher.

Yes,
Thank you. It's like no one has worked customer service before. You want to feel that? Go work at Best Buy and explain why an Xbox 360 game doesn't work on an Xbox one. Or why you need Blu-ray to play Blu-ray. I'm not belittling our career. But people just don't understand or know things.
Coming from the car world, it pains me when someone hasn't changed the oil in their car for 20,000 miles and wonders why their engine is knocking (spoiler alert: your engine is dead). Or not understanding why it's important to wash your cars underside or body at least once a month. Rust happens....
My point is that you're going to have to find a way to make this less aggravating and more... Enjoyable.
I'll never forget the day I had to take care of this 6 yr old girl with her 8 yr old sister and mom in the room. Girl was having symptoms of simple gastroint. requiring fluids. She was hiding behind her mom the whole time thinking I was going to do needle sticks or hurting her. She didn't want me to examine her because she was so worried. Her mom didn't help. Until I sat down, smiled and asked her if she liked Gatorade. She said yes. I said keep drinking and that's it. I walked out, told my attending and he agreed. Minutes later... These two girls walk out and hug me. For what? Knowing that the treatment is that simple? It was worth it. I mean, now I can't go back to that clinic without seeing a picture of that. But it basically goes back to the basics: they need your help and you should enjoy that. Don't find it annoying that you know there are otc for x, y and z. But honestly try to enjoy those moments where you felt comfortable and knowledgeable enough to help them. They need that. They need a solution and if you can do that, try to find some solace in it. Im not trying to preach but just saying what helps me.
Yes,
They aren't as intelligent. But that shouldn't stop you.

 

[Kaustikos]

I don't have a problem with uneducated or even stupid, but I take issue with those that refuse to learn.

Oh, you won't give me abx for my viral uri? Fine, I'll go find one who will.

Imo. You're talking about a different spectrum of patients. Not the one the OP and others are complaining about. Which, I agree are a different breed of difficulty

 

[giantswing]

Imo. You're talking about a different spectrum of patients. Not the one the OP and others are complaining about. Which, I agree are a different breed of difficulty

There's a pretty healthy overlap between the groups.

 

[sazerac]

Or coming into urgent care for 1 day of diarrhea and not taking any pepto or Imodium.

Lol yeah that was me. About once a year I eat some sketchy street food and suffer GI distress for a week, then drop by the clinic for some metronidazole that clears it up instantly. This year when it hit Saturday afternoon I just couldn't deal with those symptoms for a week, so I went down to urgent care the very next morning (student clinic closed Sunday).

$120 later (after insurance) I was strongly urged to try some pepto and come back in a week if I was still suffering. Problem was gone by Sunday night. The doc probably thinks they are training a new generation of idiots at the medical school

 

[Kaustikos]

There's a pretty healthy overlap between the groups.

Prolly. It doesn't make it any more entertaining to me. Or enjoyable. It's not fun. But imo, those are where the stories come from.

 

[CBSstalker]

Stress can make a person say and do the most ridiculous and strange things. I have seen many intelligent and educated patients do stuff that makes one wonder.

 

[Bacchus]

Oh. Thought your focus was going to be different.

You do the best you can. They won't get as much out of it compared to those with a brain, but you'll still be helping them, even if it is what OTC decongestant to use for symptomatic relief of their cold. Just grit your teeth at their stupidity, smile (while thinking how thankful you are you don't come to the doctor's with a cold, especially as an adult), and do the best you can.

After multiple colds in a season from these visits I get annoyed. But, boy can I put one hell of a smile on my face.