Crazy Patients

[Planktonmd]

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I feel that the percentage of my patients that could fit under the category of "CRAZY" has increased dramatically over the past 10 years!
There are more drug seekers, more bipolars, more emotionally unstable, more histrionic women, more fibromyalgia...
What's going on?
Do you guys feel the same way or am I the one who's getting older and grumpier and as a result less tolerant of crazy people?

 

[W222]

What about when a 40 year old starts asking for her "mommy" in pre-op?


I also go by the drug allergy sign; more than three drug allergies and the likelyhood that you are insane goes through the roof. Much like the positive teddy bear sign. If you are an adult who takes a stuffed animal with you to the hospital, well...enough said.

 

[pgg]

I also go by the drug allergy sign; more than three drug allergies and the likelyhood that you are insane goes through the roof.

NSAID, tape, and epinephrine allergies get double points on my crazy scale.

 

[drccw]

NSAID, tape, and epinephrine allergies get double points on my crazy scale.

you've got to remember what the allergy to epinephrine is... "it makes my heart race..." oh ok...

another good one is the prednisone allergy.....
I of course like the local aneshetic allergy... "it makes me start breathing..." or "it gave me a seizure..." those seem to always happen at the dentist.. hmm wonder what happened there

I find myself using more and more midazolam, especially on the crazies... At least 4 mg is my standard of care.... and my sedation for blocks.. I am pretty aggressive... but they are of course "sedated, but interactive.."

drccw

 

[W222]

I find myself using more and more midazolam, especially on the crazies... At least 4 mg is my standard of care.... and my sedation for blocks.. I am pretty aggressive... but they are of course "sedated, but interactive.."
drccw

I had an old school attending tell me how he used to use scopolamine iv for awake procedures. Said it made Pts into zombies and they wouldn't remember the entire day, let alone the procedure.


Had a lady tell me that albuterol "makes my chest get tight"? Ohh, chest tightness in the setting of asthma, go figure?

I love when Pt's with these crazy allergies say something like,"I just don't like how it made me feel." That seems like a good reason to cross off broad categories of meds. Or when Pts are allergic to almost everything and it prevents treatment of legit issues. Well, just gona have to suck it up then.

 

[lfesiam]

you've got to remember what the allergy to epinephrine is... "it makes my heart race..." oh ok...

another good one is the prednisone allergy.....
I of course like the local aneshetic allergy... "it makes me start breathing..." or "it gave me a seizure..." those seem to always happen at the dentist.. hmm wonder what happened there

I find myself using more and more midazolam, especially on the crazies... At least 4 mg is my standard of care.... and my sedation for blocks.. I am pretty aggressive... but they are of course "sedated, but interactive.."

drccw

have to add this one in there. not crazy but "misinformed" - true story:

"doc, i'm allergic to lopressor"

Ok, what does it do to you sir?

"It slows my heart rate down."

--------------------------------------

My current top: 60 yo fibromyalgia lady reported 44 allergies. That was when I went down one by one and explain to her what is a true allergy vs. minor side effects of each drugs. In the end = 3 true allergies.

 

[modelslashactor]

i had a patient who was allergic to vitamin c, somehow managed to escape scurvy nonetheless. she was also allergic to tape and every antibiotic on the market except linezolid and was easily the craziest patient i have seen.

 

[pjl]

Sometimes the alergies make you wonder though.
I had a guy who was "allergic" to eggs. I asked him about it, and he said he just didn't like them for breakfast and that was the ony way he could get something different. Maybe overkill, but I am not sure about crazy.

 

[urge]

Allergy to benadryl is a good one too.

 

[Gern Blansten]

For me, the shiny shoe factor is huge. If they wear the gold or silver "shiny" or "sparkly" shoes they are usually nuts. That combined with >5 allergies confirms it. If their shiny purse matches their shiny shoes, the crazy factor increases exponentially.

 

[jd1572]

Question for everyone:

How do you guys deal with a patient who is freaking out in the pre-op area before surgery? Sometimes I have seen patients who are pre-panic attack, and it seems that when they get to that stage you can't say anything to them because they're not even paying attention. They're lost in anxiety/terror. Sure I'd like to give them midaz, but I need to get consent and get my H&P first.

Just wondering if you guys have any tricks.

 

[Licoricestick]

you've got to remember what the allergy to epinephrine is... "it makes my heart race..." oh ok...

another good one is the prednisone allergy.....
I of course like the local aneshetic allergy... "it makes me start breathing..." or "it gave me a seizure..." those seem to always happen at the dentist.. hmm wonder what happened there

I find myself using more and more midazolam, especially on the crazies... At least 4 mg is my standard of care.... and my sedation for blocks.. I am pretty aggressive... but they are of course "sedated, but interactive.."

drccw

I had someone tell me they had an adrenaline allergy last night, but what really got me was that not one, but TWO DOCTORS had written it down as an allergy, including on the "allergy" section of the drug chart!


I did however have a patient with a genuine anaphylaxis to prednisolone - turned out he was allergic to the colouring in the tablet. He was, however, appropriately counselled, so I hope he doesn't go around telling people he's allergic to pred.

 

[inmyslumber]

The benadryl allergy really is the best.

Also, have you had the patient that says zofran makes them nauseous?

As for the "crazy" situation, it probably is increasing. In general, people no longer recognize public areas from private areas. For example, not thinking that screaming and acting out might make the person in the next holding area slot feel uncomfortable. Seems like people have in general lost their inhibition control. I am not even going to mention the "crazy" patients in ob.

Maybe I am getting older...

 

[bigdan]

I was looking through the electronic record on one of our patients while on my vascular surgery rotation. She prolly had a dozen allergies listed in the allergy section of our electronic record - all of these were pretty meticulously documented: allergies to certain types of soap, etc. The best was "Bee stings - causes redness, swelling, and pain".

No ****? We'll have to get this patient one of our special bee-free rooms.

dc

 

[maceo]

Question for everyone:

How do you guys deal with a patient who is freaking out in the pre-op area before surgery? Sometimes I have seen patients who are pre-panic attack, and it seems that when they get to that stage you can't say anything to them because they're not even paying attention. They're lost in anxiety/terror. Sure I'd like to give them midaz, but I need to get consent and get my H&P first.

Just wondering if you guys have any tricks.

ever heard of anxiolytic?

IF IV giveMidaz until panic attack stops

if no Iv give PO benzo....

If at all possible..

GO HOME EARLY

 

[geogil]

ever heard of anxiolytic?

IF IV giveMidaz until panic attack stops

if no Iv give PO benzo....

If at all possible..

GO HOME EARLY

So you'd give an anxiolytic before you got the consent ?

 

[giddyup]

at my program we can't give midaz before consent but we can give "pain medicine." i usually just pile on the fentanyl for the crazies. 50mcg fent x # of allergies = dose.

 

[rsgillmd]

So you'd give an anxiolytic before you got the consent ?

Assuming my attempts at calming the person down by talking to them/getting family members to talk to them have not worked, I would give a benzo.

Sometimes a little bit of sarcasm/humor works also, like "You mean you are scared about having major surgery? That's totally abnormal. We should call a psychiatrist." On select patients I'll say something along those lines, and can usually get them to calm down and laugh. You have to be careful who you say that to though, they can take it seriously and assume you are mocking them.

This extremely anxious patient situation is not much different from what you see not infrequently in OB -- a person in pain will sign anything without understanding it, and if you sedate them to control the pain you have a possible quandry as well.

This is just a non-pain corollary. An extremely anxious person's judgment is in question just like the judgment of a sedated person.

And to answer Plank's original question, yes I agree that the number of "crazy" patients has increased.

 

[pseudoknot]

Sorry, I don't think your allergy stories can compete with what I saw on medicine a few months ago. Documented in both the electronic medical record and a sticker on the paper chart (which I saved) was:

"Patient sensitive to sterile water."

 

[Dogdaze]

Agree with all - the more allergies the crazier.

In med school during in-patient psych, my (very funny) attending had two (tongue-in-cheek) tenets:

1. Adult in-patient + Teddy Bear = Borderline Personality d/o
2. Multiple rings on fingers/thumbs = one for each personality d/o

Obviously all in jest, but thread of truth...



One other good story from that rotation. This is in Bible belt; In-patient is bipolar during manic phase. Her sister is a reverand at local AME church. Visiting on Sunday AM they obtain private conference room for "services". For the next hour we hear many repetitions of "Praise Jesus" and Lordy Lordy".

After a particularly vigorous sequence of "Lordy, Lordy, Lordy" x20. My attending looks at me with a straight face and says: "Looks like we have a bad case of 'Tachy-Lordia'" I was in tears...

 

[anesthesiadoc]

Had a lady with tattoos covering the entirety of her arms and thorax. Got called by the nurse in OB triage to start IV because the patient was "very needle phobic."

 

[powermd]

Sorry, I don't think your allergy stories can compete with what I saw on medicine a few months ago. Documented in both the electronic medical record and a sticker on the paper chart (which I saved) was:

"Patient sensitive to sterile water."

That is so hiliarious (and telling..) it would be a crime to delete from the record!

 

[Apollyon]

Had a lady with tattoos covering the entirety of her arms and thorax. Got called by the nurse in OB triage to start IV because the patient was "very needle phobic."

Oh man, do I see this one to excess here in Hawai'i. What is interesting, though, is when the male S.O. of the female patient is complicit with me, when he laughs and agrees after I say "You have a tattoo on your NECK! An IV is MUCH less painful!"

 

[DScully]

One other good story from that rotation. This is in Bible belt; In-patient is bipolar during manic phase. Her sister is a reverand at local AME church. Visiting on Sunday AM they obtain private conference room for "services". For the next hour we hear many repetitions of "Praise Jesus" and Lordy Lordy".

After a particularly vigorous sequence of "Lordy, Lordy, Lordy" x20. My attending looks at me with a straight face and says: "Looks like we have a bad case of 'Tachy-Lordia'" I was in tears...

This is SO funny!!

 

[dillpickles]

I was rotating through a rural ER in as a third year medical student. An older woman with a southern drawl and leathery skin showed up one night insisting that "someone needs to examine her ginny."

I asked her, "What's going on, ma'am?"

She explained that she woke up with a "bad itch down there," she "grabbed a pencil to scratch that-them-there itch," and "that damn pencil is stuck in my ginny."

After talking to her a bit more, I proceeded to listen to her heart and lungs, and explained that I'll need to do an exam.

After a thorough exam, it was clear there was no pencil in her vagina, nor any obvious signs of foreign object trauma.

As I told her this, she became hysterical and billigerant, with (honest to god) saliva frothing in the corners of her lips, screaming in a thick, southern drawl, "THERE IS A WHITE PENCIL IN MY GINNY! THERE IS A WHITE PENCIL IN MY GINNY!"

 

[amyl]

there is a definite correlation between # of allergies and crazy and chrons and crazy.... not all are crazy but the craziest people I have ever had to deal with are the chrons pts.
i once had a pt tell me she was allergic to normal saline. she told me her arm got red and there was a big bump there. I tried to reassure her in words she could understand that it wasn't the normal saline, but she wasn't having it. if you can't used versed, fentanyl, etc (which for me now is because my staff hasn't gotten a chance to talk to them yet) and you suspect your patient is not the brighest just use big words in a very matter of fact way... sometimes they dont want to admit they dont know what you just said.
I told that pt being allergic to normal saline is incompatible with life and that her prior intravenous line infiltrated and that was the cause of her symptoms but to make her feel better I would use lactated ringers solution instead. she shut up.

 

[RAToronto]

In my case, it doesn't seem as bad as what you've described. I've had a few "crazies" but nothing major 😛

 

[nitrous82]

My all time favorite allergy story has to be the following:

Post-op CABG pt in the ICU, extubated and doing well. Next morning stop by to post-op the patient and noticed on her chart that she was allergic to POTASSIUM. Upon further questioning she said that it made her "breathe real fast" and "get sick to her stomach". I tried to explain how this "allergy" would be incompatible with life and nearly impossible to avoid in her diet on a daily basis. I unfortunately decided to elaborate on the fact that it would be necessary to replace this electrolyte as part of her post operative care. This precipitated a histrionic fit of epic proportions that included, but was not limited to threats of litigation. Some people........

 

[rsgillmd]

My all time favorite allergy story has to be the following:

Post-op CABG pt in the ICU, extubated and doing well. Next morning stop by to post-op the patient and noticed on her chart that she was allergic to POTASSIUM. Upon further questioning she said that it made her "breathe real fast" and "get sick to her stomach". I tried to explain how this "allergy" would be incompatible with life and nearly impossible to avoid in her diet on a daily basis. I unfortunately decided to elaborate on the fact that it would be necessary to replace this electrolyte as part of her post operative care. This precipitated a histrionic fit of epic proportions that included, but was not limited to threats of litigation. Some people........

🤣 👍👍

The best post in this thread so far, in my opinion. Picturing this situation in my head has given me the best laugh of the day.

 

[fakin' the funk]

Not a "crazy patient" story but a great allergy nonetheless. Yes, this was actually in the EMR, and where I'm at you have to click through the allergies every time you order meds.

Allergy: chili
Reaction: diarrhea

Needless to say, I did not order chili for that patient.

 

[fakin' the funk]

No ****? We'll have to get this patient one of our special bee-free rooms.

And to think that with all of the standard (bee-filled) rooms there hasn't yet been a Sentinel Event.