Disrespectful patients

[Maddox_doc]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

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[Smurfette]

How do you deal with patients that appear unreasonable, or disrespectful?
Any experience anyone?

Can you be more specific? There are a variety of scenarios that come to mind, and most of us probably tailor our responses accordingly.

 

[tux4]

Some people may appear this way because of the stress of being thrown into the medical environment, are trying to stress you out so that you give them what they want cause they know you don't want to deal with them, or because they are just an a$$. Many different scenarios that have to be handled differently. Was there a specific situation that made you post this?


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[scootad.]

Very important to develop a thick skin in medicine. Especially as a medical student, you will be getting very little respect from your attendings, residents, nurses, patients, and even support staff. In medicine, you EARN respect as you move up the ladder and gain experience. Can't take anything too personal. Keep your head down and work hard.

 

[JustPlainBill]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

Agree with the other posters -- need more specifics. It's one thing for a patient to be "unreasonable" because their kids sick and they are scared spitless and don't feel you're doing enough -- that usually requires patient/parent education; it's another thing to have some 50 y/o male who's a frequent flyer in the ED who's come in on a Sunday morning for "back pain" -- and then proceeds, after not being able to move during PE, to get up screaming off of the bed when you discharge him with an NSAID and muscle relaxer and comes at you yelling about, "This ain't yo' pain, Dis is my pain and I needs Norco" --- completely different management technique for that one.

So, what sort of scenario are we talking about?

 

[Maddox_doc]

I made a patient's chaperone extremely upset by asking her to identify herself and her relation to the patient. The resultant outburst of anger included her getting personal, and screaming uncontrollably.

I find this unfortunate, and regret that the situation got out of hand.

 

[Smurfette]

I made a patient's chaperone extremely upset by asking her to identify herself and her relation to the patient. The resultant outburst of anger included her getting personal, and screaming uncontrollably.

I find this unfortunate, and regret that the situation got out of hand.

It may have been how you phrased it? I routinely ask "and who's this lovely lady/gentleman with you today?" (or something similar) when I introduce myself to the patient and rarely get any negative reactions. OTOH, I have previously made the mistake of guessing the relationship incorrectly and had difficulty recovering. Some people's children look older than they should. Sometimes it's a May-December relationship. Sometimes it's just complicated and letting them explain it however they prefer is best.

 

[Promethean]

I can see how someone might take offense to that question, if they thought that you were questioning their right to be there with their loved one.

I had to ask relationships frequently, as family members always accompanied my pediatric patients to the OR holding area. (Since kids can't generally sign their own consents, it was much more complicated and somewhat concerning when someone *wasn't* with them.) I would jokingly ask the kid "So, who have you brought with you today?" That was a great way to find out that the person accompanying them was not the parent, but an aunt or neighbor or some other person unqualified to provide consent for the minor to undergo major surgical procedures under anesthesia.

Before labeling a patient or family member as disrespectful, consider whether there might be a reason for their behavior. Are they scared or in pain or just exhausted from having been dealing with a medical problem / transferred between facilities, etc. Also, step back and think about whether you or someone else on the staff may have behaved toward them in a way that they could have perceived as disrespectful, and now they are giving it back to you. Treat their attitude, not as a social cue that you should respond to, as if you were meeting on the street or at a party... but as a piece of data that may inform you of their condition.

Step back, look at the situation objectively, and think critically. Don't be drawn into the trap of reacting the same way that they are treating you. Remain calm, and professional. Apologize for any inconvenience or misunderstanding and redirect their attention to the purpose of your interaction with them and your desire to help them. If they persist in their behavior despite your best efforts, obtain a chaperone just as if you were dealing with a patient who made a pass at you... a second pair of eyes to witness your side of the conversation.

Document as needed. Again, treat it like any other clinical data. Learn how to phrase things professionally, but if a patient is openly hostile toward you and uncooperative with care despite attempts to accommodate whatever concerns they may have, that may be medically relevant and should be part of their health record. What if it is a sign of a neurological or behavioral health disorder? You do the patient and future providers a service by *appropriately* documenting.

 

[Redpancreas]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

I'm very sensitive and have a low anxiety threshold so this is an area I'll sometimes struggle in. The key is to realize that your evaluators are the ones you need to make a good impression on. That doesn't mean to disrespect the patient or heaven forbid force anything on them, but when they challenge you, the thought of missing something on rounds gets me over that hump.

First, after watching residents I notice some of them don't even know 100% what they're talking about but they'll carry themselves in an authoritative manner which helps.

For you:

Angry patient: Try to relate to them and be nice and try to understand why they're angry and rephrase what they are saying is pissing them off to show you are listening. This is already more than what most do which in my experience establishes rapport. Sometimes on the psychiatry floors the patient is just confused so try asking the question when you've established better rapports and you may get a different answer. If you're on psych, watch your distance too. Patients can get violent when confused or spit if they're in a acute mood state. Don't take it personally either. I'm 99% sure when the patient is feeling better they'll feel genuinely bad for actions.

Rude patient: This type of patient is either has an attitude or is in a bad mood. They'll be short with you, not repeat things, etc. it's important here to strike a balance between firmness and kindness and persistence and respect. If they insist on being rude, try to apologetic at first and sympathize. Sometimes that'll further embolden the patient to be like, yeah that's right, get outta here. In that case, be firm and state the reason you asked your questionand assert yourself. Something like "Mr. X the reason I asked you this is because we need this information in order to do this which is what I believe you want. Will you tell me so I can relay this to my supervisor quickly? Sometimes they ease up. If not respect their wishes. Never force anything but at the same time, never be OVERLY apologetic or you'll get nothing done.

Hates medical students and doesn't want them involved in their care: Haven't found a way around this that involves talking to the patient and frankly it's better that way because you don't want to directly be in conflict with a very clear desire the patient has. Sometimes if you've got an awesome attending or resident, they'll refuse to see or operate on the patient without the medical student. Otherwise leave and tell your resident. There's no shame in that.


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[Redpancreas]

I made a patient's chaperone extremely upset by asking her to identify herself and her relation to the patient. The resultant outburst of anger included her getting personal, and screaming uncontrollably.

I find this unfortunate, and regret that the situation got out of hand.

If you asked it in that exact way and are not just stating it formally it is unfortunate and the person overreacted but you could ask better. When I ask this question I try to make the person feel good whereas your statement has the potential to be seen as a challenge to the patient if they are defensive or sensitive. It's easier for guys as a guy. Just say Who's this awesome guy" here or and for women guests I first say hello, make eye contact with warm eyes and ask them "before WE start, it's a pleasure to meet you. How are you related to the patient?" It established inclusion. If it's just a sitter you'll look awkward but it's better than offending a atient.


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[Phloston]

You speak to patients the same way you would to your Japanese girlfriend's grandparents, using 敬語 (keigo) and 謙譲語 (kenjougo).

Not necessarily anything you don't already know, but always keep your cool, speak professionally, and don't get defensive. Apologies are never baneful. Then once the situation is resolved, never speak about it negatively or rant to anyone else. Professional always.

 

[Rendar5]

I go into the room and introduce myself to everyone. I ask "And you're his...?" It is awkward, but it's better than being demanding as in "who are you and why are you here" type question and it's definitely less awkward than "and I assume you're his mom?" When it's his wife...l

 

[Bacchus]

Let the patient identify their accompanying person.

I always ask if it's ok they're in the room because if I'm discussing a difficult diagnosis or potentially life altering results I don't want to reveal anything without permission.

Case in point: HIV screening is recommended on 15-65yo. HCV screening on birth year 1945-1965. It's easy to say they're negative but the last thing you wanna do is ramble on about them being positive. Same goes for substance abuse problems.

 

[Anicetus]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

Deal with it. We are a service. And according to America, healthcare is a basic human right.

 

[DrYoda]

Remember we generally do not see people at their best. with few exceptions most people are not thrilled to be in the hospital. But really just don't it bother you I see pissed off patient's on a pretty frequent basis and I just be polite (aka take the high ground) and roll my eyes when I get back to my desk. Occasionally some patients imo do need a tough love type approach, but that's not something to do as a medical student.

 

[QofQuimica]

I made a patient's chaperone extremely upset by asking her to identify herself and her relation to the patient. The resultant outburst of anger included her getting personal, and screaming uncontrollably.

I find this unfortunate, and regret that the situation got out of hand.

As already mentioned, next time, ask the patient to explain their relationship. I, too, do this by asking the patient something to the effect of, "and who is this gentleman/young lady with you?"

 

[KinesiologyNerd]

Thick skin and passive aggression

 

[hmockingbird]

If you asked it in that exact way and are not just stating it formally it is unfortunate and the person overreacted but you could ask better. When I ask this question I try to make the person feel good whereas your statement has the potential to be seen as a challenge to the patient if they are defensive or sensitive. It's easier for guys as a guy. Just say Who's this awesome guy" here or and for women guests I first say hello, make eye contact with warm eyes and ask them "before WE start, it's a pleasure to meet you. How are you related to the patient?" It established inclusion. If it's just a sitter you'll look awkward but it's better than offending a atient.


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This, sometimes people get really defensive about stuff we don't think is a big deal, or are sensitive.

Next time you could try to phrase it more openly/warmly with suggestions here. And if someone gets offended, I usually just get really sweet/apologetic about it. E.g. mom is pissed that I asked about her relationship to her 2yo. "Oh thank you so much, I ask everyone that, I just wanted to clarify things because sometimes we have patients come in with aunts so I want to make sure we are on the same page, I am so glad you could come in today and it's always a great thing to see parents so involved..." etc. Just butter them up!

 

[highway31]

This is kind of a long podcast on managing difficult patients, and it focuses on the ER, but I think there's a lot of takeaway to managing difficult and disrespectful people in general:

https://emergencymedicinecases.com/...nt-communication-managing-difficult-patients/

The best option, of course, would be to avoid a situation where a patient becomes disrespectful altogether, but that's not always possible.

As to your issue with identifying visitors with a patient, I agree with the other posters that you should probably change your approach. Bottom line is you need to make sure the visitor is appropriate to consent to examination of the patient (as in the case with a minor or someone not capable of consenting), but more importantly that your patient is okay with discussing health information in front of them (HIPAA). I usually ask "Who's this with you?" in a kind, non-accusatory tone. Depending on the issue, I may ask if the patient is okay talking about their health with other people in the room, or if they would prefer some privacy. If I know the problem is something most people would prefer privacy when discussing, I may ask the visitors to step out for a moment so I can ask the patient if they would like privacy without being put on the spotlight. Ask politely, treat it like it's just part of the process, and most folks are happy to oblige. If the patient stops you and says it's fine the visitor stays in, then you have your answer. There's some grey area with this (i.e. abusive spouses, parents with teenagers, sexual history with spouses in the room, etc.), but if you're polite and confident in what you're doing, you'll get the interaction right (most of the time).

 

[postbacpremed87]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

Contemplate a career in Pathology.

 

[caffeinemia]

If someone gets racist, sexist, sexual, derrogatory, or aggressive/threatening, you're well within your rights to first tell them to stop. Second you should probably tell them you're going to be stepping out of the room to give them a moment to calm down. That's important for your safety, and it gives people space to really check themselves. Finally, you should ask them if they'd like you to continue to care for them given the conflict. If not, find someone else for them (though that may be easier said than done).

Finally, you're always welcome to contact your superiors/hospital risk management/security, if you feel it's a threat to your safety to be around the patient or if the patient is threatening the health of others. Finally, IDGAF about family or visitors. If they act up, they get 1 chance before security is called. No screaming, no yelling, etc. It's a threat to your ability to care for the patient and a threat to the health of other patients.

 

[Jamers]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

As a student or resident (depending on where you work) your options maybe limited. As an attending the phrase "get the f*** out of my ED" has been spoken by myself to many a patient; I would not do this as a resident. I personally remind the patient of our respective roles and if the abuse continues I either leave, attempt to peace making gesture ("I want my sister back now!", "I need a turkey sandwich!") or have the patient escorted out. You can always turn to your attendings and I personally have a zero tolerance policy for ANY disrespect to my staff.

 

[Beezlebub]

As a student or resident (depending on where you work) your options maybe limited. As an attending the phrase "get the f*** out of my ED" has been spoken by myself to many a patient; I would not do this as a resident. I personally remind the patient of our respective roles and if the abuse continues I either leave, attempt to peace making gesture ("I want my sister back now!", "I need a turkey sandwich!") or have the patient escorted out. You can always turn to your attendings and I personally have a zero tolerance policy for ANY disrespect to my staff.

Just to clarify, you can't discharge an emergency patient (even with a distasteful personality), correct?

 

[JustPlainBill]

As a student or resident (depending on where you work) your options maybe limited. As an attending the phrase "get the f*** out of my ED" has been spoken by myself to many a patient; I would not do this as a resident. I personally remind the patient of our respective roles and if the abuse continues I either leave, attempt to peace making gesture ("I want my sister back now!", "I need a turkey sandwich!") or have the patient escorted out. You can always turn to your attendings and I personally have a zero tolerance policy for ANY disrespect to my staff.

Interesting twist -- as a resident doing my month in the ER, had an elderly patient who had recently had a hip replacement; Really sweet lady turned out later -- heard a loud snap when she stepped up on the stool at home to get back into bed after going to the bathroom around midnight. Brought in by family and was very loudly causing a commotion in the side hallway -- I went over and she literally began to climb up my white coat I was wearing over scrubs while moaning, writhing and doing the entire "I'm really in pain routine" -- so I started some pain relief, got the story, ordered Xrays and off we go --- well, she kept really causing a commotion so I figure we needed some more pain control which I ordered and given her age, we were approaching highest dose I was comfortable with --- I didn't snow her but we were getting up there;

I presented the case to the attending when about that time she began crying out again and moaning such that we could hear her in the next hallway where the physician's area was and the attending asked what was up -- I told him it was the patient I had just presented; He got this exasperated look on his face, stood up and walked quickly around the corner to the hallway, telling me to stay put.

He returned about 2 minutes later and all was quiet on the Western Front; I asked about it and he told me that he walked over, asked what was up and she started into her routine on him -- that was when he told her to shut the heck up cause she was scaring the cr@p out of all the other patients; She quickly and meekly apologized and laid back down. He asked about her pain and she said it hurt but she could tolerate it and he explained about how much she had been given; she apologized for causing a ruckus and things were quiet -- turns out no fractures and all was good;

he later told me that this certain patient population/demographic evidently had the cultural belief that they communicated how great their pain was by how demonstrative they were and sometimes you had to be very forceful and direct to control it. lesson learned.

 

[themockjock]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

Escalating doses of haldol.

 

[Gastrapathy]

How do you deal with patients that appear unreasonable, or disrespectful?

Any experience anyone?

Send a note to the schedulers: follow up with PA only

 

[siliso]

The people are sick and scared. You may be the one to have time to devote your attention to them and figure out what feelings and needs are underlying their challenging behavior, and present it to the team to strategize on how to address their concerns. If you can reframe your thinking from difficult/unreasonable to frustrated/worried/suffering or experiencing barriers to care, it can help you an the team to work with the person more productively.

Dealing with difficult situations and people with some equanimity without taking personally is a key clinical skill that you can be learning on rotations. So is mobilizing your resources for the nonmedical aspects of care like working with case managers, social workers, etc.