How do you deal with a patient who is acting inappropriate towards you?

[snowhite]

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I have a patient who is continuously hitting on me/asking me out on dates. He is a patient in the psych ward of the hospital so I have to see him everyday and track his progress. He was admitted with major depressive disorder with psychosis. He has in fact risen from his slump miraculously...at first he was depressed and was in bed for about a week, lacked motivation for anything and barely spoke to anyone - now he's up and about, chatty and follows me around whenever I'm on the ward.

The situation is this - He keeps asking me for my phone number, he keeps giving me his, asking me to go meet him after he gets discharged, making me bracelets etc etc. He says things like, "my sister is throwing a party for me and it would really mean a lot to me if you could come." I have explained to him several times that I cannot do those things, that they're inappropriate and if he ever needs me or any medical/psych help that I or others can always be found in the hospital should he need to come back.

I'm nearing my wits end and I've exhausted every professional response I can muster to explain to him that these things he's asking of me and expecting are very inappropriate. I've explained to my attending the situation and she thinks that it's harmless and because of me he's actually gotten out of bed and so it's a good thing for him to have a crush.

I feel horrible that I am consciously avoiding this patient these days because of this. He creeps me out. I try the best I can to speak to him because I realize the doctor depends on our assessment of the patients' functioning abilities, but damn - I'm soooo frustrated. I don't know how much longer I can say the same thing over and over again.

Has anyone else ever experienced something similar? Anyone have any suggestions as to what I should do? My rotation is almost over, so I guess I could ride it out but I am worried that my rejecting him might make him relapse into his depressive state again since he has mentioned that no one really likes him.

 

[Anka]

Just keep doing what you're doing -- very professionally, and firmly, saying "no, that's inappropriate". Don't worry about being repetative; that often helps. Often it's a matter of the patient realizing you are a fixed, entirely predictable quantity -- this input gets this response. Especially true of psych patients.

Anka

 

[Winged Scapula]

Its pretty common, I think, for most of us females in medicine, to have experienced something similar. Yes, often its a psych patient who doesnt' realize they are being inappropriate, but you'll have regular medical patients do the same.

(vis a vis I actually had a young guy hitting on me in the ED two months or so ago while I was doing a rectal exam AND his gilrfriend and new baby were right outside the door. Please.)

At any rate, you've done the right thing: you've told the patient that he is being inappropriate and you've informed the attending. Unfortunately, it sounds as if they still wish you to continue to see this gentleman and maybe the best way to look at it, is that he isn't psychologically normal and that perhaps his having a crush on you has been beneficial. If he relapses, its not because you rejected him but part and parcel of his disease. Be firm with him and as long as you don't feel endangered by him, consider your presence to be helpful to him and a learning experience for you.

 

[mindquick]

maybe it's all a trick, and you are the actual patient. it is a test.

have you ever thought about that?

 

[Sureshot83]

On Step 1 the answer would be to "use direct yes/no questions and avoid open-ended questions." Unfortunately, real life might not be as simple.

 

[AmoryBlaine]

The fact that he thinks the psych ward is an appropriate place to pick up women proves that it is the right place for him.

 

[OldPsychDoc]

Your attending is not responding appropriately.

The patient needs to hear this: "I am glad to have been able to assist you as a member of your care team. However, your behavior is not appropriate, and you have not been able to refrain from inappropriate behaviors despite my reminding you. Therefore, I am transferring your care to Doctor ____ today."

You don't need to be subjected to this. If your setting of appropriate limits results in a decompensation, then the attending will have valuable diagnostic information to guide her future treatment decisions.

 

[snowhite]

On Step 1 the answer would be to "use direct yes/no questions and avoid open-ended questions." Unfortunately, real life might not be as simple.

I'm not sure what you mean. I can't avoid asking or getting asked open-ended questions unfortunately.

 

[snowhite]

Just keep doing what you're doing -- very professionally, and firmly, saying "no, that's inappropriate". Don't worry about being repetative; that often helps. Often it's a matter of the patient realizing you are a fixed, entirely predictable quantity -- this input gets this response. Especially true of psych patients.

Anka

Thanks! I'll keep doing this then. The patient will be discharged on Friday so I have a feeling he'll lay it on thicker as it gets closer, but I'll do as suggested. 🙂

 

[snowhite]

(vis a vis I actually had a young guy hitting on me in the ED two months or so ago while I was doing a rectal exam AND his gilrfriend and new baby were right outside the door. Please.)

That's horrible. Some people are so sleezy. *shakes head*

At any rate, you've done the right thing: you've told the patient that he is being inappropriate and you've informed the attending. Unfortunately, it sounds as if they still wish you to continue to see this gentleman and maybe the best way to look at it, is that he isn't psychologically normal and that perhaps his having a crush on you has been beneficial. If he relapses, its not because you rejected him but part and parcel of his disease. Be firm with him and as long as you don't feel endangered by him, consider your presence to be helpful to him and a learning experience for you.

Thanks for the advice...I'll try to see it as a learning experience. As a matter of fact, I've learned a lot about myself and how transferrance/countertransferrance affects the provider and patient.

Your attending is not responding appropriately.

The patient needs to hear this: "I am glad to have been able to assist you as a member of your care team. However, your behavior is not appropriate, and you have not been able to refrain from inappropriate behaviors despite my reminding you. Therefore, I am transferring your care to Doctor ____ today."

You don't need to be subjected to this. If your setting of appropriate limits results in a decompensation, then the attending will have valuable diagnostic information to guide her future treatment decisions.

I'll remember that in the future; however, I think it'd be really hard for me to be comfortable saying that. Unfortunately, I won't be able to transfer this patient to some other medical student because of my attending. Thanks for your response. I appreciate the insight.

 

[sga814]

Rx: Bilateral ECT max voltage for 150 seconds. He will forget you even exist.
Tell the patient to act catatonic if he really wants to show he cares. He will, they'll try to give him meds- keep telling him to act catatonic- and if he does speak, tell him to say, "I shall imminently kill myself"- that'll get the ECT prescribed. Benefits include retrograde and anterograde amnesia 😉

 

[DireWolf]

See you in the morning honey 😎

 

[sga814]

wtf?

 

[ddmo]

Just order Q2 Gut Punches.