How do you deal with abusive patients?

[spiffycats]

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I dont know if im just unlucky, but nearly every week i have at least one drug seeking patient that makes my life hell. They refuse to leave the hospital after discharge dispite multiple consultants stating there is no evidence to support their complaints of unbearable pain including normal vitals, no MRI findings, etc. They threaten to sue, scream at me, threaten to talk to administration. How do you deal with these types of patients?

 

[rokshana]

I dont know if im just unlucky, but nearly every week i have at least one drug seeking patient that makes my life hell. They refuse to leave the hospital after discharge dispite multiple consultants stating there is no evidence to support their complaints of unbearable pain including normal vitals, no MRI findings, etc. They threaten to sue, scream at me, threaten to talk to administration. How do you deal with these types of patients?

you have security escort them out.

 

[deleted480308]

Security

 

[IMreshopeful]

I dont know if im just unlucky, but nearly every week i have at least one drug seeking patient that makes my life hell. They refuse to leave the hospital after discharge dispite multiple consultants stating there is no evidence to support their complaints of unbearable pain including normal vitals, no MRI findings, etc. They threaten to sue, scream at me, threaten to talk to administration. How do you deal with these types of patients?

It’s not a hotel. There are some ways that patients can appeal their discharge especially if they are on Medicare, but once a patient is medically ready for discharge and they can safely leave the hospital then you call security and escort them out. If they are being threatening, or verbally or physically abusive, call security

 

[DrMetal]

I dont know if im just unlucky, but nearly every week i have at least one drug seeking patient that makes my life hell. They refuse to leave the hospital after discharge dispite multiple consultants stating there is no evidence to support their complaints of unbearable pain including normal vitals, no MRI findings, etc. They threaten to sue, scream at me, threaten to talk to administration. How do you deal with these types of patients?

So if you're a resident, I would talk to your attending before calling security. If you have the tough love approach, but you're attending is the "compassionate" type, you might get burned. (Even though in all honesty you're doing the right thing). These patients are difficult, but you don't want to get in trouble with your program over it.

If you're the attending boss in charge, by all means, call security!

Sent from my Pixel 2 XL using SDN mobile

 

[deleted480308]

So if you're a resident, I would talk to your attending before calling security. If you have the tough love approach, but you're attending is the "compassionate" type, you might get burned. (Even though in all honesty you're doing the right thing). These patients are difficult, but you don't want to get in trouble with your program over it.

If you're the attending boss in charge, by all means, call security!

Sent from my Pixel 2 XL using SDN mobile

I forgot they might be a resident. Yes, always clear with an attending your permission to be “that guy”.....

 

[Anicetus]

So if you're a resident, I would talk to your attending before calling security. If you have the tough love approach, but you're attending is the "compassionate" type, you might get burned. (Even though in all honesty you're doing the right thing). These patients are difficult, but you don't want to get in trouble with your program over it.

If you're the attending boss in charge, by all means, call security!

Sent from my Pixel 2 XL using SDN mobile

Compassionate type or not. Resident or not. If they are making threats you can swing that you feel unsafe in the situation, get one nurse to vouch for the same (usually it is the nurses who call security anyway). In my intern experience with a hospital in a major city, personal safety takes priority over anything written in the Hippocratic oath.

 

[DrMetal]

Compassionate type or not. Resident or not. If they are making threats you can swing that you feel unsafe in the situation, get one nurse to vouch for the same (usually it is the nurses who call security anyway). In my intern experience with a hospital in a major city, personal safety takes priority over anything written in the Hippocratic oath.

Agree. I was thinking more of the soft situations where a patient is just being verbally difficult, or just flat-out refuses to leave. But yes, if there's a physical threat always call Security First

Sent from my Pixel 2 XL using SDN mobile

 

[rokshana]

if they are being physically threatening, you may have to call the police...in many places, security are not police and may not get involved with violent pts...though security needs to be notified in either case.

 

[FutureInternist]

Q1 hour neuro checks to include rectal tone.
Keep NPO past lunch every day for a possible procedure.
Put on NPR on TV and steal remote.
DC all vital signs so they have no one to complain to.
DC all PRN meds.

🙂

 

[TraumaLlamaMD]

Q1 hour neuro checks to include rectal tone.
Keep NPO past lunch every day for a possible procedure.
Put on NPR on TV and steal remote.
DC all vital signs so they have no one to complain to.
DC all PRN meds.

🙂

Diabetic sodium-resticted finger food diet.

 

[jurassicpark]

You'll get used to how you deal with them. The most important thing is confidence. Your'e caving in to them because they can sense you're fearful they may make good on the threat of lawsuit, etc. But in the end you have to be firm as hell, and if not, security.

One thing I will NEVER put up with is disrespect and violence to staff. If that happens, as soon as they're not dying they're bounced to either street or police.

 

[DrSnips]

If medically ready for discharge, then discharge them. If they refuse to leave after discharge order is placed, then security as others have said. Be sure to discontinue all narcotics as well -- most people who are drug-seeking won't bother to stick around when they realize they can't get what they want.

 

[shiftingmirage]

At some point, when a patient is medically ready to be discharged and has a safe disposition plan, you and the hospital are committing insurance/medicare fraud when you continue to submit a bill for unnecessary services. I don't know how often this is pursued by insurance/medicare, but that is basically what you are doing. I'll tell patients that they are welcome to pay out of pocket, and I don't know what the actual number at my hospital is, but I say it's generally ~$1500 a night. The Ritz Carlton would be cheaper if we had one in our city.

 

[FutureInternist]

At some point, when a patient is medically ready to be discharged and has a safe disposition plan, you and the hospital are committing insurance/medicare fraud when you continue to submit a bill for unnecessary services. I don't know how often this is pursued by insurance/medicare, but that is basically what you are doing. I'll tell patients that they are welcome to pay out of pocket, and I don't know what the actual number at my hospital is, but I say it's generally ~$1500 a night. The Ritz Carlton would be cheaper if we had one in our city.

Problem is they can always ask to change docs (2nd opinion), and that will add another 24-48 hours to their stay.... although it does have benefit of now being your colleague’s problem 😉

 

[IMreshopeful]

Problem is they can always ask to change docs (2nd opinion), and that will add another 24-48 hours to their stay.... although it does have benefit of now being your colleague’s problem 😉

Medicare also mandatory allows an appeal of discharge that requires a minimum 48-72 hour stay. Several patients I saw in my residency knew about this and abused it - and nothing can be done about it thanks to the strict rules

 

[DrSnips]

Medicare also mandatory allows an appeal of discharge that requires a minimum 48-72 hour stay. Several patients I saw in my residency knew about this and abused it - and nothing can be done about it thanks to the strict rules

I remember back in med school sometimes a patient who abused the system like that had their diet changed to a pureed vegan diet. They often did not wait for the appeal to finish processing and left.

 

[siliso]

Tell them I’m sorry they’re feeling that way
Offer to transfer them to another physician if they are unhappy with my care
Wish them best wishes in resolving their complaints - get the patient advocate for them
Tell them I will not tolerate having my learners or staff abused and leave the room/call security in case of threats or acting out
Don’t take it personally, they’re dealing with serious struggles or mental illnesses

But normally if the problem is desire for controlled substances that aren’t medically necessary then just discontiuing these will solve the problem. If they know the Medicare rule and it applies to them then they can stay an extra day or two - but aren’t entitled to opioids during that period

 

[Elixir6]

Agree with the above, and unless it's clear drug seeking or abuse of the systems you really will sleep better by taking the approach of the last poster, siliso. I definitely agree with bring confident (they will be more upset if they believe you don't know what you are doing, even if you do). Lastly, I always take the compassionate approach, but don't take it personally when people get mad. Sometimes they are upset for a variety of reasons that occur despite the doctor (they would be angry regardless of what you have said or done).

And take no abuse. Remember, you actually have all the power in the relationship.

 

[Trogghunter]

You can....

Make them npo. Change the diet. Fluid restrict. Stop all pain or anxiety meds. Restrict all visitors. Ask bed rep to transfer them to another room, maybe a shared room or on a floor with nurses that don't take ****.

Serial abgs, hourly BG can give a lot of useful information. Enemas every hour are also good for the bowels. If they refuse, then what do they expect you to do?! If they refuse that care then surely they can leave.

Think outside the box.

You could also just ignore it and see them, write your note, and walk away for the day. You're not a butler.

 

[NotAProgDirector]

You can....

Make them npo. Change the diet. Fluid restrict. Stop all pain or anxiety meds. Restrict all visitors. Ask bed rep to transfer them to another room, maybe a shared room or on a floor with nurses that don't take ****.

Serial abgs, hourly BG can give a lot of useful information. Enemas every hour are also good for the bowels. If they refuse, then what do they expect you to do?! If they refuse that care then surely they can leave.

Think outside the box.

You could also just ignore it and see them, write your note, and walk away for the day. You're not a butler.

Other than transferring them to another room with different nursing care (that might be in their best interest), the rest of these suggestions will open you to a lawsuit which you will lose, for millions of dollars. You cannot just make people NPO, or get hourly blood glucoses, to torture your patients.

You can have sound clinical policies that set limits. For example, when I admit patients with chronic pancreatitis for pain control, our group has a policy that we only give IV narcotics if you're NPO. If you can eat, then you get oral pain meds. That's clinically sound reasoning. Perhaps it has a secondary effect of having these patients leave the hospital a bit earlier when their IV pain meds get stopped.

 

[IMreshopeful]

You can....

Make them npo. Change the diet. Fluid restrict. Stop all pain or anxiety meds. Restrict all visitors. Ask bed rep to transfer them to another room, maybe a shared room or on a floor with nurses that don't take ****.

Serial abgs, hourly BG can give a lot of useful information. Enemas every hour are also good for the bowels. If they refuse, then what do they expect you to do?! If they refuse that care then surely they can leave.

Think outside the box.

You could also just ignore it and see them, write your note, and walk away for the day. You're not a butler.

There’s no medical justification for hourly enemas in someone who’s not constipated. You will get sued and lose.

Stopping IV pain meds is one thing, this is actually not going to go over well

 

[deleted709825]

I remember back in med school sometimes a patient who abused the system like that had their diet changed to a pureed vegan diet. They often did not wait for the appeal to finish processing and left.

A vegan diet is supposed to be a punishment?

Vegan food is usually healthy & tastes great - best of both worlds!

 

[Raryn]

A vegan diet is supposed to be a punishment?

Vegan food is usually healthy & tastes great - best of both worlds!

That's nice.