How do you deal with uncooperative patients?

[Terpskins99]

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More of a rant than anything else. Today in clinic, I had to interview this one B**** of a woman that refused to even acknowledge that I was in the room. Her words: "I don't talk to medical students". Then she literally looks away and points her chin up. 😡

When I was on floors a couple months ago, we had this guy that was a COMPLETE jerk. Malingering bastard that was making up reasons to stay, refused to provide us with information about his prior hospitalizations or prior meds (saying WE should be responsible for coming up with all of that from scratch), refusing to get his blood drawn or go for testing because he wasn't "ready yet"... and then get pissed off and tells me to my face that I'm completely "incompetent and ******ed" (the a-hole actually said this!) because I'm not treating him.

WTF is wrong with these people? Do patients think that because they're in a hospital setting that they can get away with any kind of behavior they want to? That one guy left me so fuming that I felt like I needed to decapitate him with my clipboard.

Hard as it may be to believe, I'm actually very friendly and approachable in real life. I do just about everything I can to be as hospitable and nice to every patient I see. And so far I've been able to grin and bear it with these kinds of patients, but it just leaves me with a terrible taste in my mouth. What worries me is I get so mad I often find myself pre-occupied the rest of the day with it (even when I'm talking to those patients that I actually do enjoy being around).

How do you guys do it? How do you get those few scumbag patients out of your head and not let it affect you? I mean, I understand that they're sick and I do sympathize with them. But some of these people seem to enjoy making others feel like sh** (not a misery loves company-kind of thing, but a make it their mission in life to crap on everyone's parade-kind of thing) and that absolutely pisses me off.

 

[lil pook]

a lot of people in this world are unthankful, rude, have no manners, and no class

do like i'm gonna do. choose a specialty with very little patient contact.

 

[Brian Griffin]

Any career that deals with the public has to put up with the occasional jerk with no manners and no class. I realize in medicine it can be a little more uncomfortable because we have to cross so many boundaries with our patients... but as much as there are some horrible patients out there wreaking havoc in clinics and hospitals... man I have seen some nasty *** people in restaurants treating servers horribly... it's everywhere. It's just a fact that not every consumer will appreciate nice and polite service when they get it.

When a patient treats me like crap, 99% of the time I can safely say it's not about me... they're just a miserable person who will treat everyone and anyone like crap. It's usually because they've had some terrible experience in the past (and when I think about that, I'm usually able to conjure up a little bit of empathy for them). Either way, I just try to laugh it off (behind their backs of course, haha). It's definitely not personal. (I also take this approach when a resident or an attending is rude to me).

 

[Brian Griffin]

Sorry, double post.

 

[analgold09]

I, too, tend to linger on the unfortunate attitudes of some patients -- so much so that it taints the remainder of my day. I've found that they fall into two categories: those who cope poorly with illness (and who would be pleasant in any other circumstance) and those who are innately miserable, obnoxious human beings. In any case, people are fond of reminding me that being slighted by patients is rarely about anything I have done. Unfortunately, I've never found that advice helpful. Illness may be an excuse for a bad mood, but it is not an excuse for incivility.

More practically, I would always round on problem patients last during ward months. When you think about it, you only see them for less than five minutes a day (esp. if your attending does sit down rounds). Be perfunctory; ask yes or no questions. Get as much info as you can from past discharge summaries so that you can minimize your contact with them for the initial h&p.

Alternatively, how about 5 mg haldol IM prn, ADA diet w/ no snacks, and lactulose 15 ml tid for "constipation prophylaxis."

 

[Mariah246]

5 mg haldol IM

I see someone beat me to it.

That makes for a spectacularly cooperative patient.

😉

 

[Ypo.]

What I was wondering today is; how far are we supposed to go in order to get them to cooperate in order to give us the information we need? Should we coax, try and reason? Or just drop it completely?

I had a psych patient today who pulled the "I don't want to talk about that." I just said "Ok, you don't have to." I wasn't going to argue with her.

 

[Chizwheel]

So I have a gratifying story of one of these prick type patients (the ones who are innately miserable people and just want to be a general a** to everyone else). It was very much like the patient that Terpskins99 described, refusing to cooperate with the doctors at all. So eventually we just discharged him for refusal to cooperate with any medical staff, unwillingness to pursue any recommendations or alternatives, and being extremely rude to staff. He refused to leave so we called security. He was dragged out by the police and tried to beat them up and now he's in jail. That was a good day.

 

[waldenwoods]

Yeah there are patients who do things that are upsetting and it's hard to shake the anger off--moreso on inpatient than outpatient, because with outpatient I know that most likely I will never see them again. When I was on psych we were taught to become aware of countertransference reactions so that we could use it to help understand the patient better. I find that I can look back on a difficult interaction with an uncooperative patient and maybe understand them then, but when I'm in the moment and even for hours later, I am pissed off at the patient and not empathetic toward him/her.

Ok so since the subject of this thread is uncooperative patients, I'll share my story of one, actually was in the outpatient setting, in the resident continuity clinic. With this particular resident, I was allowed to go by myself to see patients before the resident had finished up with the previous patient...so I walked into this patient's room and I introduced myself as a student and that her doctor would see her soon, and the patient said something along the lines of she didn't want to tell me and have to tell him the same story. At that point I noticed the patient was a bit restless and I'd rather not see her get too agitated or anything, so I was all right with that. But then, the patient asked me how long it would be until the resident would see her, which made me really angry because she was trying to get me to promise something I had no control over, probably so when she would become pissed off for waiting too long she could displace some of the anger onto me if I were to have given her a time estimate. And this person was a returning patient (her chart was quite thick) so she knew how the clinic would always get backed up!!!! So I told her I don't keep his schedule and therefore I can't tell her how much longer she will be waiting (duh), although really what I wanted to do was confront her on why she had this unrealistic expectation.

Then we return to see this patient together, and her greeting for him was "I was waiting so long, I was about to call 9-9-1." (Yes, 991, not 911...but what I don't get is how would calling 911 get the resident to see you sooner? And are you trying to piss him off before the door to this exam room has closed?) Then she laughed. It was totally uncomfortable. I could see that this patient was unable to empathize with other people: she didn't care about this being a teaching program and refused to talk to me to pass the time before the resident was able to see her, and she didn't have the capacity to understand that the other people scheduled in clinic that day were equally deserving of the resident's time.

 

[MR1]

More of a rant than anything else. Today in clinic, I had to interview this one B**** of a woman that refused to even acknowledge that I was in the room. Her words: "I don't talk to medical students". Then she literally looks away and points her chin up. 😡

When I was on floors a couple months ago, we had this guy that was a COMPLETE jerk. Malingering bastard that was making up reasons to stay, refused to provide us with information about his prior hospitalizations or prior meds (saying WE should be responsible for coming up with all of that from scratch), refusing to get his blood drawn or go for testing because he wasn't "ready yet"... and then get pissed off and tells me to my face that I'm completely "incompetent and ******ed" (the a-hole actually said this!) because I'm not treating him.

For the first one as a medical student, I would just say "okay" and leave. Then tell the resident/attending the patient refused to talk to you because you were a medical student. This only happened to me mabye twice in medical school so I didn't care, obviously if it happened more it might be a problem for your education/evaluation, otherwise I wouldn't worry about it.

The second one, this happens unfortuantely too often. What you do - document, document, document - and then like someone else said you discharge them for refusing care and use security if needed.

My biggest advice, do NOT let this crap bother you or get you down, remember the nice and thankful patients you have taken care of. At least once every few months I still overhear patients and\or their families referring to residents as not real doctors so you can imagine what they think of the medical students.

 

[Kubed]

Haha, funny stuff!

On one of my medicine rotations I had an attending who wanted to sit in the room and watch me do a H&P. Patient didn't even look at me while I took the history except to turn to me once and say "you have 5 min left." Attending actually started laughing at the guy

 

[Kubed]

...

I had a psych patient today who pulled the "I don't want to talk about that." I just said "Ok, you don't have to." I wasn't going to argue with her.

Come on! You know the correct response!

"I don't want to talk about that"

"why?"

"Because I don't like to talk about it"

"why?"

"I JUST DON'T!!!!!!"

"ok...... why is that?" 😀

 

[MastahRiz]

Some of our rotations take place at a free clinic where there are loads of patients. When we get stuck with a rude patient we just tell him to find another hospital. It works wonders. Beggars can't be choosers haha

 

[Mayhem]

This doesn't happen very often but I love having these patients because it just means less work for me. Unless i'm on psychiatry, I'm going to assume that you are mentally competent and if so all I need to hear is something like "I'm not talking to you" and suddenly that patient doesn't exist. I am much too busy to be fighting you to help you. I'm not the sick one. If you want to play around and act like an idiot, i'll move on to the next person that wants my help. One thing I notice about our university hospital though is that the best way to ensure that you are seen by a medical student is to say you DON'T want to be seen by a medical student. The Doctor's tend to be less acommodating with the uncooperative people, almost like they're trying to teach them a lesson.

For example, I had a lady once who let me know that she already gave blood this morning and she can't give anymore now (lady was being observed due to possible MI that morning). I simply said ok and let my attending know the situation. The conversation rouhgly went like this:

Doctor: (nonchalant) So I hear you're going home?

Patient: Really?

Doctor: Well, if you're not going to give us the blood then there's no reason for you to be here. Am i right?

Patient: (bitches and moans and complains about having medical students taking blood.)

Doctor: Look, here's the situation. This is a teaching hospital, you knew that when you chose to come here. We need that blood to help treat you and he needs to learn how to take blood. If you have a problem with that, there's another hospital 20 minutes away, you are more than welcome to go there.

And voila, suddenly I got permission to take the blood. She started to bitch and moan under her breath during my history until I asked her what she was saying and she finally shut up. She didn't become any nicer the rest of the time she was there but at least she was respectful.

 

[nancysinatra]

Come on--have any of you actually BEEN a patient in a teaching hospital before? Have you actually ever been interviewed/examined by an awkward med student? Do you know how weird that can be? I had a friend who had cancer and was in and out of a major teaching hospital for two years. She'd always report to me on what my fellow med students were saying--and some of the stupid questions she got asked were amazing! Such as: "Do you exercise regularly?" [No] "How do you FEEL about not exercising?" (This was right before going into brain surgery. Who cares??!) Believe me, med students do not need short white coats to stand out. We announce ourselves in other ways.

Don't tell me none of you have had embarrassing moments with patients where you were messing up some physical exam skill, totally failing at drawing blood, or something like that. Patients notice those things! The nice ones don't say anything. But I can see why some people would much prefer to be seen by an attending than some bumbling student. And telling a story multiple times is tiring. It just is.

Plus, these difficult patients--they are as deserving of good care as the more pleasant ones. The challenge is to not let them get to us or have their attitude interfere with the care they get.

All that said, some of the stories of things I've heard patients say are pretty entertaining. Yeah, I agree, some patients can be very frustrating!

 

[GoBuckeyes913]

Doctor: Look, here's the situation. This is a teaching hospital, you knew that when you chose to come here. We need that blood to help treat you and he needs to learn how to take blood. If you have a problem with that, there's another hospital 20 minutes away, you are more than welcome to go there.

So far, this line has always worked for me and my classmates. If they are so anti-med student they need to go to a non-teaching hospital, or suck it up and deal with it. I've been a patient myself many times at a teaching hospital, and there are worse things in life to experience.

I once had a patient that was so ridiculous, my attending was praying that she'd leave AMA. She came in for abdominal pain, refused to see anyone except the attending, was completely non-compliant with treatment.... i.e. she stole her roomate's dinner tray while NPO, knowing she wasn't aloud to eat, and of course wanted something for pain but was "allergic" to everything except Dilaudid.🙄

After explaining to her how unacceptable it is to be non-compliant, and how important it was for proper diagnosis and treatment, she whined saying "i'll just leave then", which took me 0.1 seconds to grab and AMA form and tell her to go if she felt it necesarry. No one should be afraid to stand up to patients, particularly the ones that act difficult/bully staff on purpose to get what they want.

 

[Mayhem]

Come on--have any of you actually BEEN a patient in a teaching hospital before? Have you actually ever been interviewed/examined by an awkward med student?

Actually, yeah. I had my gallbladder taken out at my university hospital. They offered to list me as a non-student case but I didn't bother because...well, i did choose to come to the teaching hospital and it was such a classic textbook case that it would have been a crime not to let them do a history and physical exam.

Seriously, I don't disagree that being poked and prodded by med students is tedious and telling us the history after telling the dude in emergency then the intern on the ward is pretty annoying but it's a necessary evil. I accept when patients say "Dude, I'm tired. Somebody asked that already," but I'm less accepting of the ones that come to the teaching hospital and demand not to be seen by students. And it's usually not the emergency cases, they're always grateful to be taken care of, it's the ones that leisurely drove pass the non-teaching hospital on their way to ours that want to start the battle.

 

[vtucci]

Haldol? Just kidding.

I try to be as pleasant as possible. I harken back to my days as a waitress with a demanding clientele. Smile, never raise my voice, try to be as reasonable as possible.

If the patient does not want a student to examine them, I let the patient know that the "doctor" will be examining them as well and this way, they are getting the full once over from me as well as the doctor. The more people who examine you, the less likely things are going to be missed. It usually works.

 

[LadyJubilee8_18]

a lot of people in this world are unthankful, rude, have no manners, and no class

do like i'm gonna do. choose a specialty with very little patient contact.

Or, chose pediatrics! Kids are usually cooperative, and parents, while often overly dramatic, will usually be cooperative when their kid's health is on the line. The problem I've run into is trying to deal with parents who have abused their kids. I just want to beat them with the chart, but I have to be civil 👎

 

[happygirl3]

Or, chose pediatrics! Kids are usually cooperative, and parents, while often overly dramatic, will usually be cooperative when their kid's health is on the line. The problem I've run into is trying to deal with parents who have abused their kids. I just want to beat them with the chart, but I have to be civil 👎

Yeah, I plan on going into pediatrics and I think it will be really great working with kids, but I worry about running into those that get abused by their parents/family members. I think I'd have a really hard time not killing them in my own office..

 

[happygirl3]

Yeah, I plan on going into pediatrics and I think it will be really great working with kids, but I worry about running into those that get abused by their parents/family members. I think I'd have a really hard time not killing them in my own office..

I just read over what I said and wanted to clarify that its the abusive PARENTS, not the kids, whose butts i'd wanna kick..