I want another doctor...

[JoBlo]

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Has anyone ever had to deal with the situation that a patient on your service tells you that they don't want you as their doctor anymore and request someone else? Be it for whatever reason (for example, you won't give them the type of analgesics they want or they don't want a woman doctor or just don't like you for whatever reason)?

Do you comply and switch them to another team? I have to admit, that no one wants to treat someone that doesn't want your help... and it is a free country right; no one must get care from a person they don't want care from...

.. anyone ever experienced this? How did you handle it?

 

[sirus_virus]

Has anyone ever had to deal with the situation that a patient on your service tells you that they don't want you as their doctor anymore and request someone else? Be it for whatever reason (for example, you won't give them the type of analgesics they want or they don't want a woman doctor or just don't like you for whatever reason)?

Do you comply and switch them to another team? I have to admit, that no one wants to treat someone that doesn't want your help... and it is a free country right; no one must get care from a person they don't want care from...

.. anyone ever experienced this? How did you handle it?

One less biocth to worry about.

 

[lucky_deadman]

Has anyone ever had to deal with the situation that a patient on your service tells you that they don't want you as their doctor anymore and request someone else? Be it for whatever reason (for example, you won't give them the type of analgesics they want or they don't want a woman doctor or just don't like you for whatever reason)?

Do you comply and switch them to another team? I have to admit, that no one wants to treat someone that doesn't want your help... and it is a free country right; no one must get care from a person they don't want care from...

.. anyone ever experienced this? How did you handle it?

3 little letters: AMA (and I don't mean the organization 😀 )

 

[Tired]

One less biocth to worry about.

Seriously.

My residents usually start cheering and passing around the high-fives. Then someone makes a comment about how we should treat everyone like crap to get them to switch off the service. Then the chief gets really serious and says something like, "That's really not funny. We need to remember to treat all our patients with respect, and do our best to keep them happy." Then he starts laughing and passes around the champagne.

 

[Winged Scapula]

When I was a junior resident on Vascular, a patient complained to the attending that she didn't want any of the residents or fellow to continue to participate in her care. Instead of telling the patient that we were part of the team, the attending agreed and told us we didn't have to round on her anymore.

Boy did we have a laugh when we saw that our instructions to the nurses not to call the residents was taken to heart and the attending called at 0200 for a Tylenol order!

Seriously, it does happen. Try and resolve the problem, but if the patient is adamant, you document their request and try and honor it. Then pass the champagne.

 

[oldbearprofessor]

Seriously, it does happen. Try and resolve the problem, but if the patient is adamant, you document their request and try and honor it. Then pass the champagne.

This happens to attendings as well on in-patient services. In several decades of caring for babies whose families didn't get to select me but just got stuck with me (this is the way it is in intensive care), I've only had one family ever tell me (actually they told everyone else) that they refused to have me round on their baby (over a weekend). This was after a month earlier I had ordered a neurology consult for their 600 g baby with fungal meningitis. They didn't want to believe that this wasn't good for the long-term outcome and that a neurologist should talk to them about the prognosis. No big deal - I had someone else see that patient that weekend. I've done the same in reverse on very rare occasion as well.

More recently after a major disagreement about certain issues with a family, I tried to "turf" the patient to one of my colleagues and was told by them "no way OBP - dig your own way out of this mess!" Then, the family said they didn't want a switch to another doctor either! Amazing - it's not easy to get yourself fired sometimes.🙁 If the family had just said "we want a new doctor", I'd have been off the hook in a difficult situation.

As a resident, try to figure out if this happened because of something you said or did - in which case learn from it (even if it wasn't your fault, there are still lessons to be learned from these situations) and move on, or if it happened because didn't want a resident on the case. In that case, they are foolish but not much you can do about it.

 

[oompaloompa]

one of my favorite anecdotes from med school........

I look fairly young for my age, so its not uncommon for patients to comment on it, but only once has someone refused my involvement because of it. It was a 76 yo man on an IM rotation and I believe the exact wording was something like "don't want no damn punk teenager". In fact, he also decided our 30-something female attending wasn't up to the task either. We tried switching to another team, but apparently this patient's pleasant personality was the stuff of legends. Finally we were forced to use the "decoy doctor" approach (credit Scrubs) and sent in the elderly resp tech.

Hey, sometimes all a patient needs is 20 cc of grey hair!

Agree with above - most patients who refuse care aren't the most endearing to begin with. We definitely toasted the figurative champagne when this crusty old codger was booted out.

 

[Mista Suprane]

crusty old codger

fantastic terminology. i'll have to remember that once i get tired of gomer.

 

[docB]

I get this in EM a few times a year. It's usually over something like a patient wanting antibiotics for a virus, wanting an admission because they're homeless or wanting narcotics because they really like narcotics. In the ED I have the ability to give them the full and reasoned answer "No."

That same answer holds for the "I want a female doctor to do my pelvic exam." too.

 

[Stimulate]

We always get the attending involved if a patient doesn't like a resident/intern. The attending can make the call as to switching services, or whether just to tell the patient tough luck. Bottom-line is that you have to move up the chain-of-command. Before you get the attending involved though it would be helpful to ask the patient why exactly they want someone else, i.e. if it is not a problem with you personally and more with general management, etc.

 

[Tired]

I enjoy it when the patient (who is completely clueless about the medical hierarchy) decides that he/she hates all the residents and attendings who "never spend any time listening" to their complaints, then only wants to see me (the med student) who has 20min to spend with them every morning. Yeah, I'll listen to your problems, but do you really want your life in my inexperienced, sweaty hands?

The gender thing was fun on Ob as well. On one of my call nights last year we had a laboring patient whose husband was insistent that no males enter the room. Unfortunately everyone (attending, chief, R3, R2) was male except the intern. The husband, of course, wouldn't give an inch. They ended up calling in another female attending in the group on her day off. She wasn't happy.

 

[3dtp]

I enjoy it when the patient (who is completely clueless about the medical hierarchy) decides that he/she hates all the residents and attendings who "never spend any time listening" to their complaints, then only wants to see me (the med student) who has 20min to spend with them every morning. Yeah, I'll listen to your problems, but do you really want your life in my inexperienced, sweaty hands?

The gender thing was fun on Ob as well. On one of my call nights last year we had a laboring patient whose husband was insistent that no males enter the room. Unfortunately everyone (attending, chief, R3, R2) was male except the intern. The husband, of course, wouldn't give an inch. They ended up calling in another female attending in the group on her day off. She wasn't happy.

Similar situation. We had no girl doctors as the no prenatal care primip in early active labor requested. She decided to leave AMA, got as far as the front door when she came back. One of the boys did the delivery. Intrapartum, she really didn't care who delivered as she returned too late for analgesics.

Other was a travelling polysubstance abuser who moved from her previous hospital to ours. Twas a 40+ y/o who told everyone she was a sickler and needed pain meds from a "sickle cell crisis." Did my training at a hospital where half the heme peds cases were sicklers, and never ever saw a beefy, non-dehydrated sickler. Did what the admitting team should have done, read the rather thick chart, found she had over a dozen admissions and lots of narcotics each admission. She didn't like me when I d/c'd her narcotics after reading she had many repetitions of the blood proteins. Hb-SC/trait. No Sickle Cell disease.

Managed to get me booted from her care and found someone else who restarted her narcs. That team was stuck with her for nearly a month.

 

[outofhere]

I have been told this SO many times, that it is just part of my life. I am a young attending, in psychiatry, and I look about 15 years old. But, it is usually folks with axis II traits (esp the narcissistic kind) that actually think they 'deserve' someone else as their doctor.

Just yesterday, I started working with a patient, a perimenopausal woman, severely depressed, and with some borderline traits. She told me she felt so depressed, unconnected with her own family...etc, and that she wanted a doctor who is also perimenopausal. Hmm. Clearly, not me, esp since I am 9 months pregnant. Then, she asked me how long I have been a psychiatrist, I asked her how long would be long enough, and she said, '25 years.' Clearly, not me. Anyway, I told her that I am happy to be a doctor, but if she felt strongly about this, she can discuss the matter with my boss (who in general, does not make changes such as these, unless the physician fires the patient.) And if she felt that the care here did not meet her needs, it would be her right to switch hospitals. Today, she didn't mention any of this, and agreed to be started on an antipsychotic.

In general, when patients request new docs, it isn't about us, it is about them.

 

[nocallaochicas]

On my first ER rotation some lady with a fairly good-sized gash on her left great toe needed a digital block before cleaning and stiching. While I was quickly reading how to do it, the resident was filling up the syringe with lido in view of the patient who decided the resident had no idea what she was doing. The patient started yelling about the resident's incompetence and explaining (since she was a diabetic and therefore knew "all about needles") how it should be done. When I walked in, fresh from reading but already forgetting, the patient demanded I was the one to do it. The resident handed me the syringe, and with the biggest smile I ever saw on her face all month said, "Go for it". I don't think the patient liked it when I shoved the needle all the way through the plantar surface too!

Maybe informed consent sheets should include: "Short white coat = medical student". Or, now that I think about it, it is better that they don't. 🙂

 

[8744]

So you have a skanky woman with green, putrid slime oozing from her kootchie, the smell of which permeates the whole department and she wants a female resident to do her pelvic exam?

Sorry, I'm not seeing the downside to this.

 

[OldPsychDoc]

I have been told this SO many times, that it is just part of my life. I am a young attending, in psychiatry, and I look about 15 years old. But, it is usually folks with axis II traits (esp the narcissistic kind) that actually think they 'deserve' someone else as their doctor.

Just yesterday, I started working with a patient, a perimenopausal woman, severely depressed, and with some borderline traits. She told me she felt so depressed, unconnected with her own family...etc, and that she wanted a doctor who is also perimenopausal. Hmm. Clearly, not me, esp since I am 9 months pregnant. Then, she asked me how long I have been a psychiatrist, I asked her how long would be long enough, and she said, '25 years.' Clearly, not me. Anyway, I told her that I am happy to be a doctor, but if she felt strongly about this, she can discuss the matter with my boss (who in general, does not make changes such as these, unless the physician fires the patient.) And if she felt that the care here did not meet her needs, it would be her right to switch hospitals. Today, she didn't mention any of this, and agreed to be started on an antipsychotic.

In general, when patients request new docs, it isn't about us, it is about them.

I get this all the time on psych too--I share an inpt mood disorders unit with an older attending and we frequently get borderlines playing "good doc/bad doc" with us. We just refuse to play along, and like you say, the limit setting usually works out in the end.

The one time I granted this request was with a very irritable manic woman who was demanding to talk to my supervisor. As my immediate boss is the director of the acute psychotic disorders ward downstairs, I checked to see that she had an open bed, and the transfer was arranged expeditiously!

 

[Tired]

So you have a skanky woman with green, putrid slime oozing from her kootchie, the smell of which permeates the whole department and she wants a female resident to do her pelvic exam?

Sorry, I'm not seeing the downside to this.

I'm going to make t-shirts for all males on gyn services that say, "Yeah, because I really wanted to see it."

 

[GATC]

This has happened to me several times during medical school. Patients adamantly did not want residents or med students to be in the OR or participate in any portion of their care. Thankfully our attendings held their ground and stated that it was a facet of being treated in a teaching hospital and that they had the choice to go somewhere else. They were reminded of the positives and negatives of this and every single one of them decided to go ahead with the procedure.

 

[Tired]

This has happened to me several times during medical school. Patients adamantly did not want residents or med students to be in the OR or participate in any portion of their care. Thankfully our attendings held their ground and stated that it was a facet of being treated in a teaching hospital and that they had the choice to go somewhere else. They were reminded of the positives and negatives of this and every single one of them decided to go ahead with the procedure.

I wish all my attendings and residents had the 'nads that yours do. I almost didn't make my requisite number of deliveries on 3rd year Ob/Gyn for exactly the reason you describe.

Interesting though, because on Surgery is was only an issue once. And in that case, it was an idiot IM R2 who didn't want any students in the room while the attending did a lap chole on his sister, even if they didn't scrub. Instead of growing a pair and telling the control-freak he was being a turd, everyone just went along with it.

That's the only time I've ever seen a surgeon listen to the wishes of someone in Medicine. 😀

 

[cdql]

I'm going to make t-shirts for all males on gyn services that say, "Yeah, because I really wanted to see it."

I'll take one in white and one in black 😛

 

[pillowhead]

I get this in EM a few times a year. It's usually over something like a patient wanting antibiotics for a virus, wanting an admission because they're homeless or wanting narcotics because they really like narcotics. In the ED I have the ability to give them the full and reasoned answer "No."

That same answer holds for the "I want a female doctor to do my pelvic exam." too.

A question about the pelvic exam--we had to do a pelvic exam in the ED on teenager (not an adult) who had a history of being gang raped and was being treated for depression and PTSD. Would you bend in this case as far as trying to find a female to do the exam? I understand if there's literally no one there to do it and the case is urgent but this was definitely not a surgical abdomen.

As the 4th yr med student, I got pulled in on to do the exam because every attending and resident that evening was male (which is actually pretty unusual in the pediatric ED).

 

[8744]

I wish all my attendings and residents had the 'nads that yours do. I almost didn't make my requisite number of deliveries on 3rd year Ob/Gyn for exactly the reason you describe.

Interesting though, because on Surgery is was only an issue once. And in that case, it was an idiot IM R2 who didn't want any students in the room while the attending did a lap chole on his sister, even if they didn't scrub. Instead of growing a pair and telling the control-freak he was being a turd, everyone just went along with it.

That's the only time I've ever seen a surgeon listen to the wishes of someone in Medicine. 😀

Whoa. It is common for residents to not want students or their fellow residents involved in their or their families care. I don't mind but at the same time I also know not to get sick and go to the hospital in July. There are also privacy issues.

First of all, it's not the IM resident's choice unless the he's the sister's legal guardian. She may have told him to keep students and residents out and he was just relaying her wishes. My wife doesn't want residents or students involved in her care because she knows a lot of residents and our skill level.

 

[deleted109597]

Some residents just don't want you to see them naked. We weren't allowed in for a cervical cone on one of our surgical residents because, well, it was kinda one of those deals. Not just us not doing the cone, but maybe she just didn't want us to stare at her crotch for an hour. Can't imagine why.

 

[Mumpu]

... one less person for me to round on in the morning. No skin off my back.

 

[Tired]

First of all, it's not the IM resident's choice unless the he's the sister's legal guardian. She may have told him to keep students and residents out and he was just relaying her wishes. My wife doesn't want residents or students involved in her care because she knows a lot of residents and our skill level.

It wasn't the resident's choice, he just found our team on rounds and raised his little effeminate stink about how he didn't want any of "them" (pointing at the students) in the room for his sister's procedure. Like I said, if the higher-ups on my team had had any cojones at all, they would have told him it was none of his business and if he wanted to cry then he should go home to his husband.

In my mind, the issue with your wife is completely different. I wouldn't let a friend do my prostate exam, so nothing wrong with her not letting your friends do her pap smears. My wife used to always let students do her pelvics until the day a couple years ago who one of my classmates walked in.

 

[Tigger14]

My wife doesn't want residents or students involved in her care because she knows a lot of residents and our skill level.

I would submit that some of our residents are smarter than some of our attendings, and I would want them keeping an eye on things. I have had surgery several times in teaching hospitals, most recently my own. Since it was orthopedic surgery, I was ok with a resident, but I don't think I would be with gyn unless I knew the resident well. We have had patients request specific residents to assist, and we and our attendings try to honor that.

Some residents just don't want you to see them naked. We weren't allowed in for a cervical cone on one of our surgical residents because, well, it was kinda one of those deals. Not just us not doing the cone, but maybe she just didn't want us to stare at her crotch for an hour. Can't imagine why.

Thanks for making my call night!

 

[Leukocyte]

Since it was orthopedic surgery, I was ok with a resident, but I don't think I would be with gyn unless I knew the resident well.

Why? Is Ortho sx less complicated/dangerous than gyn sx? 😕

🙄

 

[docB]

A question about the pelvic exam--we had to do a pelvic exam in the ED on teenager (not an adult) who had a history of being gang raped and was being treated for depression and PTSD. Would you bend in this case as far as trying to find a female to do the exam? I understand if there's literally no one there to do it and the case is urgent but this was definitely not a surgical abdomen.

As the 4th yr med student, I got pulled in on to do the exam because every attending and resident that evening was male (which is actually pretty unusual in the pediatric ED).

Sure but in a single coverage ED I'm it. In the private world no OB/GYN consultant would come in to do it if I hadn't already done one and had a diagnosis that required an emergent consult. That's why it's better to get your gyn issues taken care of at your gyn's office than in the ED.

Now in my area all the rape exams are referred/transferred to one hospital and the exams are done by the SANE nurses who are all female (last time I checked).

 

[8744]

I would submit that some of our residents are smarter than some of our attendings, and I would want them keeping an eye on things. I have had surgery several times in teaching hospitals, most recently my own. Since it was orthopedic surgery, I was ok with a resident, but I don't think I would be with gyn unless I knew the resident well. We have had patients request specific residents to assist, and we and our attendings try to honor that.

I always laugh at the "VIPs" who don't want residents involved in their care, Like one whose wife didn't want me to put in a central line and insisted that the attending, who hadn't done one in years, do it.

 

[Hurricane]

Now in my area all the rape exams are referred/transferred to one hospital and the exams are done by the SANE nurses who are all female (last time I checked).

So you've got insane nurses doing all the other exams? 😉

Anyway, in psych, having the inpatients tell us they want another doctor, sometimes followed by a string of obscenities, is just part of an average day. Usually occurs after the pt finds out he can't go smoke...

 

[f_w]

So you've got insane nurses doing all the other exams? 😉

http://www.mass.gov/dph/fch/sane/index.htm

 

[Winged Scapula]

I always laugh at the "VIPs" who don't want residents involved in their care, Like one whose wife didn't want me to put in a central line and insisted that the attending, who hadn't done one in years, do it.

Same issue (and laughs from me) when I hear about patients who only want the Chair of the Department to operate on them, because he must be the best.😉

Uh no, he hasn't operated in ages and is Department Chair because he/she is more interested in career advancement/doing paperwork etc.

 

[Tigger14]

Why? Is Ortho sx less complicated/dangerous than gyn sx? 😕

🙄

Ortho is not less complicated, but it does not involve being naked or having my operating team staring at my perineum throughout the procedure. The circulator actually kicked the attending and resident out until I was draped so they would not even see anything then. I did not ask for that kind of treatment (hey, I was asleep), but it was nice that they thought to do it.🙂