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Most difficult patient population...

Discussion in 'Clinical Rotations' started by bigfrank, May 6, 2002.

  1. bigfrank

    bigfrank SDN Donor 7+ Year Member

    Feb 20, 2002
    Hi, I just got finished with a rotation where I dealt with a particulary annoying patient that had to consult with the "pain team" every couple hours.

    I was considering a career as one who specializes in pain managemnt, but after dealing with this patient, it seems that pain relief is going to be impossible due to the substantial psychosomatic component of his problem. After speaking to others, this seems like a pervasive problem.

    Can anyone comment, or add to what they think is the "most difficult patient population?"

    Thanks, bigfrank.
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  3. Magree

    Magree Senior Member 7+ Year Member

    Sep 5, 2001

    Even before I read your post (i.e after seeing the thread title) I was going to say chronic pain patients. I also went through a stage where I was thinking of doing it but a clerkship discouraged me. I don't have the patience and insight to really deal well with them.

  4. doepug

    doepug Senior Member 10+ Year Member

    Jan 20, 2001
    Baltimore, MD
    Ever try taking a history from an aphasic patient? I think that's pretty difficult.

    Aside from aphasia, I think it's tough to manage patients who have severe addictions and/or live in poor urban areas. While chronic pain is definitely tough to manage, I think it's equally frustrating to grapple with something as simple as uncontrolled diabetes and hypertension in noncompliant patients.
  5. Freeeedom!

    Freeeedom! Senior Member 10+ Year Member

    Feb 21, 2001
    I am a ninja
    The most difficult patient...that is easy!

    The chronic pain patient who is upper middle class and who states "well, my sister is a nurse and she says..." You know it is gonna be a long day.
  6. droliver

    droliver Moderator Emeritus 10+ Year Member

    May 1, 2001
    I'll add Inflamtory Bowel disease, fibromyalgia, sickle cell dz., and chronic pancreatitis to the list of the least enjoyable to take care
  7. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    Yep - my initial reaction before even reading your post was remarkably similar to others: Chronic Pain, IBD/IBS, and Transplant (particularly livers which are often former IVDUs).
  8. Guitarzan the Jungle Man

    Guitarzan the Jungle Man Member 7+ Year Member

    Apr 28, 2002
    Columbus OH
    Two dead give aways to a "painful" patient encounter...
    1) They start the interview with "Well, I have fibromyalgia (or any other pseudo dz--iritable bowel, chronic panc...etc.)"

    2) Stadol nasal spray is listed at the top of their medication list (which is probably two pages and dates back to just after they were born.)
    <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
  9. EidolonSix

    EidolonSix Member 7+ Year Member

    Nov 10, 2001
    Try the diabetic population of south Texas. Fasting serum glucoses averaging 300+, obesity, blindness, kidney failure, PVD, rampant CAD, slews of amputations and a complete and utter ingnorance of the concept of diet and medication compliance.

    It is just wrong to see so many 40 and 50 year olds with CAD, an amputation and blindness. An all of it preventable.

    Its hard to get too mad at em' cuz they are nice people, but jeez...they are hard to manage.
  10. bubster9

    bubster9 Crown Prince 10+ Year Member

    May 8, 2000
    What's the deal with IBS/IBD pt's
  11. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by bubster9:
    <strong>What's the deal with IBS/IBD pt's</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">The psychopathology amongst IBS/IBD patients is notoriously high. These patients will pester you with a million phone calls when you are on call - just a sample from my last cross-cover night on Colorectal:

    Call 1:
    "I went out to celebrate with friends before my surgery on Saturday and some of them slipped some Cocaine into my drinks. Do you think it will affect my anesthesia on Monday?" - Translation: I got hopped up on &%^$loads of coke Saturday.

    Call 2 (same patient):
    "When will my NGT come out?" Me:"Typically they don't leave them in after the surgery but that will be up to (insert Attending's name here). Patient: "Really? YOU can't tell me?" (after I explained I was cross-cover)

    Call 3 (same patient):
    "My bowel movements aren't clear yet (mind you, only 4 hours after starting bowel prep) and I want to give myself an enema. Is that ok?"

    Call 4(same patient):
    "Are you SURE they will put the Foley in AFTER I'm asleep?" (he has asked this question of EVERYONE on the team, multiple times)

    Call 5 (same patient):
    "I'm feeling a bit nauseous. Is it ok to have some crackers?" Me: yes sir, you may do so, JUST AS IT SAYS on the pre-op sheet you were given. Do you have it still? Patient: "yes, but I just wanted to make sure"

    Call 6 (same patient):
    "Just wanted you to know that my bowel movements are getting clearer." Me: thank you sir, I appreciate the phone call. :rolleyes:

    After the procedure apparently the patient tried to go AMA and then tortured the next cross-cover guy with calls about his medical management - which would have been addressed had he stayed in the hospital like he was supposed to.

    This is just but ONE story of the crazies you can get with IBD.
  12. tonem

    tonem Senior Member 10+ Year Member

    Sep 13, 1999
    1)Anyone allergic to four or more medications = trouble. 2)Any borderline patient.

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