Tips for dealing with crappy patients

[PaperUmbrella]

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Ok- let's be honest. Some patients just really suck and are just bad people. At best they are rude, creepy, gross, mean, or crazy; at worst they are child abusers, drug dealers, rapists, etc. I am getting increasingly concerned about dealing with these people next year in residency and not letting these crappy patients affect my interactions with all of the other non-crappy patients. I'm starting to find that I am expecting the worst from all patients, and I would prefer to keep my world-view that the majority of people are good people. So please give me your tips for staying sane when working with non-desireable patients. Thanks!

 

[Castro Viejo]

It's really not your place to judge anyone. Everyone who comes across those hospital doors or your operating table is a person and a human being. Admittedly some humans aren't fit for our society, but even they will have problems for which you'll be called upon to fix. Remember the Hippocratic Oath? Nowherew does it state you, the physician, has the right to judge a person and render a different level of care simply because of your personal feelings. That's unethical.

I have had the unfortunate experience of treating skin heads and neo-Nazis who have hurled all sorts of racial epithets at me (I'm Asian), but the most I've ever done was asked them to keep from using offensive language in the hospital and that I didn't particularly give a damn what their sociopolitical views were.

You will develop a thick skin as a physician. That part of your brain that gets emotional because you're treating someone you personally find repulsive will die, believe it or not.

 

[Rogue_Leader]

Even not being an intern yet, on my Sub-I, I found that rude, immature patients are at least consistent and you can do what you need to with them. The hard stuff are the drug seekers. The patient who has "pancreatitis" for a week, and knows the exact dose of oxycodone he "needs", and you get reports from the nurses about how after morning rounds, he raids the patient kitchen for juice and pudding before going out for a smoke. That's where the hard part comes in about whether you treat his "pain", or make a definitive decision that he's definitely faking.

 

[Top Gun]

Ok- let's be honest. Some patients just really suck and are just bad people. At best they are rude, creepy, gross, mean, or crazy; at worst they are child abusers, drug dealers, rapists, etc. I am getting increasingly concerned about dealing with these people next year in residency and not letting these crappy patients affect my interactions with all of the other non-crappy patients. I'm starting to find that I am expecting the worst from all patients, and I would prefer to keep my world-view that the majority of people are good people. So please give me your tips for staying sane when working with non-desireable patients. Thanks!

Get used to it. Not every patient is going to be a saint. In my time in medicine, during clinical rotations and the internal medicine private practice where I'm working part-time right now, I've run into my fair share of undesirable patients. I've lost count of the number of drug-seeking patients who have come in complaining of severe back pain. That said, I've also run into a lot of patients who are really cool people. In this profession, you have to take the bad with the good. But hey, you became a doctor to help all people, right? Not just the nice ones.

 

[sunlioness]

Even not being an intern yet, on my Sub-I, I found that rude, immature patients are at least consistent and you can do what you need to with them. The hard stuff are the drug seekers. The patient who has "pancreatitis" for a week, and knows the exact dose of oxycodone he "needs", and you get reports from the nurses about how after morning rounds, he raids the patient kitchen for juice and pudding before going out for a smoke. That's where the hard part comes in about whether you treat his "pain", or make a definitive decision that he's definitely faking.

He's still in pain. Just a different kind of pain than he's claiming to have. And no, he doesn't need IV pain meds and yeah, it's frustrating dealing with him; but he still has a problem that he needs help and compassion with.

 

[PaperUmbrella]

Hmmm... perhaps I was not clear in my OP. I certainly did not mean to suggest that some patients deserve lower quality of care than others, or that I was looking for a way to avoid these people. Rather, I have noticed that I am particularly effected by the negativity of these patients, perhaps more so than other med students/physicians, so I was looking for specific ways that people deal with these interactions so that I can continue to provide all of my patients with good, equal care. So far I've tried the "get over it" method, but it's not working that well, so I'm just looking for other people's coping mechanisms. Thanks!

 

[TRAMD]

Kill 'em with kindness. I had a patient that truly almost drove me to anger today. I just went into over-kindness turbo mode and told her about how much I want her to get better and how we will work together to get her there even though deep down I know that what she needs is a major attitude adjustment that no pill or therapy that I prescribe her will give.

 

[lord_jeebus]

Thank your deity of choice daily that you were not born as one of them

 

[telenurse]

Ok- let's be honest. Some patients just really suck and are just bad people. At best they are rude, creepy, gross, mean, or crazy; at worst they are child abusers, drug dealers, rapists, etc. I am getting increasingly concerned about dealing with these people next year in residency and not letting these crappy patients affect my interactions with all of the other non-crappy patients. I'm starting to find that I am expecting the worst from all patients, and I would prefer to keep my world-view that the majority of people are good people. So please give me your tips for staying sane when working with non-desireable patients. Thanks!

I've found that I try not to learn to much about my pt's past. If I have a pt that is in custody, is shackled and handcuffed, I don't want to know what crime that they have committed. I'm not stupid, I will be careful, and I will not put myself in danger when providing care, I know these pt's can and often are manipulative, but I don't want to know their crime. It's easier to give objective care that way.

Othertimes, just think back to psych, and realize that you have to set limits, recognize manipulative and staff splitting behaviour for what it is, and don't let it anger or frustrate you. Easier said than done, but try to utilize what you have learned from psychiatry classes and clinicals to analyze why they are acting the way they are, and it can sometimes cool your emotional reactions. At least that is something I try with particularly difficult pt's.

Find someone to vent to...hopefully someone in medicine that won't think your creepy once your sense of humor becomes more and more warped as the years go by...venting helps.

Be thankful for what you to have in your life, spend time with family and friends, it'll keep you grounded and keep you from burning out and becoming too cynical...

 

[OldPsychDoc]

I find myself agreeing more with your second paragraph than your first (though I understand what you're saying about "don't get too close"--don't become enmeshed). Nevertheless, I find that getting some handle on the patient's past helps me with my most difficult patients. Oftentimes the really "bad borderline" patient is just doing the best he or she can given what they were handed in life. For example, I clearly recall a social worker presenting a patient to me at 2:00 in the morning in the psych ED--another borderline in crisis for the umpteenth time--the social worker said, "She's a borderline, but she comes by it honestly". A lifetime of sexual abuse by father, uncles, and brothers, multiple psych admissions, no ability to follow through on treatments, no positive supportive relationships...you get the picture. Anyway, that helped me to brush the sleep out of my eyes and try to figure out something that would get this gal feeling a bit better in the here and now, keep her alive for another day.

I've found that I try not to learn to much about my pt's past. If I have a pt that is in custody, is shackled and handcuffed, I don't want to know what crime that they have committed. I'm not stupid, I will be careful, and I will not put myself in danger when providing care, I know these pt's can and often are manipulative, but I don't want to know their crime. It's easier to give objective care that way.

Othertimes, just think back to psych, and realize that you have to set limits, recognize manipulative and staff splitting behaviour for what it is, and don't let it anger or frustrate you. Easier said than done, but try to utilize what you have learned from psychiatry classes and clinicals to analyze why they are acting the way they are, and it can sometimes cool your emotional reactions. At least that is something I try with particularly difficult pt's.

Find someone to vent to...hopefully someone in medicine that won't think your creepy once your sense of humor becomes more and more warped as the years go by...venting helps.

Be thankful for what you to have in your life, spend time with family and friends, it'll keep you grounded and keep you from burning out and becoming too cynical...

 

[fang]

Hey paperumbrella, I share your world view that most people are basically good and internship hasn't changed that. Oddly enough, it's not the drug dealers, rapists, borderlines, or crazies that inspire my hatred/rage, it's the people I think are abusing the system (at others' expense) or patients who feel entitled.

In the first group, their character flaws and mistakes in life are not my problem as long as I can interact with them effectively. If a pt's behavior is difficult to handle, think of strategies to manage it. As you know, you can't fix their pathology, though you can fix their etoh w/d, aspiration pna, endocarditis, etc, even if they're extremely unpleasant while you're doing it. These patients present some negotiation challenges but they don't get me down.

However, the ones I want to throw out the window are people who know how to work the system or who think they're more special than the guy in the next bed for whatever reason. For example, the 37 y/o woman with past kidney transplant admitted by a private doc for a URI (2nd cousin to one of the transplant surgeons!!), who first tells me that she wants a certain dinner at a certain time, and when I ask about allergies tells me things like "well, I tried PCN once and I just didn't feel right, and I got a Z pack once and it made my left leg tingle, and when I take tylenol I get dizzy and ....". Then pt and family demand daily meetings for updates at particular times. Grrrr!!! (I made a point for the rest of the admission not to spend any more time with them than I did with this little old lady across the hall who never really complained about anything.)

 

[Chronic Student]

Hey paperumbrella, I share your world view that most people are basically good and internship hasn't changed that. Oddly enough, it's not the drug dealers, rapists, borderlines, or crazies that inspire my hatred/rage, it's the people I think are abusing the system (at others' expense) or patients who feel entitled.

In the first group, their character flaws and mistakes in life are not my problem as long as I can interact with them effectively. If a pt's behavior is difficult to handle, think of strategies to manage it. As you know, you can't fix their pathology, though you can fix their etoh w/d, aspiration pna, endocarditis, etc, even if they're extremely unpleasant while you're doing it. These patients present some negotiation challenges but they don't get me down.

However, the ones I want to throw out the window are people who know how to work the system or who think they're more special than the guy in the next bed for whatever reason. For example, the 37 y/o woman with past kidney transplant admitted by a private doc for a URI (2nd cousin to one of the transplant surgeons!!), who first tells me that she wants a certain dinner at a certain time, and when I ask about allergies tells me things like "well, I tried PCN once and I just didn't feel right, and I got a Z pack once and it made my left leg tingle, and when I take tylenol I get dizzy and ....". Then pt and family demand daily meetings for updates at particular times. Grrrr!!! (I made a point for the rest of the admission not to spend any more time with them than I did with this little old lady across the hall who never really complained about anything.)

I absolutely want to smack these folks. The "my pain is horrible, what are you going to do about it and they won't bring me a meal tray".

Let's see you have stated allergies to morphine, codeine, demoral, strawberries, neurontin, tape, beta-blockers, tylenol, phenergan, pecans, chicken, turkey, ultram and benadryl.

Doesn't leave you with a lot of options. BTW, this is only a slight exaggeration. I had a patient recently with 12 allergies and I spent more time dealing with pain control and getting her fed than we did with her care for her lumbar fusion. The thing that scares me is that buried in all of those BS allergies is probably one real one.

 

[Castro Viejo]

BTW, this is only a slight exaggeration. I had a patient recently with 12 allergies and I spent more time dealing with pain control and getting her fed than we did with her care for her lumbar fusion. The thing that scares me is that buried in all of those BS allergies is probably one real one.

The "do you have any allergies?" question is very revealing and gives you a clue of whether or not the patient you're seeing is a) a complete ***** or b) a chronic complainer.

Example A:

"So do you have any allergies to medications?"

"Yes. To Coumadin and Nitroglycerin."

"What happens when you take those?"

"Well, with the Coumadin I bruise easily. And with the Nitroglycerin my blood pressure drops."

Example B:

"Do you have any medical problems?"

"No."

"OK. Do you have any allergies to medication?"

"Yes."

"What?"

"Methotrexate."

 

[PaperUmbrella]

Thanks for the replies. I had a long week with some difficult patients and was feeling a bit bummed about humanity, but my optimism is restored after some good sleep! Old Psych Doc- I really like the idea that patients are doing the best they can with what they have. I'm definitely going to keep that in mind.

 

[bulletproof]

Thanks for the replies. I had a long week with some difficult patients and was feeling a bit bummed about humanity, but my optimism is restored after some good sleep! Old Psych Doc- I really like the idea that patients are doing the best they can with what they have. I'm definitely going to keep that in mind.

As a 4th year med. student I was called a F**king F$$got for asking a patient admitted to an NYC ER to stop smoking crack in the ED. She proceeded to hurl expletives at the security guards as they led her boyfriend ( the supplier ) out of the ED. You know the type...."I want pain meds asap" for "pain everywhere", "no, I don't want no F**king IV...get me a real doctor".

It can definitely be a challenge, and at these times I try to remind myself that the patient is the one with the problem(s). Easier said than done admittedly. Also, focusing on what you are going to do when you get off also helps. Hope things are better.

 

[southerndoc]

As a 4th year med. student I was called a F**king F$$got for asking a patient admitted to an NYC ER to stop smoking crack in the ED. She proceeded to hurl expletives at the security guards as they led her boyfriend ( the supplier ) out of the ED. You know the type...."I want pain meds asap" for "pain everywhere", "no, I don't want no F**king IV...get me a real doctor".

It can definitely be a challenge, and at these times I try to remind myself that the patient is the one with the problem(s). Easier said than done admittedly. Also, focusing on what you are going to do when you get off also helps. Hope things are better.

"Ma'am, here's your prescription for extra-strength ibuprofen. I'm also giving you a pamphlet with all of our drug rehabilitation programs in the area. Get well soon."

 

[core0]

As a 4th year med. student I was called a F**king F$$got for asking a patient admitted to an NYC ER to stop smoking crack in the ED. She proceeded to hurl expletives at the security guards as they led her boyfriend ( the supplier ) out of the ED. You know the type...."I want pain meds asap" for "pain everywhere", "no, I don't want no F**king IV...get me a real doctor".

It can definitely be a challenge, and at these times I try to remind myself that the patient is the one with the problem(s). Easier said than done admittedly. Also, focusing on what you are going to do when you get off also helps. Hope things are better.

I actually had to right an order to nursing "please do not let the patient go outside to smoke crack cocaine". This was at a fairly well to do suburban hospital.

David Carpenter, PA-C

 

[bulletproof]

"Ma'am, here's your prescription for extra-strength ibuprofen. I'm also giving you a pamphlet with all of our drug rehabilitation programs in the area. Get well soon."

Yeah, that was pretty much the approach after her drug seeking trip had cost joe taxpayer a couple of thousand dollars for a bogus work up and an all expenses paid ambulance ride. Got to love it...

 

[bulletproof]

I actually had to right an order to nursing "please do not let the patient go outside to smoke crack cocaine". This was at a fairly well to do suburban hospital.

David Carpenter, PA-C

While I have never seen this written in a chart we had many such patients who were "accompanied" by a minder once out of their bed. But then, most of my rotations were at inner city hospitals were this type of thing was the norm unfortunately. Glad to hear this type of activity is not relegated to County hospitals.😀

 

[mlw03]

Ok- let's be honest. Some patients just really suck and are just bad people. At best they are rude, creepy, gross, mean, or crazy; at worst they are child abusers, drug dealers, rapists, etc. I am getting increasingly concerned about dealing with these people next year in residency and not letting these crappy patients affect my interactions with all of the other non-crappy patients. I'm starting to find that I am expecting the worst from all patients, and I would prefer to keep my world-view that the majority of people are good people. So please give me your tips for staying sane when working with non-desireable patients. Thanks!

my solution is that i simply won't do it - deal with all the "crappy" patients. and i realize we all define that differently. to me there's no amount of money or prestige that makes it worth it, and i just don't care enough about these people to "suck it up." i don't feel that uber-altruism many doctors seem to have, and i see medicine as a career that i enjoy where i get to provide a much needed service to the community. for me it's easier to look at it from the 10,000 foot view, where i know i'll be "helping people" (which i do derive satisfaction from), but without the daily hassles of the types of patients we all dread. i went off on a psych patient last year when i put major time and effort into helping him get back on his feet (EtOH dependence) and then 5 days post-discharge he's back after a relapse. i lost it and just berated the guy, who happened to be quite intelligent, telling him that if he wants to kill himself with booze to please stop wasting everyone's time and money treating him and just do it already. sure, i loved the genuinely good patients, but in the end they don't make up for the crappy ones. which is why i'm going into pathology - i can't handle those personal interactions, but i know that the diagnostic information pathologists provide is crucial. this is the balance that works for me. the only clinical field i considered was something pediatric because i just can't deal with the crappy patients, and in peds there are a lot of crappy parents, and some crappy teenagers, but for the most part kids are better than adults.

this probably doesn't help the original poster, as few people want to go to the extreme i am and give up all patient contact, but i'm fortunate i'll still be able to be a doctor without having to struggle through those crappy patients, which i just don't handle nearly as well as many of my classmates do.

 

[Castro Viejo]

which is why i'm going into pathology

Thank God there's that, huh?

You sound like you'd be the type who might just bring a sub-machine gun into an ED waiting room and clear that place out. Relax, dude. It may be frustrating, but it's not THAT bad, is it?

Doesn't the sun and palm trees down there in Tampa help with your mood at all?

 

[mlw03]

Thank God there's that, huh?

You sound like you'd be the type who might just bring a sub-machine gun into an ED waiting room and clear that place out. Relax, dude. It may be frustrating, but it's not THAT bad, is it?

Doesn't the sun and palm trees down there in Tampa help with your mood at all?

first, i hate the weather in florida. which is why i'm getting the hell out of here as soon as i can after graduation. second, i use SDN to vent, and i like to think i treated the crappy patients fairly well. that outburst i described happened early in the MS3 year and after that i settled down. but yeah, i do think it's that bad a lot of the time.

 

[Castro Viejo]

first, i hate the weather in florida. which is why i'm getting the hell out of here as soon as i can after graduation. second, i use SDN to vent, and i like to think i treated the crappy patients fairly well. that outburst i described happened early in the MS3 year and after that i settled down. but yeah, i do think it's that bad a lot of the time.

What about the weather do you hate in Florida? The warmth? The sun? Do you want days and weeks of perpetual darkness and dampness? Might I suggest Boston? 🙂 You'll stuff your face full of good ole New England Clam Chowder ("Chowdah!") and turn into one of those heavy set Bostonians like Norm Peterson.

 

[telenurse]

I find myself agreeing more with your second paragraph than your first (though I understand what you're saying about "don't get too close"--don't become enmeshed). Nevertheless, I find that getting some handle on the patient's past helps me with my most difficult patients. Oftentimes the really "bad borderline" patient is just doing the best he or she can given what they were handed in life. For example, I clearly recall a social worker presenting a patient to me at 2:00 in the morning in the psych ED--another borderline in crisis for the umpteenth time--the social worker said, "She's a borderline, but she comes by it honestly". A lifetime of sexual abuse by father, uncles, and brothers, multiple psych admissions, no ability to follow through on treatments, no positive supportive relationships...you get the picture. Anyway, that helped me to brush the sleep out of my eyes and try to figure out something that would get this gal feeling a bit better in the here and now, keep her alive for another day.

Maybe it's a nurse's perspective...it's really hard to premedicate someone and try to be gentle when pulling an femoral arterial sheath right after you find out the guys a rapist or a child molestor and you're a petite female who is going to be stuck in his groin for a loonngg time, or to really advocate for getting a guy more pain meds for his leg fx...but he just got arrested for drunk driving with his 8 year old kid in the car with him, and he did cause a wreck and his kid's in the PICU. Those cases are really hard on me...I really don't like knowing the crimes when it is a pt that is a prisoner.

However I do agree that knowing something of pyschosocial past does help in developing a plan of care that can be more effective. I just meant that with the felons I don't want to know too much...I should have been clearer.

 

[mlw03]

What about the weather do you hate in Florida? The warmth? The sun? Do you want days and weeks of perpetual darkness and dampness? Might I suggest Boston? 🙂 You'll stuff your face full of good ole New England Clam Chowder ("Chowdah!") and turn into one of those heavy set Bostonians like Norm Peterson.

talk to me when it's late october and it's still hitting the low 90s in the afternoon and only going down to 76 at night. it makes me sick. boston weather sucks too i hear. i'm hoping to end up somewhere with 4 very distinct seasons, but without brutal heat or bitter cold. by the way, i consider this side tangent relevant - i think someone's overall happiness affects their ability to deal with difficult patients, and i know i'll be happier when i get out of florida.

 

[XoQo]

Kill 'em with kindness. I had a patient that truly almost drove me to anger today. I just went into over-kindness turbo mode and told her about how much I want her to get better and how we will work together to get her there even though deep down I know that what she needs is a major attitude adjustment that no pill or therapy that I prescribe her will give.

I've tried this before. Sometimes it backfires and just causes patients to split the team. Which makes your team think you're crazy:

"she let you do a belly exam!?! She wouldn't even let me enter the room!"
etc etc etc


heh

 

[carrigallen]

Maybe it is good to just to treat them equally and have a good laugh about it afterwards. Don't take anything too seriously.

 

[KurosawaRhap]

If all else fails, you can set up a clandestine propofol infusion that happens to run out just as you finish signing out to the night team. Don't forget to hand that pager over and run. 🙂

 

[chicamedica]

When I was an MS4 on the first week of my medicine sub-I, one of my patients was this lady with end-stage COPD, still a smoker, admitted with pneumonia and COPD exacerbation. She was ok in the mornings when i would preround on her, but around mid-late afternoon every day, she would go crazy with meanness. She acted soo suspicious, like everyone was out to get her, she yelled at our attending at afternoon rounds, and when I went to see her shortly afterwards, she was telling me off for who knows what reason. I tried killing her with kindness, but she ended up making me cry.

It wasn't until later that I realized that mid-afternoon was the time right before her next nebulizer treatment. Hypoxia makes people anxious and mean. From then on, I never took a COPDer's temper personally. They're chronically hypoxic.

I think the key is to try not to take difficult patients personally. It's MUCH easier said than done. I know all too well.

 

[GoodMonkey]

by the way, i consider this side tangent relevant - i think someone's overall happiness affects their ability to deal with difficult patients

i completely agree ... which is why, by about ohhhh 7 months into intern year, my ability to deal with difficult patients has pretty much flown out the window. overall happiness is hard to come by as an intern when you are the hospital's BS filter.

 

[medicinesux]

I have found that I'd rather deal with the crappiest of the crappy patients than contend with certain highly toxicological psychopathologically deranged attendings. Give me a raging bipolar cussing like a sailor coked up magnet infested butt crack stickin gomer anyday over Dr. A$$Bleep!

 

[Top Gun]

I have found that I'd rather deal with the crappiest of the crappy patients than contend with certain highly toxicological psychopathologically deranged attendings. Give me a raging bipolar cussing like a sailor coked up magnet infested butt crack stickin gomer anyday over Dr. A$$Bleep!

This is very true. I have found that I can actually deal with belligerent patients better than a$$hole attendings or residents. Somehow, if a patient is behaving badly, its more understandable.

 

[ekydrd]

Crappy patients, crappy parents, crappy attendings, crappy residents... and yes, crappy nurses, are found everywhere. I just deal with it and move on. Having those people who are easy to work with, genuinely want to get better, or are helpful make a difference in my ability to cope with the former types. There are days when I want to scream and hit something, but thankfully they are few and far between.

 

[Winged Scapula]

Interestingly, the patients I find the most difficult to deal with are not the stoned crack ****** (not that I see too many of them) but rather the "pseudo physicians". These are the patients that think that just because they've Googled something and found information on the web that :

1) its legitimate
2) they know more about it than I
3) they know how to assess the validity of the "research" they've found

If patients would stick to sites like NIH, NCI, NCCN, etc. I'd be fine, but any crackpot can start a web site and post whatever the heck he wants and I end up having to explain that this "Dr" is not a medical doctor, and that his "research" is not a RCT AND most importantly, if what he says was true I'd change my practice...that I'm not in the practice of trying to hurt patients.🙄

 

[TRAMD]

Interestingly, the patients I find the most difficult to deal with are not the stoned crack ****** (not that I see too many of them) but rather the "pseudo physicians". These are the patients that think that just because they've Googled something and found information on the web that :

1) its legitimate
2) they know more about it than I
3) they know how to assess the validity of the "research" they've found

If patients would stick to sites like NIH, NCI, NCCN, etc. I'd be fine, but any crackpot can start a web site and post whatever the heck he wants and I end up having to explain that this "Dr" is not a medical doctor, and that his "research" is not a RCT AND most importantly, if what he says was true I'd change my practice...that I'm not in the practice of trying to hurt patients.🙄

Kevin Trudeau is the only reliable source of medical information that I have found.

 

[Winged Scapula]

Kevin Trudeau is the only reliable source of medical information that I have found.

Certainly enough people have bought into his mantra...those tv ads must be expensive. But there are an awful lot of conspiracy theorists out there..."THEY" (we) don't want you to know how to lose weight/cure your constipation/etc.! 🙄

 

[mlw03]

Kevin Trudeau is the only reliable source of medical information that I have found.

love it... any info obtained on a 3am informercial must be reliable.

 

[Castro Viejo]

Kevin Trudeau is the only reliable source of medical information that I have found.

Is that the guy who sells the supplements to "boost your calcium 1000%" or the lotion that makes you lose weight by inhibiting your body from producing cortisol?

Or is it the penis pump?

 

[Shalom77]

Kevin Trudeau is the only reliable source of medical information that I have found.

I ran into a guy in a grocery co-op carrying Trudeau's book trying to follow his plan to the T ("because it won't work unless you follow it exactly.") At least he was motivating this guy to buy organic veggies. 🙂 We all know how good docs are at motivating dietary change. It's a crucial part of the conspiracy.
🙄

 

[TRAMD]

If any of you haven't seen Kevin Trudeau's infomercials I beg you to search for his name to see what he looks like and stop on the channel if you see his face on TV. He is hilarious and scary at the same time.

 

[Chronic Student]

If any of you haven't seen Kevin Trudeau's infomercials I beg you to search for his name to see what he looks like and stop on the channel if you see his face on TV. He is hilarious and scary at the same time.

He is not nearly as scary as the folks who actually listen to him.

 

[RadGirl]

check out the wikipedia site on him, it's hilarious. and scary.

 

[TRAMD]

check out the wikipedia site on him, it's hilarious. and scary.

Kevin Mark Trudeau (born February 6, 1963) is an American author, pocket billiards promoter (founder of the International Pool Tour), salesman, convicted felon and self-proclaimed alternative medicine advocate.

HAHA, I love it!

 

[SweetBabyJesus]

After reading all these posts, I certainly think you all are truly nice people, and were made to be clinicians in American medicine. What I find odd is that so many healthcare workers accept some form of abusive treatment by patients as tolerable. Way back when I was interviewing for medical school admission, I remember the theme being stressed by the ADCOMs that they wanted bright, but also compassionate candidates. I used to chuckle b/c I knew so many "compassionate" premeds who couldnt get decent grades. Now as a resident, I see the ADCOMs were totally right. To deal with all the patients that frustrate the hell out of you for whatever reason, you certainly need a high level of compassion. Unfortunately, I disagree with how some patients are dealt with, and I think this has a lot to do with being in the US. For instance, if you go overseas (my personal experience has been in S. America and Europe) you will see a very different attitude patients have for healthcare workers, even in ERs and even patients of the lowest socioeconomic status. It makes a huge difference treating a drug addict who is respectful or at least polite, know what I mean? In the US, patients can say or do whatever they want, and we are taught to say "thank you, may I have another?" That ,IMOP, is bull----. Why not make it hospital policy and hang a sign outside every ER saying that patients who cannot behave properly and who mistreat the staff will not be treated. I know there will be a backlash of people saying this is inhumane, but if it were done for a short while, I gaurantee the drug seekers and crazies would either not come back or be nice next time. (obviously this would never be allowed to happen). You cant allow people to do whatever they want. Imagine if they acted similarly in any other public place. They would obviously be thrown out or arrested, and i bet most of us would agree with this happening. When we work very hard to do the best for patients, I think we deserve at least a simple polite interaction, given the fact we are trying to help these people out, many times when they dont deserve it, while we are exhausted and busy, and for free.

 

[Chronic Student]

Psssst,

Don't mess with the threadjack, let's get back to getting off topic.

 

[Castro Viejo]

Why not make it hospital policy and hang a sign outside every ER saying that patients who cannot behave properly and who mistreat the staff will not be treated.

I saw a sign like that hanging in a McDonald's in Brooklyn when I was a kid.

The issue, as you pointed out, is it's unethical to treat only "well-behaved" patients and to kick the jerks and the skanks to the curb. Perhaps they're acting crazy 'cause they've got a psychiatric "emergency" going on? Or they're acting crazy because of their diffuse peritonitis and ensuing sepsis? You just don't know unless you work them up and that involves interacting with the crazies.

I agree that we deserve at least an ounce of respect from all people who walk in through the doors of the ED, but I actually think we do get that respect or else they'd never come to the hospital.

 

[TRAMD]

I had a patient today that had positive urine for meth and marijuana. She also had a blood alcohol of 120 and was combative when she initially came in. Apparently she was kicked out of her trailer by her boyfriend after they got in a physical fight. She had somehow injured her hand (no fracture seen) and was quite polite about asking for pain meds until I told her that I was wary to use narcotics in someone with a significant abuse history such as herself. When I suggested Toradol she flew off the handle and started to swear at me (at this point I could see her boyfriend's point of view). As soon as I heard "f*ck" come out of her mouth I turned around and walked out of the room. Last I heard the Toradol wasn't cutting it for her.

I am sorry but alcoholic meth-abusing human stains with two kids taken away from them and no respect for me don't deserve respect themselves.

 

[Castro Viejo]

Refer 'em to Detox and leave it at that. I didn't mean to give into every coke head that wants a hit of Demerol or Dilaudid or something.

But they at least deserve a second for us to hear our story and then to watch us turn our backs on them. 😀

 

[TRAMD]

I had a patient today that had positive urine for meth and marijuana. She also had a blood alcohol of 120 and was combative when she initially came in. Apparently she was kicked out of her trailer by her boyfriend after they got in a physical fight. She had somehow injured her hand (no fracture seen) and was quite polite about asking for pain meds until I told her that I was wary to use narcotics in someone with a significant abuse history such as herself. When I suggested Toradol she flew off the handle and started to swear at me (at this point I could see her boyfriend's point of view). As soon as I heard "f*ck" come out of her mouth I turned around and walked out of the room. Last I heard the Toradol wasn't cutting it for her.

I am sorry but alcoholic meth-abusing human stains with two kids taken away from them and no respect for me don't deserve respect themselves.

So there's an update here. Keep in mind that this girl is a master manipulator (I am just very difficult to manipulate). I was post-call and went home. Later that day this girl was evaluated by psych and determined to be ok to go home. Oh, and she was given Vicodin. She came back two nights later (when I was on call again, of course) with a BP of 57/13 and severe respiratory depression after she had overdosed on the Vicodin. She was given Narcan and woke up long enough to bite a lab tech. She was eventually intubated and sent to the unit. I called the psychiatrist myself the next day and assured that she was going to the psych hospital. Needless to say that I was a little pissed when I heard she was back and what for.

 

[haloeffect]

Ok- let's be honest. Some patients just really suck and are just bad people. At best they are rude, creepy, gross, mean, or crazy; ... So please give me your tips for staying sane when working with non-desireable patients. Thanks!

Simple..."DONT TAKE IT PERSONALLY!"

Surely you didn't become a health professional with an expectation that "every" patient or staff member would make you leap out of bed with the treating powers of 'jesus', forgiveness of Gandi and attitude of 'Patch Adams'?...S****ty approaches wont change anytime soon but your approach can. Some poorly quoted quotes..."Theres nothing an enemy hates more than your forgiveness"; "When your going through hell, keep going!"...and my favorite, make sure you dont 'think it' out loud..."thank god I'm not like this a**h&le!" But never deny giving your best! 😉