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Usually I love my job, but...

Discussion in 'Emergency Medicine' started by WilcoWorld, Jun 19, 2008.

  1. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

    Nov 2, 2004
    Sometimes I really hate it.

    No, this isn't for the "medicine sucks" thread. Sure, I had some depressing patients last night, but that's not what's bothering me. No, what's bothering me is FAMILY MEMBERS.

    You've seen it. Someone signs out a patient to you with something like, "Non-displaced humerus fracture. Just waiting for X-Ray copies & is then going home." I don't even write it down. Then the family shows up, they want to speak with "the doctor". You go to talk with them & they're furious. "What's going on? How do you know that's what's wrong? Why haven't you fed her? Is Medicare going to cover this? Why would you give her Norco for pain? That's got less Acid-TOM-ofin than what I buy at the store. She needs more milligrams! You're an idiot, I wont take her home, and I want to see your boss!"

    And I'm thinking, "The guy who had an elective circumcision go wrong, the family of the child with sickle cell pain crisis, and the daughter of the septic woman are all being much more pleasent. I wish I could be talking to them right now."
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  3. JkGrocerz

    JkGrocerz Member 5+ Year Member

    Nov 8, 2005
    this is one of the reasons why I prefer to work in the ghetto. Im sure this type of attitude occurs everywhere but I experience it much less often in the hood. When I have to deal with high class rich "im smarter than you" yuppie/suburbanite chumps, I tell them to sign out AMA and go fix yourself at home since you know so much more than me and my attending.

    that usually shuts their hole.
  4. emedpa

    emedpa GlobalDoc 10+ Year Member

    Aug 25, 2001
    Taking an Away team....
    must be a regional thing....I work in an urban/inner city dept and the ones who complain the most have no jobs, are on disability(inappropriately) while having no visible problems and when asked why they, a strapping 22 yr old who injured themselves playing football, are on state assistance they say" I can't work because I do drugs, dude". I have no problem with folks on disability who are, well disabled, but handing it out to anyone who doesn't WANT to work is a crock. most of them drive nicer cars than I do.....
  5. AmoryBlaine

    AmoryBlaine the last tycoon 7+ Year Member

    May 1, 2006
    Far more bizarre/upsetting to me are the family members who don't seem to care at all. I've helped take care of a couple of critically ill, relatively young people (50s-60s) whose families were like, "so where's the cafeteria?"

    At one point with one group I did take the oldest son outside the room and said, "you realize your father could die today right?"

    Meanwhile in the next room is Panda's girlfriend: the 95 year old demented amputee with a stage 4 decub who is now s/p massive stroke. That family not only "cares" but wants everything done.

    (Where's the smiley with the gun to his own head?)
  6. Jeff698

    Jeff698 EM/EMS nerd 15+ Year Member

    Aug 11, 2000
    Salado, Texas
    I'm sure that goes over well.

    When it feels good to say, it's probably gonna get you in trouble. We call it an inner voice for a reason.

    Take care,
  7. Seaglass

    Seaglass Quantum Member 10+ Year Member

    Jul 25, 2003
    Winston Salem, NC
    In my experience so far this gets better the more experience you get under your belt. Mostly this can be fixed by letting them talk for a few minutes and after that you usually have an idea why they're really upset and you can deal with that.
  8. southerndoc

    southerndoc life is good Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Jun 6, 2002
    Right. Simply allowing them to vent will do wonders. Allow them to speak their piece if they are upset, and when you go to reply, the very first word out of your mouth should be "Yes" followed by "I recognize you are upset" followed by whatever explanation you can give.

    Agreeing with a disgruntled patient or family member will not only save the hospital and your image, but it will also have the best impact on your time. You can either agree with them (whether you truly agree or not) and appear to be nice, or you can disagree, appear to be an a-hole, and continue to argue with them for more time than would've been involved had you simply agreed with them.
  9. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

    Nov 2, 2004
    The above strategies are certainly good ones, and I do my best to employ them with difficult people (nurses, doctors, patients, etc...). Most of the time, just letting someone talk, and making them feel like they've been heard will do the trick. However, there are some people who are just looking for a fight, or who have such unreasonable demands that you simply can't get out of it that easily. Someone far wiser than me suggested that when you identify the former (the person who is just looking for a fight) your goal is to avoid a fight with them. This doesn't mean you have to give them what they want. It means you should go into "robot mode". Don't try to be nice or sympathetic, and certainly don't get caught up in their plan of fighting. Simply parrot off whatever non-commital platitude you've previously selected (southerndoc's would be a good one), tell them what your plan is, and be quiet. Soon they'll realize that they're not going to get you into a fight, and they'll start looking for a new target.

    Now, when you get the guy with totally unreasonable expectations ("I want a singed statement from you and the hospital saying that every penny of my wife's therapy will be paid for by Medicare."), who simply will not listen to reason, and then plants himself in the hallway and starts shouting... Well, I haven't learned how to handle that one yet.
  10. Toohotinvegas33

    Toohotinvegas33 Currently Glasgow 3 7+ Year Member

    Aug 17, 2006
    Penal Colony
    Carry one of these little guys

    nobody wants to be tased-the last 30 seconds is priceless
  11. turtle md

    turtle md Hardware Included Physician 7+ Year Member

    Jan 22, 2005
    just over there
    We call the dogs out - Canine Security... That usually chills people out...
  12. EM2BE

    EM2BE Elf 7+ Year Member

    What did they arrest him for? I didn't see any logical reasoning...
  13. kungfufishing

    kungfufishing Senior Member 7+ Year Member

    Mar 7, 2003
    If this is true, I think it is near genius. I bet that is a great deterrent and leads to far fewer "Security Rodeo" events in the ED. Seems like the show of force itself is often not quite enough and - drunken jackass/attention seeking crazy/loudmouth who got assaulted "by like four guys" and needs to quickly reestablish toughguy status - ends up getting tackled by the cops. I bet a trained police dog acting even vaguely interested is enough for most people.
  14. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner Moderator Physician Faculty 10+ Year Member

    Aug 2, 2006
    He wasn't following the rules of the forum, didn't stop when asked, and then resisted being removed from the microphone. Just because someone is liberal doesn't mean that they can do whatever they want.
  15. roja

    roja 7+ Year Member

    Oct 20, 2003
    NYC--->San Francisco
    Dealing with abusive patients is sadly just one of the downsides to our job. I think each person has to find a way to not let this drive them nuts or you will rapidly become hypercynical and end up hating your job.

    I will employ various techniques, depending on the nuances of the situation. Letting them vent, telling them what I can/will be doing for them. However, I am a firm believer that just because someone works in the health care environment (and particularly the ED) does not give patients or thier families the right to abuse me, my residents, or any of my ancillary staff. If after these explainations, including one about how abusive language is not accepted, I will have the patient and/or family member escorted out. I will also give them our complaint number.

    I also then send a brief email to my department chair explaining what the situation was so he isn't blindsided when some irate person calls. (I have been fortunate in that my boss has always been very supportive).

    You don't have to take abuse. Medicine is not burger king.
  16. docB

    docB Chronically painful Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 27, 2002
    Las Vegas, NV
    Uh oh. Becoming hypercynical and consumed with hatred has been my coping mechanism. Maybe I need to work on that.
    I thought CMS had decided it is and that's why they implemented HCAHPS. I'll keep wearing the big, plastic King costume until they say I don't have to anymore.
  17. roja

    roja 7+ Year Member

    Oct 20, 2003
    NYC--->San Francisco
    You definately need to work on it. ;) Actually, humor is a high level coping mechanism, so you are probably okay.

    btw, completely off topic, saw my 'boys' this week in nyc, and you guys must be taking good care of them. They look rich and buff and like they have to much time on thier hands. You need to work them harder. :D
  18. turtle md

    turtle md Hardware Included Physician 7+ Year Member

    Jan 22, 2005
    just over there
    Good story - drunk guy, verbally abusive to staff and even security, stands up to demonstrate his power over us, when the dog comes in -- he says, "I may be drunk, but I'm not stupid!" And sits back down...
  19. docB

    docB Chronically painful Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 27, 2002
    Las Vegas, NV
    They're doing well. They're in that "I've been around long enough to know what I'm doing but not so long that I've had my spirit crushed." phase;).
  20. EM2BE

    EM2BE Elf 7+ Year Member

    That's where I was lost...I didn't realize it was a formal thing. I thought it was just a student trying to make a point. I realized after that why he was handcuffed (the whole fighting police/security thing is never a good idea).
  21. quinsy

    quinsy 5+ Year Member

    Nov 24, 2006
    Great topic for discussion. I saw a really good example the other night. My patient and her family were getting irate about everything in general. We walk in and say 'what's going on?' and they launch into this tirade about "she's been off the monitor since she came back from the bathroom and that was half an hour ago, and the nurse is just sitting out there chatting on the phone and not paying attention, and there's blood sitting on the countertop over there and what is that blood doing over there, don't you know you don't leave tubes of blood sitting out just anyplace...." and probably could have gone on for quite some time, but my attending jumped in and says "Excuse me, but let's take a moment and just go back and talk about something else. Now, tell me about this episode that happened earlier today?" they grudgingly started going over the story again, but as he asked a few more questions about it, you could see they were visibly calming down and starting to get into telling the story. They seemed pleased at his interest in hearing about it.

    After asking about 5 mins worth of additional questions, he did a quick summary of where we were at with our studies and plan, and they all agreed it sounded good, and we left the room.

    I thought this was simple and elegant. One sentence, which he did have to forcefully interject, but it completely derailed their angry rant, and they quickly returned to being cooperative and calm. I thought they might be annoyed that he interrupted their concerns, but they seemed to realize that we had moved on to the really important part, that we both wanted the patient to be taken care of well. I plan to use this if possible in the future, though I don't think it will work on people with personality/major psychiatric disorders.

    One question for the crowd. I'm trying to become better at responding to patients that I personally have difficulty dealing with. I am a soft touch and come off as such to the patients. When I encounter drug seekers, I am able to communicate effectively to them that I do not want to prescribe narcotics for them and have picked up a few typical ways of doing this, i.e. "You need your primary care doctor to oversee your chronic pain regimen. I cannot do this for you." or "You know, we get in trouble if we are prescribing narcotic pain medications to people who are also receiving them from other doctors." (vague but implies some policy that is not your fault and therefore unarguable).

    My problem comes when they, realizing that I am a soft touch, try to guilt trip me relentlessly about denying them the Percs (or whatever, but almost always the Percs). i.e. "I'm a Vietnam veteran, and you're denying me pain medicine! I can't believe you would do this to someone who served our country." or "What kind of doctor would let a patient suffer?" I try to say something like "That's not the way it is, but I'm sorry you feel that way." but it doesn't seem very effective. I need a good one-liner that I can belt out as a 'conversation over' right before walking out of the room, something they can't easily respond to with further instigation.

    I have a secret fear (which I know many do not share) of not treating patients who are truly in pain. I think this is part of my issue in dealing with these people because I really do feel guilty. If anyone could offer advice it would be appreciated. Saying something like "get the hell out if you don't like how I take care of you" is not an option in my ED as it is in Jkgrocerz... :)

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