What to do with MEAN patients? Help!

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JaSam

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I need some advice big time cuz I just got a string on royal pain in the A patients and I'm already exhausted and really don't feel like putting up with this S. I mean I have one lady that I want to slap in face and just tell her to shut her crap. She's got such a bad attitude, has bad breath, always disturbes the nurses and thus they call me about all sorts of stuff and I know she wouldn't dare do that if I were an attending. Is there anyway to put her in her place? Can i like put her on a high salt diet and then fluid restrict her and stuff?
 
JaSam said:
I need some advice big time cuz I just got a string on royal pain in the A patients and I'm already exhausted and really don't feel like putting up with this S. I mean I have one lady that I want to slap in face and just tell her to shut her crap. She's got such a bad attitude, has bad breath, always disturbes the nurses and thus they call me about all sorts of stuff and I know she wouldn't dare do that if I were an attending. Is there anyway to put her in her place? Can i like put her on a high salt diet and then fluid restrict her and stuff?
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Let Ben Stiller of Happy Gilmore fame show you the way:

"You can trouble me for a warm glass of shut-the-he!!-up. Now, you will go to sleep or I will put you to sleep. Check out the name tag. You're in my world now, grandma."

4574138_std.jpg
 
I dunno. I have an easier time with the mean patients. It's the happy-go-lucky ones you get called to admit at 3 a.m., who then complain to your attending the next day about how you weren't excited and bubbly to see them that I hate, cuz then you get the lecture/nasty evaluation about how you need to be more happy and smile more, and be less of a malcontent.

With the nasty ones, there's no pretense about pretending to be happy when seeing them. It's just business, which is easier. 👍
 
I've had multiple patients take a swing at me, and I still took care of them (although I spent as little time in their room as possible). Suck it up. Many people are jerks. They're even more so when they're sick and not getting their crack, cigarettes, and beer. You're not going to change that, but you can make them more angry and hence, meaner.
 
the next time she is mean to you call her on it.

"why are you so angry? is there something i have done to upset you"

it may be touchy feely but unless you have done something wrong to this patient they will back off and start telling you whats really bothering them.

other than that suck it up. mean patients are abound. without the sour you cant know what sweet is.
 
Place her on a low salt, ADA diet, and give her some lactulose prior to discharge.
 
suck it up..
you're gonna be facing it for as long as your practice.
the world is aplenty with 'mean' patients
 
Man, sometimes patients just suck. I have to ask the same simple question 4 different ways, and I think we all know I've got more than one question. I mean I like people, I like patients, I like talking to them and I can usually get a pretty good rapport going with patients....but I feel like a jerk, because I find myself being totally impatient with even these sweet old ladies, even when they're polite, because they're taking forever to spit out how long they've had rectal bleeding for. How long have you had it? Yes, ma'am, I realize it's been a long time. How long is "a long time"? You don't know? Can you estimate for me? Years? Okay, how many years? Some years? Is that 2 years, 20 years, what? More than 2? Okay, more than 3? More than 4? Feel free to jump in at any time and speed things up here....more than 5? More than 6? You think maybe 6? GREAT THANKS. I can't go through that sequence after every freakin' question. And when I'm doing my review of systems and you say "yes" to everything and after every time you say "yes" I ask how long you've had it, feel free to take a hint and just go ahead and tell me "yes, for the past 4 months" or "yes, I get light-headed with my bleeding", you don't have to wait for me to say, "how long have you had it?" every time ...four months. All these things are in the past 4 months. And if you get headaches once in a while like everyone else, feel free to say, "yeah, they're just regular headaches", you don't have to wait for me to ask if they're regular headaches. If a doctor asks me if I get stomachaches, I say, "yeah, sometimes, but just regular ones occasionally if I eat something gross or something". Feel free to elaborate to convey what they're like. The question, "any fever or chills lately?" doesn't mean you have to just say "yeah" and stare blankly at me, don't they know I'm going to want to know more about it than just "yeah"? They never elaborate on the right stuff. They want to elaborate on how their cousin had pancreas problems for 2 minutes straight or their brother had a baby with his new wife but when I ask them about their chest pain I get frickin' vague-ass "eh, I get it sometimes". Come on! "Sometimes"?! You know damn well your ****in' heart's in there (and probably that there's other important stuff in there you don't want hurting) and you know chest pain's bad. You're here in the ER, presumably for an emergency, feel free to help me out here so I don't have to ask, "how often is 'sometimes'?" five different ways. You don't know? Is it every day, every week, every month....no, it's not that much? Not as much as which one? HOW OFTEN DO YOU GET IT. I don't need surgical precision here, just give me a ballpark. Okay! Great! Maybe once a week! Now we're getting somewhere. Have you tried anything to make it feel better? No? Nothing? Nothing you've tried or done makes it feel better? ...Have you tried ice? Yes? You have? Did it help? Great! Have you tried sitting & resting? Yes? You have? Did it help? Do you ever get short of breath? No? Never? What about when you lay down at night? No? Do you sleep on pillows at night? How many? Why do you sleep on pillows? Because you get short of breath if you lay flat? GREAT THANKS THIS IS GOING GREAT.
 
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JeffLebowski said:
Man, sometimes patients just suck. I have to ask the same simple question 4 different ways, and I think we all know I've got more than one question. I mean I like people, I like patients, I like talking to them and I can usually get a pretty good rapport going with patients....but I feel like a jerk, because I find myself being totally impatient with even these sweet old ladies, even when they're polite, because they're taking forever to spit out how long they've had rectal bleeding for. How long have you had it? Yes, ma'am, I realize it's been a long time. How long is "a long time"? You don't know? Can you estimate for me? Years? Okay, how many years? Some years? Is that 2 years, 20 years, what? More than 2? Okay, more than 3? More than 4? Feel free to jump in at any time and speed things up here....more than 5? More than 6? You think maybe 6? GREAT THANKS. I can't go through that sequence after every freakin' question. And when I'm doing my review of systems and you say "yes" to everything and after every time you say "yes" I ask how long you've had it, feel free to take a hint and just go ahead and tell me "yes, for the past 4 months" or "yes, I get light-headed with my bleeding", you don't have to wait for me to say, "how long have you had it?" every time ...four months. All these things are in the past 4 months. And if you get headaches once in a while like everyone else, feel free to say, "yeah, they're just regular headaches", you don't have to wait for me to ask if they're regular headaches. If a doctor asks me if I get stomachaches, I say, "yeah, sometimes, but just regular ones occasionally if I eat something gross or something". Feel free to elaborate to convey what they're like. The question, "any fever or chills lately?" doesn't mean you have to just say "yeah" and stare blankly at me, don't they know I'm going to want to know more about it than just "yeah"? They never elaborate on the right stuff. They want to elaborate on how their cousin had pancreas problems for 2 minutes straight or their brother had a baby with his new wife but when I ask them about their chest pain I get frickin' vague-ass "eh, I get it sometimes". Come on! "Sometimes"?! You know damn well your ****in' heart's in there (and probably that there's other important stuff in there you don't want hurting) and you know chest pain's bad. You're here in the ER, presumably for an emergency, feel free to help me out here so I don't have to ask, "how often is 'sometimes'?" five different ways. You don't know? Is it every day, every week, every month....no, it's not that much? Not as much as which one? HOW OFTEN DO YOU GET IT. I don't need surgical precision here, just give me a ballpark. Okay! Great! Maybe once a week! Now we're getting somewhere. Have you tried anything to make it feel better? No? Nothing? Nothing you've tried or done makes it feel better? ...Have you tried ice? Yes? You have? Did it help? Great! Have you tried sitting & resting? Yes? You have? Did it help? Do you ever get short of breath? No? Never? What about when you lay down at night? No? Do you sleep on pillows at night? How many? Why do you sleep on pillows? Because you get short of breath if you lay flat? GREAT THANKS THIS IS GOING GREAT.
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Haha, sounds familiar. I try to go through the ROS pretty fast, and if they say yes to something, I try to make sure they're not saying "yes, my nose is stuffy all the time" when they mean "yes, I get a stuffy nose for an hour a year."
 
I so know how you feel. You gotta love when they're mean, smart and hate students. I got a "oh you're one of them; I hate you guys" when my patient saw my short coat. By the time I got to the ROS, I got lectured on not being catholic, russia's taking over the world, and cheating husbands?! Just try and be nice. Eventually someone else ticks them off and they'll be nicer to you. And it gives you some crazy antics to laugh at later. My biggest problem is getting out of the room in a timely fashion. I just feel bad interrupting them all the time.

My attending gave me a nice little trick for pts who say yes for everything. When you're doing your rapid fire questions, just throw in there "does your hair hurt?" if yes then just quit. lol.
 
if you're in the emergency, you can try ways to expedite discharge/admit 🙂
 
JeffLebowski said:
Man, sometimes patients just suck. I have to ask the same simple question 4 different ways, and I think we all know I've got more than one question. I mean I like people, I like patients, I like talking to them and I can usually get a pretty good rapport going with patients....but I feel like a jerk, because I find myself being totally impatient with even these sweet old ladies, even when they're polite, because they're taking forever to spit out how long they've had rectal bleeding for. How long have you had it? Yes, ma'am, I realize it's been a long time. How long is "a long time"? You don't know? Can you estimate for me? Years? Okay, how many years? Some years? Is that 2 years, 20 years, what? More than 2? Okay, more than 3? More than 4? Feel free to jump in at any time and speed things up here....more than 5? More than 6? You think maybe 6? GREAT THANKS. I can't go through that sequence after every freakin' question. And when I'm doing my review of systems and you say "yes" to everything and after every time you say "yes" I ask how long you've had it, feel free to take a hint and just go ahead and tell me "yes, for the past 4 months" or "yes, I get light-headed with my bleeding", you don't have to wait for me to say, "how long have you had it?" every time ...four months. All these things are in the past 4 months. And if you get headaches once in a while like everyone else, feel free to say, "yeah, they're just regular headaches", you don't have to wait for me to ask if they're regular headaches. If a doctor asks me if I get stomachaches, I say, "yeah, sometimes, but just regular ones occasionally if I eat something gross or something". Feel free to elaborate to convey what they're like. The question, "any fever or chills lately?" doesn't mean you have to just say "yeah" and stare blankly at me, don't they know I'm going to want to know more about it than just "yeah"? They never elaborate on the right stuff. They want to elaborate on how their cousin had pancreas problems for 2 minutes straight or their brother had a baby with his new wife but when I ask them about their chest pain I get frickin' vague-ass "eh, I get it sometimes". Come on! "Sometimes"?! You know damn well your ****in' heart's in there (and probably that there's other important stuff in there you don't want hurting) and you know chest pain's bad. You're here in the ER, presumably for an emergency, feel free to help me out here so I don't have to ask, "how often is 'sometimes'?" five different ways. You don't know? Is it every day, every week, every month....no, it's not that much? Not as much as which one? HOW OFTEN DO YOU GET IT. I don't need surgical precision here, just give me a ballpark. Okay! Great! Maybe once a week! Now we're getting somewhere. Have you tried anything to make it feel better? No? Nothing? Nothing you've tried or done makes it feel better? ...Have you tried ice? Yes? You have? Did it help? Great! Have you tried sitting & resting? Yes? You have? Did it help? Do you ever get short of breath? No? Never? What about when you lay down at night? No? Do you sleep on pillows at night? How many? Why do you sleep on pillows? Because you get short of breath if you lay flat? GREAT THANKS THIS IS GOING GREAT.
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ROFLMAO!!!! Uhmm a little frustrated are we??:laugh::laugh:
 
omental caKe said:
I so know how you feel. You gotta love when they're mean, smart and hate students. I got a "oh you're one of them; I hate you guys" when my patient saw my short coat. By the time I got to the ROS, I got lectured on not being catholic, russia's taking over the world, and cheating husbands?! Just try and be nice. Eventually someone else ticks them off and they'll be nicer to you. And it gives you some crazy antics to laugh at later. My biggest problem is getting out of the room in a timely fashion. I just feel bad interrupting them all the time.

My attending gave me a nice little trick for pts who say yes for everything. When you're doing your rapid fire questions, just throw in there "does your hair hurt?" if yes then just quit. lol.
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You guys are hilarious...Man I can't wait to get into med school.
 
JeffLebowski said:
Man, sometimes patients just suck. I have to ask the same simple question 4 different ways, and I think we all know I've got more than one question. I mean I like people, I like patients, I like talking to them and I can usually get a pretty good rapport going with patients....but I feel like a jerk, because I find myself being totally impatient with even these sweet old ladies, even when they're polite, because they're taking forever to spit out how long they've had rectal bleeding for. How long have you had it? Yes, ma'am, I realize it's been a long time. How long is "a long time"? You don't know? Can you estimate for me? Years? Okay, how many years? Some years? Is that 2 years, 20 years, what? More than 2? Okay, more than 3? More than 4? Feel free to jump in at any time and speed things up here....more than 5? More than 6? You think maybe 6? GREAT THANKS. I can't go through that sequence after every freakin' question. And when I'm doing my review of systems and you say "yes" to everything and after every time you say "yes" I ask how long you've had it, feel free to take a hint and just go ahead and tell me "yes, for the past 4 months" or "yes, I get light-headed with my bleeding", you don't have to wait for me to say, "how long have you had it?" every time ...four months. All these things are in the past 4 months. And if you get headaches once in a while like everyone else, feel free to say, "yeah, they're just regular headaches", you don't have to wait for me to ask if they're regular headaches. If a doctor asks me if I get stomachaches, I say, "yeah, sometimes, but just regular ones occasionally if I eat something gross or something". Feel free to elaborate to convey what they're like. The question, "any fever or chills lately?" doesn't mean you have to just say "yeah" and stare blankly at me, don't they know I'm going to want to know more about it than just "yeah"? They never elaborate on the right stuff. They want to elaborate on how their cousin had pancreas problems for 2 minutes straight or their brother had a baby with his new wife but when I ask them about their chest pain I get frickin' vague-ass "eh, I get it sometimes". Come on! "Sometimes"?! You know damn well your ****in' heart's in there (and probably that there's other important stuff in there you don't want hurting) and you know chest pain's bad. You're here in the ER, presumably for an emergency, feel free to help me out here so I don't have to ask, "how often is 'sometimes'?" five different ways. You don't know? Is it every day, every week, every month....no, it's not that much? Not as much as which one? HOW OFTEN DO YOU GET IT. I don't need surgical precision here, just give me a ballpark. Okay! Great! Maybe once a week! Now we're getting somewhere. Have you tried anything to make it feel better? No? Nothing? Nothing you've tried or done makes it feel better? ...Have you tried ice? Yes? You have? Did it help? Great! Have you tried sitting & resting? Yes? You have? Did it help? Do you ever get short of breath? No? Never? What about when you lay down at night? No? Do you sleep on pillows at night? How many? Why do you sleep on pillows? Because you get short of breath if you lay flat? GREAT THANKS THIS IS GOING GREAT.
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:laugh: I just finished a month of ER and boy do I sympathize with this.

The biggest challenge of ER for me was finding out the patient's motive. Ie-OK you've had this problem for months now; why did it suddenly become an emergency to you and is there anything specifically you want from the doctor?

I had this 70 year old patient come in last night with "bumps" on her arms which were visible to her and only her. She had them for 6 weeks. When I asked what made her worried this was an emergency and what she wanted, she said she was concerned it might be her gallbladder and that she just wanted to know what it was. Sigh.
 
Ypo. said:
:laugh: I just finished a month of ER and boy do I sympathize with this.

The biggest challenge of ER for me was finding out the patient's motive. Ie-OK you've had this problem for months now; why did it suddenly become an emergency to you and is there anything specifically you want from the doctor?

I had this 70 year old patient come in last night with "bumps" on her arms which were visible to her and only her. She had them for 6 weeks. When I asked what made her worried this was an emergency and what she wanted, she said she was concerned it might be her gallbladder and that she just wanted to know what it was. Sigh.
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Those imaginary bumps aren't going to go away on their own, Ypo. Not when that goddamn gallbladder's behind it. That's what the ER is for - confirming patient diagnoses of imaginary bumps secondary to EMERGENT gallbladder disease. Imaginary arm bumps are pretty commonly the only presenting symptom of gallbladder disease. They must have gotten imaginarily pretty bad over the past 6 weeks for her to show up to the ER.

I wonder if they would clear up S/P cholecystectomy. Or you could have fetched an invisible I&D tray and done an imaginary I&D. You could have cured her. Could be a publishable case report. But would you have the balls to attach your name to her forever in print?
 
JaSam said:
I need some advice big time cuz I just got a string on royal pain in the A patients and I'm already exhausted and really don't feel like putting up with this S. I mean I have one lady that I want to slap in face and just tell her to shut her crap. She's got such a bad attitude, has bad breath, always disturbes the nurses and thus they call me about all sorts of stuff and I know she wouldn't dare do that if I were an attending. Is there anyway to put her in her place? Can i like put her on a high salt diet and then fluid restrict her and stuff?
Click to expand...

A different side to think about: I talk to the crackheads in the ER all the time, and most of them said they dislike med students because they are always the ones that never want to deal with them, and they pick up your vibe if you're cringing about seeing them. Any patient will pick this up, not just the druggies. (Although the druggies are the ones that will tell you like it is to your face hahaha). The only thing I would suggest is just try to be nice and talk to her, and maybe she will lighten up...some peeps are just needy. Nurses attitude doesn't help either.

I hate to be devil's advocate about this, but you don't wanna blow a pain in the ass patient off and have something really be wrong with them. I understand that this is not the majority of time, and most likely not in your scenario. Last week an ED "regular" came in for the 5th consecutive time in 2 months complaining of hip pain, no one really dealt with her the first 4 times and blew her off cause she was a jerk to staff and everyone assumed she just wanted drugs....turns out she had a septic joint and is now gonna lose her hip

BIG LAWSUIT
 
GoBuckeyes913 said:
Last week an ED "regular" came in for the 5th consecutive time in 2 months complaining of hip pain, no one really dealt with her the first 4 times and blew her off cause she was a jerk to staff and everyone assumed she just wanted drugs....turns out she had a septic joint and is now gonna lose her hip

BIG LAWSUIT
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Maybe. The biggest lawsuits come from people who now have serious lost income (like John Ritter's widow). Your typical ED regular doesn't have much of that going for them. If the ER staff didn't do a proper eval at all, then yeah, they could get in serious trouble, but if they just didn't pick up on an atypical presentation of a septic joint, well, sh-t happens. (If she was febrile, had an elevated white count, etc., and they blew her off, that's a big no-no)

Also, who knows if the woman would pursue legal action anyways.
 
GoBuckeyes913 said:
A different side to think about: I talk to the crackheads in the ER all the time, and most of them said they dislike med students because they are always the ones that never want to deal with them, and they pick up your vibe if you're cringing about seeing them.
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Because if we liked talking to crackheads without anything wrong with them we'd go into emergency medicine. Mandatory rotations ensure we all have to spend crackhead time but we don't have to pretend to like it.

"Cringing" or any other form of weakness just encourages them to get on you. I prefer the dead eyed silent stare of an uncomfortable duration. They can't tell whether it means I'm just completely indifferent or whether I'm about to go Lecter on them.
 
I believe the official AAMC stance is to kick them in the balls
 
TheProwler said:
Was her presentation obvious enough that she has a good case for negligence?
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At first, it could have definitely been easily missed. She had 2 normal CBCs with other normal labs, and negative films. 3rd visit and 4th visit showed mildly elevated white count, but nothing impressive (like 11) and supposedly negative plain films. I haven't seen her films, so I'm not sure if there were changes or not..... 5th visit someone decided to CT her hip and found a hot mess. So it sounds at first definitely no negligence, but not sure what happened 3, 4th visit. I'll have to poke around a bit or pull up her old films without being nosey around attendings...
 
Mahatma Gandhi once said :

""A patient is the most important person in our Hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our Hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so. ""

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

If you're worried about what your attending thinks more than your patients - you need to extricate your nose from said attendings ass. Have some respect for yourself, and moreover - your patients.

If you're convinced that you're in the right career - you should try and think about why it is that your patient is irritating you.

Having been on the 'other side', as a patient a few times now, it's really obvious when your doctor is NOT listening to what you're saying, and thats very irritating because patients come there precisely for that reason (in my opinion anyway).

Sometimes, when you are overworked, and have a lot of things on your plate, you can portray bodylanguage of 'disinterest', with a distinct lack of empathy or emotion. You may find that you're not listening completely - or mistinterpret what the patient says. The consequence of this is that your patient never has the same story in the morning, and you never have any idea whats going on because you duffed the history.

For this reason, its very very important that when you go to see a patient - you have allocated enough time, and there AREN'T more pressing jobs to be done, so you can give them your undivided attention. If you're stressed - don't go into a consultation carrying that stress/anxiety over. Deal with it appropriately. If you STILL can't concentrate - you'll either need to find someone else to see the patient - or be happy to do a poor job.

If you really want to work at this problem - I suggest having a chat with your attending about it when you get some 'down time', or a spare moment.

Other ways to help would be to get a colleague to 'sit in' on some of your consultations. Having a third party to critically analyse how you phrase questions, how your body language works can be really useful to learning about your own weaknesses which aren't always so apparent on the wards, when you're marching up and down with that steth on.

Patients dont always frame their problems in the same context that you've been trained to.

For you, fever + a murmur for you means endocarditis. Additional marked respiratory distress at rest, not even speaking words, with low volume pulse, quiet breath sounds and crackles everywhere + CXR looks a mess - youre probably thinking patient's in florid failure, and you're then worrying about the 2 sets of blood cultures because you cant find those veins, you cant remember whether it was Dukes or Jones criteria, and you cant even remember what half the criteria are, and whether you should ring the boss to get that urgent TOE, and which antibiotics to start? should you call Intensive Care ? what was it about CPAP and LVF good or bad? ****...what was that JVP again?! and what the hell does that ECG show?.... etc. etc.

For patient, fever + murmur + profound breathlessness means - **** I'm sick, am I going to die? Who the hell is going to look after my kids? What am I going to tell my boss tomorrow. I need an operation???!!! WTH?! Who's going to pay for it? Why is everyone running around with worried looks doing stuff so quickly... Why wont anyone listen to me? I want to go home.... I don't wanna be sick and be like this....Im scared.

I was quite bemused that one of you mentioned something along the lines of patients should know what sort of information you want. That's actually a very clear indicator that you lack any insight into what a patient might be thinking. I'm not trying to criticize you for it - but recognize it now, and deal with these unsubstantiated assumptions before you turn into a real *******.

These sorts of issues are perhaps the most important to address now, especially when you're still relatively new to the 'game'. You can worry about little details like ECG's or which antibiotic is better after you can do the basics properly.

But I cant say it enough ::

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

You are responsible for your own actions. If you're having difficulty, blaming your problems on some sick person you don't know is the biggest cheap shot in history = not to mention making you look like a real *****.
 
Also curiously - the patient with the septic hip. Don't know the case, so won't comment.. but i thought it's funny that you choose to focus on non-suggestive blood results or radiology for negligence (chances are...everyone else did too...and that's perhaps why it was missed). History taking and examination ?? !!
 
mrantarctica said:
Also curiously - the patient with the septic hip. Don't know the case, so won't comment.. but i thought it's funny that you choose to focus on non-suggestive blood results or radiology for negligence (chances are...everyone else did too...and that's perhaps why it was missed). History taking and examination ?? !!
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So i've been told the blood work results and negative films... unfortunately through word of mouth. I personally did not see the patient, and being a student I'm sure selective info is told to me. Its highly possible something obvious was missed or not even looked at. Wish I had more input to share.
 
mrantarctica said:
Mahatma Gandhi once said :

""A patient is the most important person in our Hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our Hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so. ""

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

If you're worried about what your attending thinks more than your patients - you need to extricate your nose from said attendings ass. Have some respect for yourself, and moreover - your patients.

If you're convinced that you're in the right career - you should try and think about why it is that your patient is irritating you.

Having been on the 'other side', as a patient a few times now, it's really obvious when your doctor is NOT listening to what you're saying, and thats very irritating because patients come there precisely for that reason (in my opinion anyway).

Sometimes, when you are overworked, and have a lot of things on your plate, you can portray bodylanguage of 'disinterest', with a distinct lack of empathy or emotion. You may find that you're not listening completely - or mistinterpret what the patient says. The consequence of this is that your patient never has the same story in the morning, and you never have any idea whats going on because you duffed the history.

For this reason, its very very important that when you go to see a patient - you have allocated enough time, and there AREN'T more pressing jobs to be done, so you can give them your undivided attention. If you're stressed - don't go into a consultation carrying that stress/anxiety over. Deal with it appropriately. If you STILL can't concentrate - you'll either need to find someone else to see the patient - or be happy to do a poor job.

If you really want to work at this problem - I suggest having a chat with your attending about it when you get some 'down time', or a spare moment.

Other ways to help would be to get a colleague to 'sit in' on some of your consultations. Having a third party to critically analyse how you phrase questions, how your body language works can be really useful to learning about your own weaknesses which aren't always so apparent on the wards, when you're marching up and down with that steth on.

Patients dont always frame their problems in the same context that you've been trained to.

For you, fever + a murmur for you means endocarditis. Additional marked respiratory distress at rest, not even speaking words, with low volume pulse, quiet breath sounds and crackles everywhere + CXR looks a mess - youre probably thinking patient's in florid failure, and you're then worrying about the 2 sets of blood cultures because you cant find those veins, you cant remember whether it was Dukes or Jones criteria, and you cant even remember what half the criteria are, and whether you should ring the boss to get that urgent TOE, and which antibiotics to start? should you call Intensive Care ? what was it about CPAP and LVF good or bad? ****...what was that JVP again?! and what the hell does that ECG show?.... etc. etc.

For patient, fever + murmur + profound breathlessness means - **** I'm sick, am I going to die? Who the hell is going to look after my kids? What am I going to tell my boss tomorrow. I need an operation???!!! WTH?! Who's going to pay for it? Why is everyone running around with worried looks doing stuff so quickly... Why wont anyone listen to me? I want to go home.... I don't wanna be sick and be like this....Im scared.

I was quite bemused that one of you mentioned something along the lines of patients should know what sort of information you want. That's actually a very clear indicator that you lack any insight into what a patient might be thinking. I'm not trying to criticize you for it - but recognize it now, and deal with these unsubstantiated assumptions before you turn into a real *******.

These sorts of issues are perhaps the most important to address now, especially when you're still relatively new to the 'game'. You can worry about little details like ECG's or which antibiotic is better after you can do the basics properly.

But I cant say it enough ::

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

You are responsible for your own actions. If you're having difficulty, blaming your problems on some sick person you don't know is the biggest cheap shot in history = not to mention making you look like a real *****.
Click to expand...

although I agree with you in principle, there are hordes of physicians who hate patients who find completely acceptable jobs. Rads/path/and a few others lend themselves well. Frankly, I find these people are actually some of the happiest physicians because they get their science jollies with no patient interaction. some of the least happy are the ones who go into heavy patient interaction fields and then sour on it later.

the exception is geriatricians. you could put them underneath a hogpile covered in incontinent 90 year olds and they'd be ecstatic.
 
mrantarctica said:
Mahatma Gandhi once said :

""A patient is the most important person in our Hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our Hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so. ""

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

If you're worried about what your attending thinks more than your patients - you need to extricate your nose from said attendings ass. Have some respect for yourself, and moreover - your patients.

If you're convinced that you're in the right career - you should try and think about why it is that your patient is irritating you.

Having been on the 'other side', as a patient a few times now, it's really obvious when your doctor is NOT listening to what you're saying, and thats very irritating because patients come there precisely for that reason (in my opinion anyway).

Sometimes, when you are overworked, and have a lot of things on your plate, you can portray bodylanguage of 'disinterest', with a distinct lack of empathy or emotion. You may find that you're not listening completely - or mistinterpret what the patient says. The consequence of this is that your patient never has the same story in the morning, and you never have any idea whats going on because you duffed the history.

For this reason, its very very important that when you go to see a patient - you have allocated enough time, and there AREN'T more pressing jobs to be done, so you can give them your undivided attention. If you're stressed - don't go into a consultation carrying that stress/anxiety over. Deal with it appropriately. If you STILL can't concentrate - you'll either need to find someone else to see the patient - or be happy to do a poor job.

If you really want to work at this problem - I suggest having a chat with your attending about it when you get some 'down time', or a spare moment.

Other ways to help would be to get a colleague to 'sit in' on some of your consultations. Having a third party to critically analyse how you phrase questions, how your body language works can be really useful to learning about your own weaknesses which aren't always so apparent on the wards, when you're marching up and down with that steth on.

Patients dont always frame their problems in the same context that you've been trained to.

For you, fever + a murmur for you means endocarditis. Additional marked respiratory distress at rest, not even speaking words, with low volume pulse, quiet breath sounds and crackles everywhere + CXR looks a mess - youre probably thinking patient's in florid failure, and you're then worrying about the 2 sets of blood cultures because you cant find those veins, you cant remember whether it was Dukes or Jones criteria, and you cant even remember what half the criteria are, and whether you should ring the boss to get that urgent TOE, and which antibiotics to start? should you call Intensive Care ? what was it about CPAP and LVF good or bad? ****...what was that JVP again?! and what the hell does that ECG show?.... etc. etc.

For patient, fever + murmur + profound breathlessness means - **** I'm sick, am I going to die? Who the hell is going to look after my kids? What am I going to tell my boss tomorrow. I need an operation???!!! WTH?! Who's going to pay for it? Why is everyone running around with worried looks doing stuff so quickly... Why wont anyone listen to me? I want to go home.... I don't wanna be sick and be like this....Im scared.

I was quite bemused that one of you mentioned something along the lines of patients should know what sort of information you want. That's actually a very clear indicator that you lack any insight into what a patient might be thinking. I'm not trying to criticize you for it - but recognize it now, and deal with these unsubstantiated assumptions before you turn into a real *******.

These sorts of issues are perhaps the most important to address now, especially when you're still relatively new to the 'game'. You can worry about little details like ECG's or which antibiotic is better after you can do the basics properly.

But I cant say it enough ::

If it really irritates you to listen to what your patients have to say, perhaps you should re-consider whether you're in the right career.

You are responsible for your own actions. If you're having difficulty, blaming your problems on some sick person you don't know is the biggest cheap shot in history = not to mention making you look like a real *****.
Click to expand...

Okay - on one hand, you're absolutely right. I agree with everything you said, in principle. It's those principles that motivate me to be a passionate and compassionate provider.

In reality, I think it's pretty magnanimous and self-righteous to come into a thread where medical students, struggling with the stress to learn, conduct good patient care, and hone their skills are venting their frustrations with their communication with patients. Do I blame patients for every time we struggle to get a simple, straight-forward, truthful answer to a simple, straight-forward question? No, and I acknowledged that I felt bad when I get impatient. That said, I think I'm well within my basic privileges as a human being to anonymously voice frustrations (yes, even frustrations with our sacred, noble, honored patients) in the company of other students (who have voiced the ability to relate to my experience) on an anonymous internet medical student forum. The fact that you can't see the legitimacy of that from all the way up there on your high horse doesn't mean squat to me.

And of course no one expects patients to read our minds. Feel free to reread my post that elaborated on this, but my point was that it's frustrating when they elaborate spontaneously on totally unimportant stuff (e.g. your brother's girlfriend's dad with prostate cancer) and get tight-lipped and vague on important health complaints. I guess that makes me an insensitive *******. As a person who is immune to frustration with your patients during your time as a medical student, I wouldn't expect you to understand the thought process that being able to develop coping mechanisms and ways to protect your rapport even in the face of that human emotion of frustration is something worth learning, and based on your post I would say that you see no merit in that because patients can always tell whenever we're frustrated. As an imperfect person, I disagree.
 
Last edited:
JeffLebowski,

Just to clear up a few misconceptions you might have...

Most of my comments relating to YOUR particular response were to do with some of your comments regarding patients knowing what information might be important. Judging by your last post - I still don't think you grasped what I was trying to say about that.

To incompletely quote your response

"its frustrating when they elaborate spontaneously on totally unimportant stuff and get tight lipped and vague on important health complaints"

The point I was making was that a patient's idea of what is important information may not be YOUR idea of important information. It is THIS discrepancy which can be the most difficult hurdle in sound history taking because on the one hand you have to just ask the 'medical' questions and run your diagnostic sieve and all that side of things - but on the other hand you only have 15 mins or so to really grasp what the patients concerns are, what things are important to the patient so that when it comes to formulating a problem list, and an overall plan - it encapsulates these things. Without it, your plan will never be complete because the patients concerns are rarely 'hyponatremia' or 'ejection fraction 16%'. More often, they are more earthly, but no less important things like "when can i go home", "am i able to drive my car", "i need help with laundry because i get breathless.. who will help me?", "i cant walk anymore", "my husband died and i am really sad, and finding it difficult to get my motivation back". And if you really want to help them out, then you've got to somehow marry the two together. Well, I think so anyway.

I think I might have mentioned in another thread - that were not only there to correct someones sodium, or make sure they HbA1c is optimal, but to pay attention to more social aspects. Indeed, that is the very purpose of the social history - to place a patients medical problems in the context of their lives. Taking a holistic approach works certainly seems to work better in the long term - which is why I'd say there's been a general swing in conventional medicine to accomodate more of this in our practice.

As for my comment on getting irritated with patients. That was more directed at the first commentary on this thread about a fellow student feeling like "slapping their patients face". I still stand by all the comments I made in this respect... I think violent attitudes to patients are unjustfiable - and lack critical insight into why you form those responses in the first place.

I'd suggest you're perhaps a little quick to judge. Having not witnessed my behaviour, or attitudes during my training - saying that I'm immune to frustrations is an oversight. Perhaps you were feeling threatened by my comments? And felt the need to make some personal judgements in retaliation? If that's the case - then I apologise. Like i mentioned in my first post earlier - I'm not out to embarass anyone, just point out some things that they may or may not have thought about. I definitely don't know what you have or haven't considered - so offer very general comments in that regard.

The general intention of my post was "dont blame your patients". I didn't/wasnt question the legitimacy of voicing frustrations. But I think when it comes to suggestions such as "slap the patient", "lace them with laxatives" or "get tough, act indifferent", whether in jest, or for real - you are essentially dissolving yourself of any responsibility for a negative interaction between 2 people - and placing all the responsibility on the patient. In a place where they are the very reason you come to work - that seems counter intuitive to me. Hence the suggestion to find a new career (something less counter intuitive).

At the same time, I'm not advocating that you should always blame yourself, and yourself alone either. It's a fine balance.

I certainly never mentioned, at any point, that I am immune to frustration - or have not experienced a feeling of dissatisfaction after a less than ideal consultation with a patient. However, in the numerous times this HAS occurred - I have taken the chance to look at my own behaviour during the consultation, and I HAVE spoken to my seniors about the reasons why consultations don't always go to 'plan', and that's why I felt well within my rights to make any comment in the first place. I do take my advice most of the time. I drink sometimes though, enjoy a 'fry up' with my mates, and enjoy a cigar on occasions too, so I'm not perfect either.

Having been actively involved in mentoring, and peer groups with my younger colleagues both in and out of the medical world, in the sports world, the academic world, and the music world, for a pretty long time - I think i've learnt the value of sharing frustrations and negative experiences and coming up with practical solutions to problems we encounter. And I encourage more of the same!

Hope that clears things up.
 
mrantarctica said:
JeffLebowski,

Just to clear up a few misconceptions you might have...

Most of my comments relating to YOUR particular response were to do with some of your comments regarding patients knowing what information might be important. Judging by your last post - I still don't think you grasped what I was trying to say about that.

To incompletely quote your response

"its frustrating when they elaborate spontaneously on totally unimportant stuff and get tight lipped and vague on important health complaints"

The point I was making was that a patient's idea of what is important information may not be YOUR idea of important information. It is THIS discrepancy which can be the most difficult hurdle in sound history taking because on the one hand you have to just ask the 'medical' questions and run your diagnostic sieve and all that side of things - but on the other hand you only have 15 mins or so to really grasp what the patients concerns are, what things are important to the patient so that when it comes to formulating a problem list, and an overall plan - it encapsulates these things. Without it, your plan will never be complete because the patients concerns are rarely 'hyponatremia' or 'ejection fraction 16%'. More often, they are more earthly, but no less important things like "when can i go home", "am i able to drive my car", "i need help with laundry because i get breathless.. who will help me?", "i cant walk anymore", "my husband died and i am really sad, and finding it difficult to get my motivation back". And if you really want to help them out, then you've got to somehow marry the two together. Well, I think so anyway.

I think I might have mentioned in another thread - that were not only there to correct someones sodium, or make sure they HbA1c is optimal, but to pay attention to more social aspects. Indeed, that is the very purpose of the social history - to place a patients medical problems in the context of their lives. Taking a holistic approach works certainly seems to work better in the long term - which is why I'd say there's been a general swing in conventional medicine to accomodate more of this in our practice.

As for my comment on getting irritated with patients. That was more directed at the first commentary on this thread about a fellow student feeling like "slapping their patients face". I still stand by all the comments I made in this respect... I think violent attitudes to patients are unjustfiable - and lack critical insight into why you form those responses in the first place.

I'd suggest you're perhaps a little quick to judge. Having not witnessed my behaviour, or attitudes during my training - saying that I'm immune to frustrations is an oversight. Perhaps you were feeling threatened by my comments? And felt the need to make some personal judgements in retaliation? If that's the case - then I apologise. Like i mentioned in my first post earlier - I'm not out to embarass anyone, just point out some things that they may or may not have thought about. I definitely don't know what you have or haven't considered - so offer very general comments in that regard.

The general intention of my post was "dont blame your patients". I didn't/wasnt question the legitimacy of voicing frustrations. But I think when it comes to suggestions such as "slap the patient", "lace them with laxatives" or "get tough, act indifferent", whether in jest, or for real - you are essentially dissolving yourself of any responsibility for a negative interaction between 2 people - and placing all the responsibility on the patient. In a place where they are the very reason you come to work - that seems counter intuitive to me. Hence the suggestion to find a new career (something less counter intuitive).

At the same time, I'm not advocating that you should always blame yourself, and yourself alone either. It's a fine balance.

I certainly never mentioned, at any point, that I am immune to frustration - or have not experienced a feeling of dissatisfaction after a less than ideal consultation with a patient. However, in the numerous times this HAS occurred - I have taken the chance to look at my own behaviour during the consultation, and I HAVE spoken to my seniors about the reasons why consultations don't always go to 'plan', and that's why I felt well within my rights to make any comment in the first place. I do take my advice most of the time. I drink sometimes though, enjoy a 'fry up' with my mates, and enjoy a cigar on occasions too, so I'm not perfect either.

Having been actively involved in mentoring, and peer groups with my younger colleagues both in and out of the medical world, in the sports world, the academic world, and the music world, for a pretty long time - I think i've learnt the value of sharing frustrations and negative experiences and coming up with practical solutions to problems we encounter. And I encourage more of the same!

Hope that clears things up.
Click to expand...

Alright, fair enough. We'll just chock it up to a combination of difference of opinion and miscommunication and move on.
 
It's nice to know I'm not the only one that becomes incredibly frustrated with patients. While I do have a duty to treat my patients with respect and do everything I can to provide them with the best possible care, they also have a duty to treat me with that same kind of respect . . . not to be combative or mean.
And I don't think getting angry or frustrated with patients means you're not going to be a good doctor, or need to consider a new career . . .just means you are human.
 
Ypo. said:
:laugh: I just finished a month of ER and boy do I sympathize with this.

The biggest challenge of ER for me was finding out the patient's motive. Ie-OK you've had this problem for months now; why did it suddenly become an emergency to you and is there anything specifically you want from the doctor?

I had this 70 year old patient come in last night with "bumps" on her arms which were visible to her and only her. She had them for 6 weeks. When I asked what made her worried this was an emergency and what she wanted, she said she was concerned it might be her gallbladder and that she just wanted to know what it was. Sigh.
Click to expand...

Haha, reminds me of a story a FP doc told me this week. A patient came to him last year convinced he had cancer. He was a previous smoker, but had no symptoms, no family history, nada, zip, zilch. So the FP doc ordered a blood panel, guy was healthy as a horse, and sent him on his way. He couldn't even elucidate why the patient was suddenly convinced he had cancer.

Got a call from radiology at the local community hospital this week. The guy had presented to the ED with acute chest pain. CXR revealed multiple mets in his lungs.

Talk about s***ty luck.
 
On the bright side [of a train wreck] you only have to have bits and pieces of bad patients. Imagine the nurse assigned to this person for 12 hours. Usually it ends up being the entire nursing staff who has to deal with these mean patients, because in order for a mean patient to be taken care of, they have to be nice to someone. It is the border-line's tried and true strategy of divide and conquer. 15 or 30 minutes talking to mean patients may be intense, but it is shorter.
 
rachmoninov3 said:
On the bright side [of a train wreck] you only have to have bits and pieces of bad patients. Imagine the nurse assigned to this person for 12 hours. Usually it ends up being the entire nursing staff who has to deal with these mean patients, because in order for a mean patient to be taken care of, they have to be nice to someone. It is the border-line's tried and true strategy of divide and conquer. 15 or 30 minutes talking to mean patients may be intense, but it is shorter.
Click to expand...

Make sure that your patient has prn prescriptions for Benadryl, Phenergan, Ambien and/or Xanax to avoid nurse calls. Also Tylenol, because if they get a headache at 3 am it is an EMERGENCY, and they will bug the nurse to call.

Yeah, everyone has gotten frustrated with a patient at some time. Honestly, the nurses do have it worse.

Jeff, your diatribe totally cracked me up! I think most of us have had that experience. You vented in such a funny way, though! Some of us realize that you were just venting to us and not really yelling at patients.

I found that it helps to preface my ROS with: "I'm going to go through a really long list of questions. Please answer yes or no so that we can get through them quickly." Then I ask them questions like "Do you have UNUSUALLY INTENSE headaches?" "Have you had indigestion MORE SEVERE than what we all normally get?" If they start going on and on, I gently remind them that there are a lot more questions to go through and that I need a succinct answer. Usually the problem is that they don't know what is relevant and what isn't, so I try to be clear that I am looking for things outside of normal things that we all get. (Unless I am looking for something specific, of course.)

And for the family history, I ask "Have your father, mother, siblings or children had..." and that way they realize that you don't want to discuss their third cousin's wife who had heart disease.

Also, I sometimes just give up and write "patient states he has had rectal bleeding for a number of years but is unable to be more specific" or something like that.

Try doing it that way a few times and see if it works for you.
Hope it helps!
 
mrantarctica said:
Also curiously - the patient with the septic hip. Don't know the case, so won't comment.. but i thought it's funny that you choose to focus on non-suggestive blood results or radiology for negligence (chances are...everyone else did too...and that's perhaps why it was missed). History taking and examination ?? !!
Click to expand...

Unfortunately, with some of these frequent fliers you really have to base your decisions on some of the more concrete objective evidence. You still have to interview and examine everone, every time, and yes malingerers sometimes get sick for real too, but it is just plain stupid to start from scratch every time with a patient you know has a reputation for lying to you.

Now whether this patient was previously a true frequent flier or just kept coming back because her problem wasn't being addressed, I don't know.
 
Just suck it up.
some of the mean patients will get a little nicer to you when you are one of the docs...especially the smart ones. They know who has any ability to do something for them, and who doesn't (that's you right now!).

Don't let them get under your skin. Some of them are just borderline or other personality disorders and they act this way toward everyone. It isn't personal.

Sometimes "reflective listening" techniques help. That is where you repeat the question/complaint back to them and state you understand their frustration/point of view, but you feel/need 'blah blah blah' and so on. This actually works sometimes, esp. if the patient is just scared or frustrated. It won't work in the real meanies.

mrantarctica makes some valid points, but I think is being a little harsh. Learning to communicate w/patients is just part of the learning process, as is sometimes being frustrated. It doesn't mean every frustrated med student is in the wrong profession. Some patients would frustrate ANYONE.
 
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