What was your hardest patient to treat?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Jabberwocky12

Pharmaceutical Wizard
10+ Year Member
Advertisement - Members don't see this ad
Not really talking about "difficult" customers that give you a hard time for doing your job. I'm talking more about what was the hardest patient that you had to manage therapy for? Retail or otherwise. What made them so hard?

Did they have a weird dosage of a medicine from a doctor you had to question/research, or were they on some kind of wild therapy with different drugs, or did they have some kind of disease or condition that made treatment tricky (transplant or HIV patient, pediatrics, etc.)? Maybe it was in the ER and there was little time and the drug of choice would make their situation worse?

I am just trying to get an understanding on what the hard patients could be like in a variety of settings. We all hear about the patient who was on coumadin with different NSAIDs or duplications of therapy and things of that nature but we never hear about the ones that make you flex some old muscles from school.

C'mon, this is the time to shine here. People always say pharmacists are pill pushers, why not put a thread out there that tells you what you're really paid to do (script count jokes aside).

Here is one I heard:
My pharmacist told me a little bit about a patient who got a heart transplant and also had HIV, insulin-mediated diabetes, and was on coumadin 😱. I didn't even know a patient could be on all those drugs safely but I guess he had no other alternative. He said there were some issues with doing a therapy that didn't interfere with all the drugs he was on or aggravate one of the conditions. I never got the details on the therapy though or the outcome.

Any others?

This is what happens when I have an organic assignment due the next morning...
 
When your bug is resistant to colistin, there isn't much I can do for you.

Have a patient right now during my rotation who had KPC bacteremia and that's all it was susceptible to...and in a week his SCr jumped from 0.8 to 3.7...hurray...
 
Advertisement - Members don't see this ad
Diabetic and obese white female in her 50's in an auto accident...saw her screaming in the ER "help me..help me" while her 9 year niece was dead lying on a bed next room.

she had some scratches on her thigh.. looked minor. Then the next day the scratch became a wound.. and started to get nasty.. threw every antibiotic at her but no progress. She ended up with an AKA... except the surgical site didn't heal... She died.

It really taught me how decreased circulation can be detrimental in diabetes.
 
Last edited:
Give up too easy...

Throw in AG, Colistin, and Carbapenem all 3 despite the resistance and see if the combo will kill it.

Was an on AG and carbapenem...both which were int sensistive. He had been in the hospital for a month and had an overall poor prognosis. The ID issues were a small issue in the grand scheme of things.
 
Was an on AG and carbapenem...both which were int sensistive. He had been in the hospital for a month and had an overall poor prognosis. The ID issues were a small issue in the grand scheme of things.

Of course. But did you try triple therapy?
 
pt #1: strips/lancets directions
sig: Test blood sugar 16 times daily
QTY: 500 strips/lancets per month

comment: we checked with md, and apparently the sig is correct. He gets his blood sugar tested while sleeping according to the family. Billing that many tests strips/lancets thru insurance becomes a problem sometimes.

pt#2 HIV meds required PA....
pt got new insurance card and HIV meds got rejected because of cost. I called the processor to ask how long it is going to take to process the PA because it is the weekend, and they said about 3 days. I told him if he realize that they are rejecting HIV meds and he kinda need it to live, they got it approved in 30 mins and even called me to inform me.
 
pt #1: strips/lancets directions
sig: Test blood sugar 16 times daily
QTY: 500 strips/lancets per month
comment: we checked with md, and apparently the sig is correct. He gets his blood sugar tested while sleeping according to the family
We have a patient who tests 10-12 times, not while sleeping though. Apparently he works some sort of construction dealing with large glass panes, and is very concerned about passing out since it would probably cause a disaster with shards going everywhere 😱


We had another patient on my IPPE taking a whole mess of psych meds: Clozaril, benzos, seroquel, ssri, bupropion, lithium. Oddly enough, he seemed perfectly normal and you would never guess he was on anything.
 
We had another patient on my IPPE taking a whole mess of psych meds: Clozaril, benzos, seroquel, ssri, bupropion, lithium. Oddly enough, he seemed perfectly normal and you would never guess he was on anything.

Polypharmacy with the psych meds is not so evidence-based, though we see it lots at my workplace. I imagine they were using seroquel in lower doses as a sedative? Doesn't make sense to add another antipsychotic to Clozaril. Though between those 2, and the lithium, I imagine your pt was rather chubby.

The most difficult pts I encounter are psychiatric pts non-compliant with meds.
 
got called by a colleague who was on call Thanksgiving night...

Pregnant patient with a PE. And HIT. And obesity. And some degree of hepatic dysfunction. I don't remember all the ridonkulousness but it was a hot mess.

As the night went on we found out she was no longer pregnant and it made our lives easier to throw her on some Fondaparinux.
 
the one with the mcdonalds bag in their hand


can't seem to get their lipitor dosage down for some reason
 
got called by a colleague who was on call Thanksgiving night...

Pregnant patient with a PE. And HIT. And obesity. And some degree of hepatic dysfunction. I don't remember all the ridonkulousness but it was a hot mess.

As the night went on we found out she was no longer pregnant and it made our lives easier to throw her on some Fondaparinux.

Did she deliver, or was it a fetal demise?
 
Advertisement - Members don't see this ad
I believe there was a very recent miscarriage that wasn't relayed to my colleague at first.
 
We have a patient who tests 10-12 times, not while sleeping though. Apparently he works some sort of construction dealing with large glass panes, and is very concerned about passing out since it would probably cause a disaster with shards going everywhere 😱


We had another patient on my IPPE taking a whole mess of psych meds: Clozaril, benzos, seroquel, ssri, bupropion, lithium. Oddly enough, he seemed perfectly normal and you would never guess he was on anything.

We don't know the specific reason why he needs to be tested this much, but yes, the family test him when he sleeps.

I don't know how he can stand to be tested that many times a day, or how many places on his body is left untouched by the lancets.

Imagine having lancets used on you 16 times a day........
 
Had to do a medication interview on a patient who had attempted suicide via Tylenol PM Overdose. I was so nervous throughout the interview.


I interviewed a tylenol attempted suicide patient... since one of the major side effects of tylenol is headache.. I asked her if she wants some tylenol for the headache.. she laughed.