Difficult Patients!!!!!!!!!!
Ever had a difficult patient, i bet all doctors have hads their fair share of them, right now im still stewing from my encounter (not directly) with one very difficult patient a few minutes ago.
Of course he is male (sorry guys) but i tend to have men as more difficult to handle than the women folk. A few days ago it was another man! But the funny thing is that at the end of their stay in hospital we are usually good friends or at least we entertain some semblance of friendship.
My perceived percentage of difficult patients in my small experience as a doc, well lets say 1 in 50 patients are difficult. I just remebered another difficult one just now hmmmm lets increase the ratio to about 1 in 20.
What makes them stand out, well ill try and give a list.
1. The difficult patient has his preconceived notion of how his treatment must be and despite your pathological description of his disease process he clings stubbornly to his own idea of the probable cause. i.e About two weeks ago an elderly man with a classic case of 3rd degree haemorrhoids first presented at our clinic he told me quite pointedly that he believed that 'kokoro" which translated mean little insects (sorry my yoruba is pathetic but if anyone has a better translation let me know) were responsible for his condition, of course i took great pains to explain to him that dilated veins in his anus were the cause of his intermittent bleeds but i may as well have been talking to a brick wall with ears drawn on them! For after surgery for his haemorhoids he appeared a few days ago to say that he needs drugs to kill the "kokoro" disturbing him even when he was no longer bleeding!
2. The difficult patient knows more than the doctor- this looks like a continuation of the first comment but i tell you the patient who thinks he knows more than you (of course some patients really do) will not allow you to rest but take every little oppurtunity to show you that you don't know anything and if you listened to them much more their illnesses would have disappeared.
3. The difficult patient views the doctor as his personal hired servant- This category of patients in my estimation are the worst, because you are hunted down by them their relations and the nurses who they constantly harass to get the doctor to see them even if the problem is a slight itch on their nose! This category of patient was the one who got me riled this evening. Since his admission for injuries he sustained in a road traffic accident, i have been constantly hunted by his relations who he i suppose also harasses to get the doctor. At first i was a bit perturbed as to the nature of his complaints especially since i was called upon almost three times in an hour, finally i got annoyed and told his relations i would not see him until the nurses sent for me which was the proper order anyway.
On getting to his bedside he begins a long litany of complaints all of which have been explained to him as normal in his healing process and immediately a solution is profeered he jumps to the next one which he assures you is very serious. Im at my wits end especially when i note on entering his room before he sees me that he is as well as can be! He is not respectful and hia attitude as he talks and expressions he uses show you that he sees you no more than he does his personal maid at home, which he may not even have.
4. The last difficult patient example is that of a patient who is never satisfied with the outcome no matter what you do, The patient is male but the caregiver was female and she was the one who gave us problems. She arrived the hospital about 2am that day i was in the doctors room of the emergency room and it was her wails that awakened me, her shouting could probably have woken the dead up for it seemed like she was in the same room with me when she was actually some distance away.
'E gba mi, e gba mi' she shouted, it means save me, 'are there no doctors around, no nurses?, i came here today with my son, open the doors, won't anyone answer me' her crying continued though it took us less than 30secs to open the doors of the emergency room.
What was the matter, her son suffers fron Sickle cell and he had been seen earlier in the day with a history of bone pains, she had been advised to come in for admission but she had declined citing financial reasons, his Packed cell volume done then was 16% (too low). Now she was back and her son was barely alive, a quick dash to the lab got us group compatible screened blood and this we hurriedly set up, luckily thelight was on and somehow he came back from wherever he had been when the transfusion was commenced.
Seeing her son now wide awake, the problem of how to return the blood became another problem, she claimed to have been brought by stranfgers and could not tell any of them to donate blood, we decided to wait till morning but her cantankerous response to our seemingly benign questions made us wonder if we would ever see the bag of blood.
The next time i saw her she had spent a few days on the ward and she was shouting to the hearing of all the patients and visitors how she had been seemingly abandoned by the staff on duty, her son was having bone pains and did they not know that bone pains caused shortage of blood, she claimed that she had not been seen by any doctor that day though the medicine team had made their rounds, she made a big show of packing her sons things and have him limp off towards the door as though they were going home.
The staff on duty informed me that they had not paid their bills and that they had been seen that morning. Whatever had caused her dissatisfaction with the system i dont know but i sure had a hard time convincing her to return her son to his bed and that all would be well.
Talk about difficult patients!
Of course he is male (sorry guys) but i tend to have men as more difficult to handle than the women folk. A few days ago it was another man! But the funny thing is that at the end of their stay in hospital we are usually good friends or at least we entertain some semblance of friendship.
My perceived percentage of difficult patients in my small experience as a doc, well lets say 1 in 50 patients are difficult. I just remebered another difficult one just now hmmmm lets increase the ratio to about 1 in 20.
What makes them stand out, well ill try and give a list.
1. The difficult patient has his preconceived notion of how his treatment must be and despite your pathological description of his disease process he clings stubbornly to his own idea of the probable cause. i.e About two weeks ago an elderly man with a classic case of 3rd degree haemorrhoids first presented at our clinic he told me quite pointedly that he believed that 'kokoro" which translated mean little insects (sorry my yoruba is pathetic but if anyone has a better translation let me know) were responsible for his condition, of course i took great pains to explain to him that dilated veins in his anus were the cause of his intermittent bleeds but i may as well have been talking to a brick wall with ears drawn on them! For after surgery for his haemorhoids he appeared a few days ago to say that he needs drugs to kill the "kokoro" disturbing him even when he was no longer bleeding!
2. The difficult patient knows more than the doctor- this looks like a continuation of the first comment but i tell you the patient who thinks he knows more than you (of course some patients really do) will not allow you to rest but take every little oppurtunity to show you that you don't know anything and if you listened to them much more their illnesses would have disappeared.
3. The difficult patient views the doctor as his personal hired servant- This category of patients in my estimation are the worst, because you are hunted down by them their relations and the nurses who they constantly harass to get the doctor to see them even if the problem is a slight itch on their nose! This category of patient was the one who got me riled this evening. Since his admission for injuries he sustained in a road traffic accident, i have been constantly hunted by his relations who he i suppose also harasses to get the doctor. At first i was a bit perturbed as to the nature of his complaints especially since i was called upon almost three times in an hour, finally i got annoyed and told his relations i would not see him until the nurses sent for me which was the proper order anyway.
On getting to his bedside he begins a long litany of complaints all of which have been explained to him as normal in his healing process and immediately a solution is profeered he jumps to the next one which he assures you is very serious. Im at my wits end especially when i note on entering his room before he sees me that he is as well as can be! He is not respectful and hia attitude as he talks and expressions he uses show you that he sees you no more than he does his personal maid at home, which he may not even have.
4. The last difficult patient example is that of a patient who is never satisfied with the outcome no matter what you do, The patient is male but the caregiver was female and she was the one who gave us problems. She arrived the hospital about 2am that day i was in the doctors room of the emergency room and it was her wails that awakened me, her shouting could probably have woken the dead up for it seemed like she was in the same room with me when she was actually some distance away.
'E gba mi, e gba mi' she shouted, it means save me, 'are there no doctors around, no nurses?, i came here today with my son, open the doors, won't anyone answer me' her crying continued though it took us less than 30secs to open the doors of the emergency room.
What was the matter, her son suffers fron Sickle cell and he had been seen earlier in the day with a history of bone pains, she had been advised to come in for admission but she had declined citing financial reasons, his Packed cell volume done then was 16% (too low). Now she was back and her son was barely alive, a quick dash to the lab got us group compatible screened blood and this we hurriedly set up, luckily thelight was on and somehow he came back from wherever he had been when the transfusion was commenced.
Seeing her son now wide awake, the problem of how to return the blood became another problem, she claimed to have been brought by stranfgers and could not tell any of them to donate blood, we decided to wait till morning but her cantankerous response to our seemingly benign questions made us wonder if we would ever see the bag of blood.
The next time i saw her she had spent a few days on the ward and she was shouting to the hearing of all the patients and visitors how she had been seemingly abandoned by the staff on duty, her son was having bone pains and did they not know that bone pains caused shortage of blood, she claimed that she had not been seen by any doctor that day though the medicine team had made their rounds, she made a big show of packing her sons things and have him limp off towards the door as though they were going home.
The staff on duty informed me that they had not paid their bills and that they had been seen that morning. Whatever had caused her dissatisfaction with the system i dont know but i sure had a hard time convincing her to return her son to his bed and that all would be well.
Talk about difficult patients!
Reading my post above made me laugh! I have reconsidered my views of the above post. I now know that some patients have a good reason for their stance. Lets talk about viewing things through the lens the patient sees through. A lifetime of experience, fear of hospitals, an experience with new doctors who feel the world should bow down as they pass:) lack of finances, and many other things may make a patient seem difficult.
ReplyDeleteEmpathy and understanding on the part of the doctor will do a lot to bridge the 'divide' between a seemingly stubborn patients stance and the doctors equally firm opinion.
Written 4 years later!
ReplyDelete