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Happy Marriages, Rainbows, Yin and Yang

“She’s a peach,” the nurse quipped as I clicked the link assigning the new patient to my list.
“A positive review of systems … if you know what I mean,” she winked.
I like getting a head’s up about patients before I go to see them, but sometimes advance notice of a difficult patient gives me anxiety. I took a deep breath and put on a big smile as I pulled back the curtain.

“Hi, I’m Dr. WhiteCoat. What brings you here today.”
“Didn’t you read the chart? I’m not explaining it again.”
“I did read your chart, but it looks like you have a lot of things going on, so I’m going to have to get some more information from you about all of them.”
She rolled her eyes, sighed loudly, and gave me a brief end-expiratory “You’ve got to be kidding me.”
I listened and took notes as the patient described her chest pain, her chronic dyspnea, the dry socket she had when her wisdom tooth was pulled 6 months ago, and how a tingling sensation sometimes begins in the fingers of one hand, runs up her neck, down her back and into her leg like someone is “ripping the nerves out of her body one at a time.”

My “kill them with kindness” tactic seemed to be working … at first. But the more I asked questions about her eight different complaints, the more that the patient became impatient. Finally, she snapped.

“You ask too many questions. THIS is why people hate coming to the emergency department.”
“Well, I need to find out more about what is bothering you so I can try to figure out how to fix the problems.”
“YOU’RE the problem and YOU’RE bothering me. Why don’t you just run some tests?”
“But learning more about your problems helps me figure out what test need to be run, though.”
“You don’t listen very well, do you?”

By this time, I was getting frustrated. “Ma’am …,” I started, but she cut me off.

“I bet your wife LOVES it when you leave for work in the morning.”

Ooooh. Eeee. Oww. Oww. Poke me with those pointed barbs. I was going to be a smart ass and tell her that I work nights, too, but my inner peace took over and I bit my tongue.

“Tell you what. Why don’t I … order some tests … to see if we can get to the bottom of all of these problems you’re having.”
Then I left the room.

About 15 minutes later, the nurse hunted me down and told me that the patient had pulled off her EKG leads and walked out of the emergency department while yelling at someone on her cell phone.

One of the other doctors at the nursing station smiled and shook his head. I briefly explained what had happened.

“That’s nothing. Yesterday, I had a lady tell me that men like me were the reason she became a lesbian.” We both got a good laugh out of that one.

Later that day, though, I had a patient and her family ask me if I had an office where they could see me as patients outside of the emergency department.

Ahhhh. That’s better. The yin and yang of my day has now been re-equilibrated.

7 comments

  1. Hey – Welcome back! We missed you!

  2. It’s like a class reunion around here! How awesome!

  3. Thank you for coming back! This sounds like my night last night.

  4. relevant Treatment Algorithms:

    >five chief complaints = fast track
    complaints to staff = >4 hours of Flourescent Light Therapy in the waiting room

    It’s also both salutary and ethical to refer them to Doctor Siri. (She’s in the same practice group as Jenny McCarthy.)

    And Messrs. Press and Ganey (May Satan torture them for Eternity in Hell!) can bite my shiny metal ass, but the minute the patient decides any practitioner is the problem is the point at which I invite them not to let the door hit them in the ass on their way out, and offer to have security help them find the exit. This is the point at which AMA becomes AMF, in medico-legal terms, and I’ll happily find a second person to vouch for the patient’s unwillingness to sign before ejection.

    Unless one arrives with a spike protruding from their chest, rude abusive and obnoxious asshollery deserves a boot to the butt, and an invitation to seek out other pastures in health care. It should be not only legal but standard-of-care to body-cam such interactions and fill out restraining orders for cause.

    Or place them on psych holds, and let the pshrinks deal with them.

    The best way to handle Special Snowflakes is with a snow blower.

  5. Well since she didn’t say it I will- thank you for asking a lot of questions, because you do care and you are through. And so very sorry she was ungrateful and unappreciative. I love how you always take the high road, or make light of it- lets me know that the patients who follow won’t suffer a consequence because of her bad attitude. I don’t know how you guys do it, but God bless for hanging in there!!!!

    • :-)
      It becomes a game sometimes. The thing is that you’d be surprised how many people who start off as antisocial personalities are really good people on the inside and are just having a hard time coping with whatever problems brought them to the emergency department.
      Not all patients are like that, mind you. Otherwise these posts would get rather boring …

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