What do patients do that drive you crazy? RANT!

[Guest ERCat]

As a disclaimer -  I love my job and love caring for sick patients. But it's inevitable that patients are going to do some pretty annoying things that wear on you throughout the day. 

What things do patients do that drive you nuts? Here are mine:

- At the end of the entire visit, after I spent hours doing exams, ordering meds, doing my entire work up, periodically checking on the patient and updating them on the results, when I go in to the room and tell the patient the plan often he/she says, "When am I going to see the doctor?" When I tell them what my role is they say, "Oh, SORRY! I thought you were the nurse!"

- When people with zero medical experience telling you that you're not doing your job right. When I was doing a lumbar puncture the other day a patient's estranged daughter kept asking me "Are you sure you're doing this right? Why are you having to poke her so many times?" 

- Patients who bring up every single chronic symptom they have ever had. "I have vertigo" - "Is that new or old?" - "Oh, that's been going on since I was 18! I also have a headache." - "Have you had headaches before?" - "Yeah, I get headaches like this a few times a week for like ten years." I hate it when I constantly have to ask a patient "Is this a new or old issue? New or old?" Because they don't understand what they are coming to the ER for is an acute issue.

- When patients come in to the emergency department for clearly nonemergent things yet act irritated and impatient when they think things take too long. Sometimes the nonemergent issues are the things that do indeed take a very long time. i.e. Yesterday I had a lady with years of gait instability come in to see if she could get placed into a skilled nursing facility because she was unable to get insurance to cover it through her primary care provider. She and her family were so mad that it took a few hours I had to consult case management, physical therapy, occupational therapy, wait for insurance approval, etc.) All while sick patients were in other rooms.

- Cell phone use is the worst. When I walk into the room and the person is on their cell phone, chatting away. I stand in there for fifteen seconds tops and wait for them to end the conversation and if they don't get off the phone, I leave and take care of more pressing matters. Then there are the patients who play games on their cell phone while you're doing an exam. It is so bizarre and so rude. 

- In my ER  we don't have a very big clinician area so sometimes I have to sit out in the nurse stations. It's usually bored old men who pace the hallways or who stand right in front of my station and plop their elbows down on the counter with their chin resting in their hands, just chilling there 1.5 feet from me as I am documenting, getting phone consults, etc. I love that the charge nurse automatically  steps in and tells them but due to patient privacy they need to stay IN their rooms.

- Patients who act like they're starving because they haven't eaten in three hours. They ask if one of their family members can bring them McDonald's. I usually have to tell them know. I had one person ask me for "IV nutrition" after two hours of not eating. 

- Patients and their families who just stand by their door with their arms crossed and just stare at you as you are working.

- When you ask patient if they have any medical problems and they say they have none. Then the nurse puts in the med list - Novalog, Coumadin, Carbodopa Levodopa, Diltiazem, Geodon...

- When a patient doesn't understand that bringing up a thousand different symptoms rather than focusing on their main complaint results in unnecessary work up and possibly a missed diagnosis (because the real issue gets clouded by all the BS). The worst thing ever was I had a 50 year old lady come in for "not acting right." Her symptoms were a headache that started suddenly and maximally, vertigo, chest pain and shortness of breath, abdominal pain, vomiting, back "cramps," frequent urination with a history of recurrent and resistant UTIs, right leg pain, chronic edema worse in the last week, and lower extremity numbness and weakness. Her husband also stated she passed out three times last night and hit her head. During the history taking process she seemed overly sedated and kept falling asleep whenever I would ask her for more clarification. I would have to wake her up and really push her to clarify. Must have asked about fifty times, "Is this a new or old issue?" Took me 30 minutes to get the history and by the time I was done, I felt exhausted. Of course, there was nothing emergent wrong with her but she was gorked out on her oxycodone and had to give her Narcan. After Narcan she said most of those symptoms resolved. 

- When you ask a patient if they have any medical problems and they look at their spouse or family member in the room, they look at each other knowingly and laugh  - that's when you have to take a deep breath - then the patient says "I have every medical problem" and they proceed to launch into a list of 30 medical problems like when they broke their big toe at age 17.

- When you ask what hurts and it's "my whole body." This is not meant to be racist - I, after all, am Hispanic myself - but it seems like a cultural thing that the little old Spanish ladies say "Todo mi cuerpo" ("all of my body") when asked what hurts. Then I clarify - "Does your head hurt?" - "Si." - "How long has that been going on?" "Months and months!" "Does your chest hurt?" - "Si." - "When do you notice chest pain?" - "Every day for years." - "Does your tummy hurt?" - "Si." ARGH!!!

- When you ask a patient what brings them into the ER today and they say, "I don't know... you tell me! That's what I am here for." Usually it's an 85 year old male trying to be a wise guy.

- When you ask a patient what brings them into the ER and they say, "Everything." Then you always have to say, "What is new that brought you into the emergency department TODAY?"

 

 

 

[sk732]

My biggest pet peeve is ventriloquism by the patient and the significant other in the room.  When I ask what that person is feeling and someone who really doesn't know answers, I actually will ignore them the first time and, continuing to look at the person I'm talking to, revisit the question...if they aren't big on subtleties, I look at the one moving their lips and phonating and ask them to stop and let the sick one talk - I usually use the line "You can't read their mind and they need to tell me what's going on.  When I need something that they might not be able to relate to me, I'll look at you and ask."  When kids are involved, if they're at an age that they can talk for themselves, I will talk to them, not the parent...and if it's a teenager and the Mommy is talking, I'll look at Mommy Dearest and ask "Does Johnny talk?"  If she says yes, "Could you please let him - he's 19 years old and you actually have him about 4 developmental stages behind his peers if you don't let him do the talking".  If they don't get the hint, "Johnny is 19 years old, I'm asking you to leave."   In a similar vein,  I hate adult children that belittle and try to talk over their very mentally competent parents and act like they aren't switched on enough to look after themselves.  

Second pet peeve is adult children needing their Mommies and Daddies/Mommies and Daddies needing to be in the room because they're either clueless or the cords haven't been cut yet - you see a lot of intact umbilicals these days...I wouldn't let my mother into a doctor's appointment after I was about 12...at 13, I was booking and walking to my own appointments (as long as my legs weren't broken anyway).

I'm a firm believer that some people should have Dermabond applied to their lips upon entering an ER or exam room and solvoplast applied upon leaving...other option is 1-0 Silk sans lidocaine (that's the one on the end of a darning needle).

SK

 

 

[GetMeOuttaThisMess]

9 hours ago, sk732 said:

My biggest pet peeve is ventriloquism by the patient and the significant other in the room.  When I ask what that person is feeling and someone who really doesn't know answers, I actually will ignore them the first time and, continuing to look at the person I'm talking to, revisit the question...if they aren't big on subtleties, I look at the one moving their lips and phonating and ask them to stop and let the sick one talk - I usually use the line "You can't read their mind and they need to tell me what's going on.  When I need something that they might not be able to relate to me, I'll look at you and ask."  When kids are involved, if they're at an age that they can talk for themselves, I will talk to them, not the parent...and if it's a teenager and the Mommy is talking, I'll look at Mommy Dearest and ask "Does Johnny talk?"  If she says yes, "Could you please let him - he's 19 years old and you actually have him about 4 developmental stages behind his peers if you don't let him do the talking".  If they don't get the hint, "Johnny is 19 years old, I'm asking you to leave."   In a similar vein,  I hate adult children that belittle and try to talk over their very mentally competent parents and act like they aren't switched on enough to look after themselves.  

Second pet peeve is adult children needing their Mommies and Daddies/Mommies and Daddies needing to be in the room because they're either clueless or the cords haven't been cut yet - you see a lot of intact umbilicals these days...I wouldn't let my mother into a doctor's appointment after I was about 12...at 13, I was booking and walking to my own appointments (as long as my legs weren't broken anyway).

I'm a firm believer that some people should have Dermabond applied to their lips upon entering an ER or exam room and solvoplast applied upon leaving...other option is 1-0 Silk sans lidocaine (that's the one on the end of a darning needle).

SK

 

 

Quickie question, and I'm guilty of this.  If you're the family member do you sit quietly and allow them (patient) to speak or as in my case where I'm speaking for an elderly parent with poor memory recall, I chime in both to provide an accurate history and to also "present" the patient in a succinct and timely manner?  I know, it drives me bat guano as well as the provider and I do the same as you if I have the coat on but when I do it I'm actually trying to save the poor schmuck some time because frankly, they aren't going to take the time to exam the patient or ask the pertinent question(s).  Case in point, my elderly mom's May ED visit for a kidney stone (with clinically significant concurrent conditions that may impact decision making if they check a good 'ol CPK on her, which they did).  The yahoo never laid a hand on her so I'd love to see what his PE read like.

[sk732]

I usually sit quietly until asked if I have anything to add...unless my parent is gorked, then I'll do the talking.  My mother was on the liver transplant list last year and became severely encephalopathic - I did the talking, since my Dad, who liked to think he was medical proxy, wasn't - had to make a decision regarding intubation for a time until her ammonia levels came down enough to ungork her.  My dad has metastatic Ca - I went to his last oncology appointment, hung out and waited until I was asked I if had anything to add or questions.  He's pretty switched on still, despite the fact he only wants to use voodoo medicine - the questions I had were to make sure he actually heard was told to him previously about treatment goals, likely results, etc.  His attending (who looked and sounded about 12 years old) knows who I am and what I do...his resident however, didn't, but the guy did a good job and actually checked him out pretty thoroughly.

There was a time when I had to point out to my mom's hospitalist one time that she needed a tap and he was reluctant to do one because a recent INR wasn't available and it was previously a bit elevated, and other excuses - I had to put PA hat on an point out that there isn't much in the literature that makes that a contraindication...didn't help my mother is a horrible patient to begin with.  I talked with her floor nurse not long after the doc said he'd tap her and he left instead - she called him and pretty much told him to get his arse back and do the tap - for double digit litres.  So I'll do the advocate thing when needed - problem is I'm staff in the hospital she was admitted to, so I have to try to be diplomatic (something I don't do particularly well incidentally) while making a firm point.

SK

 

[Guest ral]

On 8/12/2017 at 9:04 AM, GetMeOuttaThisMess said:

 The yahoo never laid a hand on her so I'd love to see what his PE read like.

I have never understood this.  I have worked alongside many a doc/pa/np who seem to wear a stethoscope as a wardrobe accessory, evaluate from the comfort of a doorway, or read a chief complaint, then start typing in orders.  I tend to stick by the ”Just examine the patient" theory.  Amazing what you can find out.

Have also had the luxury of scribes in one of the EDs I cover.  I would have to specifically instruct them NOT to document anything that I did not state, or examine.  Most were used to documenting complete HEENT and abdominal exams for other practitioners evaluating sprained ankles.  Seriously? You want me to believe you listened for bowel sounds, and palpated for organomegaly on this patient?  I always felt that would be a plaintiff's lawyer slam dunk.  "Your honor, if the doctor is willing to falsify his documentation with regard to his examination of my client, how can we be sure he actually did any part of what he says he did?"  Plus, it just makes you look stupid.