Problem Patient 1 Posted by webmaster
on June 20 2007
I had attended a lecture taken by a medical student from United States who spoke about how doctors, specifically emergency physicians can improve their behaviour towards patients. She spoke about introducing yourself first, about telling them goodbye etc, very agreeable. Now what she said was that patients have a right to ask all questions they want and that if she was a patient she would be a horrible patient and give so much trouble to the doctor asking about all the things happening to her, every hour.
Now what would I do if I faced a patient like her? I would simply get somebody else to see her. I will in no way let her get onto my nerves which would affect the care of lot of other patients. And she will be dealt with by another doctor.
The question is why would patients want to behave in such a manner. The biggest thing I hate is a patient who doesn't trust his/her doctor, questioning every move or intervention involving treatment. I don't say that patients shouldn't be informed of their treatment plan. But what irritates is that "advice given by an uncle in US or an article read in some website or magazine" which interferes with patient care.
I had a patient who had a massive MI and LVF. While I was resuscitating him, his relative paid no attention to my words and hands me his cellphone. At the other end was his surgeon who was telling me what to do without even knowing the patients vitals. I had to tell the relative that if anybody was going to save the patient now, it was me. It was not his surgeon. Ultimately the guy managed to shut up, let me stabilize the patient and get a cardiologist to see him. This is just one example.
If a patient comes to a doctor, he should have some amount of trust in him/her. A patient should not come to a doctor and order him to give a certain treatment or medication which was prescribed by someone else.
Such incidents are extremely common in large corporate hospitals. This is partly due to the class of people visiting here who are mostly from the upper section of the society. These people demand that only the consultant of a specialty they choose, see and touch the patient first(even if the choice is wrong!). And partly due to the ignorance of the patients to the presence of a specialty called Emergency Medicine.
I think this kind of problem will always exist. How it is dealt with is upto the skill and experience of the doctor. And this is more difficult for the emergency physician due to the extremely short time period available for patient/attender interaction.
Dr. Imron Subhan Senior Resident Dept. of Emergency Medicine Apollo Hospitals, Hyderabad, India.
I think it all depends on place u r working .People have slowly started recognisng that a doctor who is there in ER is competent enough to handle all cases. What need to be conveyed to other specelities is that the EM is not just Triage any more .As far as answering of Q is concerned i strongly feel doctor in ER should be given enough time by relatives to treat first and then answer.If they still disagree to this protocol they should be directed towards the doors out
considering how young and developing this branch of medicine in india is,i think, atleast for the next five years when em would have definitely found its place in the mci, we as part of emergency medicine should ignore such arrogant /ignorant patients.let me ask you all....how many such patients do we get in our er in one single shift....i suppose the number would be two or three among say an average of fifty patients per shift.do we really need to break our heads over such people and if at all we are inclined to do so i think these are the perfect group of people who are a challenge to our communicative skills.our administrative skills,and through them we should strive to hone our skills.and,if in these situations if patient trust is gained,i think there is nothing else more satisfying and proving one's competence.
We in India have still to wake up to the phenomenon of patients questioning the treatment of Doctors!We have to climb down from a high perch and have a more realistic perspective.
Today it is naive to expect anybody to have implicit trust during a first time patient doctor encounter.
Agreed ,there are instances where someone has to be told off politely so as not to interfere with a patients management but to adopt a defensive attitude towards all patients is not in anybodys interest.
I believe it is just part of a normal birthing process-EM is being increasingly recognised as a speciality area and it is upto us to prove that we are better communicators in times of stress than during the normal routine encounters.The most fascinating part of patient care in this speciality is precisely this-To create a trustworthy encounter,with the patients safety and well being always at the top of our mind-Everything else can wait-(outside if needed!)
I couldn't agree more with Gopalakrishnan. You've really nailed the issue.
We have to realise that it is afterall the patient and his health that matters the most.
Good communication throughout the entire management process only goes on to improve his trust and faith in you.
