Patience for Patients

There’s an overused, knee-slapper of a joke tossed around in the health care field that “medicine would be great if not for the patients.”  It’s a little cheesy and generally evokes an eyeroll or a sympathetic laugh, but its roots in reality are undeniable and its candor is something to which most people in the medical field can relate at some point or another.

One of the first things I learned when I started working as a PA is that despite your best efforts and preparations, there is a lot that can’t be taught in school.  You can’t be taught to give a patient bad news.  You can’t be taught time management.  Although it would be helpful, you can’t learn from a textbook or powerpoint the art of arguing with insurance companies or coping with endless paperwork so patients can get the prescriptions/tests/referrals they need.  I could continue this list ad nauseam.  But often the most common and challenging aspects of medicine – that have little to do with medicine itself – are the personalities of everyday patients.

I hope I don’t appear ungrateful, grumpy or disgruntled in this post (although at times I am probably a little of all these things).  I love patient care. I have a good job. I love feeling I’m doing some small good in the world by helping others, and I truly enjoy the broad spectrum of ages, races, health conditions, income levels, demeanors and quirks that comes with family care.  But when it comes right down to it, sometimes patients can be real A-holes.  To someone outside of the medical field, I hope you don’t judge me a burnt out jerk.  I am not.  And for the record, even to the buttholes I am nice.  Having been a patient myself, I know it is a scary and vulnerable position; I know first-hand it can be emotional, frustrating and expensive.  This encourages me to be empathetic and sympathetic.  But because at the time of this particular post I am overtired and hormonal and more easily exasperated than usual, I feel inclined to offer insight on the most common offenders that make our jobs much more difficult than need be.  Perhaps by sharing you might get a laugh, or even nod in agreement.  And if you ARE one of these people, then perhaps you will make changes to get off this list or at least be kind to your provider while being a pain in our backside.

#1: The Noncompliant Victim.

I have allergies and 14 cats.    WHYYYYY am I so SICK????

I have allergies and 14 cats. WHYYYYY am I so SICK????

Even people with the healthiest of lifestyles get sick.  Sometimes it’s bad genes, bad luck, or a nasty accident.  Sometimes there’s no real reason at all.  But a lot of patients cause– or fail to improve – the diagnoses themselves.  People make poor decisions all of the time.  My drug of choice, for example, is an oversized jar of Nutella and a spoon.  I’m not proud.  But those who fail to acknowledge or change their ways, knowing they are sick, are among the most frustrating to treat.  The man with the chronic cough who continues to smoke two packs a day curses his inhalers for “not doing their job.”  The diabetic with the 20 oz. Mountain Dew peeking out from her purse blames me  – and those “worthless medications” that her sugar isn’t under better control.  Or the patient who didn’t show up for their previous 3 appointments, shows up a year later for a previous condition that “DIDN’T GO AWAY!”  Despite extensive conversations, education, attempted treatment and every bit of energy I can muster to be understanding, supportive and thorough, the noncompliant leave me feeling I would be more successful beating my head into a wall then spending another second explaining why they need to make their medications.

#2: The Googler.

I might just start selling shirts for The Googler’s that say, “I use WebMD, therefore, I have cancer.”  You know ‘em.  You’ve probably done it (raise your hand if you’re guilty…my arm is getting tired).  I remember early in my college years I got sick and when a large lymph node popped out on my neck, the urgent care doctor said “if it’s not gone in a couple of weeks we’ll send you for biopsy.”  Not having any legitimate medical education at this point, I turned to the internet for the questions I was too embarrassed to ask and saw the words: CANCER. Obviously, it was lymphoma.  Time to drop out, use my measly triple-digit savings account balance to create and fulfill the world’s most pathetic bucket list, and wallow in self pity. Why did the doctor want to wait two weeks? I WOULD PROBABLY BE DEAD BY THEN.

948198-frightened-woman-looking-at-the-computer-screen-in-the-dark-with-the-light-coming-from-the-computer

I thought it was just bad take-out, but now I have diverticulitis, hepatitis, cholera AND lactose intolerance!! What would we do without technology??

But – plot twist! – I didn’t die. I didn’t have lymphoma.  And I never went back (even though it took well over 2 weeks to go away).  I am still here to share the tale that not every symptom indicates a serious, life-threatening, disabling illness.  For the reason I just described, I am not angered by these patients, but they can be…tiresome.  It is essential to educate and explain things to patients – I do and I should.  But it seems these people require all but me promising to give them my next born to reassure that the eye twitch they had last week isn’t a brain tumor.  We are taught to look for and acknowledge the “zebras” (a term for the rare, unusual and serious conditions that you might only see once in a career – if ever – but need to be aware of nonetheless).  But The Googler seems to think they ARE a zebra and as soon as a sniffle or rash or sore throat appears, they jump to the world wide web and are in our office that day for confirmation they have Ebola (they don’t).  To be clear, I am not suggesting people ignore illnesses or concerning symptoms.  But stay away from the internet, give it a day, cut back on the Red Bulls and RELAX and that eye twitch will go away without the charge of an office visit.  And if it doesn’t – or if you start bleeding out the eyeballs – then, well, you should probably get it checked.  With haste.

#3: The manipulator.

Sooooo many manipulators.  Right out of school, bright-eyed and bushy tailed, I was naïve to these individuals.  Diligent and freshly educated, it hadn’t crossed my mind I couldn’t trust a patient.  I needed them to trust ME, after all!  I took every complaint and demand seriously (as I still do, bear with me…) and took in every patient’s sob story with deep concern.  But guess what? People are liars.  Sadly, the majority of these patients fall into the oh-so-familiar category of “drug seekers,” because they will travel far and wide – tell stories big and small – and feign or even create injuries, illnesses and obvious trauma to get their hands on a handful of pills or an injection.  Because my first job was working in an emergency department, I was – fortunately and unfortunately – exposed to the manipulators quickly and frequently.  Since they often burn bridges with “regular” providers, the ER becomes their dealer of choice and they will do and say anything – and I mean ANYTHING – to get what they so desperately need.  Unfortunately the manipulators have ruined things for the general population.  It makes providers less trustful, more reluctant using or prescribing pain medications (not that this is an entirely bad thing), but it also presents the ol’ “boy who cried wolf” concern.  Initially, these patients will likely get unnecessary tests, prescriptions, or referrals because we don’t want to undertreat or misdiagnose their pain or complaints.  After being seen in offices or ERs every 6 minutes, however, their intentions become apparent and when they do have a legitimate injury or illness, they are much more likely to get blown off or ignored.  There starts a whole new barrage of problems I won’t get started on…

Image

I’m allergic to every medication that has ever existed except for Percocet. And…ummm…Dilaudid.

[Did I just import a photo of Nick Nolte?  Yikes.]

I could list at least a dozen more: The “We just met, but I definitely know more than you” king,  Mr. “My life is miserable but I don’t do anything to change it and I want you to be my therapist and fix everything,” and Miss “I regularly show up 14 minutes late for every appointment just enough so you can’t turn me away but I muck up your schedule for the rest of the morning” were close runner-ups among my favorites.  But I’ll spare you any more novellas as you probably want to stab your eyeballs from taking in all this whine.  I’m sure anyone else with experience in the medical field could contribute – and I would love to hear them because misery loves company and I fancy me a communal bitch session from time to time.  Now, if you’ll excuse me, there’s a bucket of chocolate-y hazelnut spread calling my name.

Happy Hump Day!

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One comment on “Patience for Patients

  1. Sue Reed says:

    How can you be so insightful at such a tender young age ???!!! You hit the nail on the head for so many in the healthcare field- I will use this forum to share my personal favorite irritation- the patient who despite an hour long one on one education as to their upcoming surgery with everything that was just told to them is written down for them to read in the comfort of their own home will still tell the hospital staff upon their arrival “I have no idea what is going on, nobody told me anything” – I will NEVER gt that 🙂

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