Saturday, January 29, 2011

The Customers

It’s nice to have friends who are also nurses. A few days ago, one of my very good friends (I’m looking at you, J) met up with me after a harrowing night shift to vent (errr debrief) about a challenging family member who demanded medical care only to refuse every single treatment option offered. I’ve run into far too many similar situations and they’re a pain in the ass to deal with Every. Single. Time. I greatly respect the fact that a patient knows their body better than anyone else and that those who live with chronic diseases often know more about effective treatments than emergency RNs and MDs. I for one welcome the feedback because it not only enhanced my own learning but allows me to provide better care. However, when patients come in armed with a medical degree granted by Drs Wiki and Google and expect us to follow random internet advice to cure what ails them because they are ‘customers’ of the health care system, it’s not going to happen. Ever. Why? Because we use best practice guidelines to provide COMPETENT and SAFE care even if that care contradicts the generous stacks of printouts from magicunicornhealingpower.com. There are LEGAL ramifications to not providing care that is based on sound science.

One of my most irritating encounters happened with a middle aged man who came in complaining of shortness of breath. It was clear he had pneumonia (what with the raging fever, gunky sounding lungs and the dramatic expectoration of army fatigue coloured phlegm) but he absolutely refused the antibiotics citing concerns about antibiotic resistance and his consumer power. And yes, he had stacks of printouts, mostly with ads for weight loss remedies on the side, to ‘argue’ his case. Logic did not have a place in that exam room. I hate to get all flustered, but WTF??! Why bother coming into emerg at all?

This whole business about the customer always being right is total crap when it comes to providing safe, competent, evidence based care to a ‘customer’ who picked up their medical knowledge from internet pop-up ads and snippets of TV shows.

20 comments:

Grumpy, M.D. said...

Bless you! You are SO right!

I don't understand it. If you don't want my help, then why did you come see me?

Syndal said...

oh my gosh how frustrating!! there is so much garbage floating around the internet and people think it's true, and that they know better than we do (even though we have our degrees and our experience to back us up--much more sound than wikipedia!)

SeaSideRobin said...

I wonder why people think that the patient is the customer? Maybe I'm a throwback to the 50s and 60s but when I go to the doctor, it's because he/she actually knows more about medical problems than I do. And not just from reading about it, but from the experience of seeing dozens of similar cases.

Anonymous said...

I've occasionally bounced an idea off of my doc, along the lines of "I've heard that ____, whadda ya think?" Then again, my doc also knows that I'm not a sucker for the latest woo and honestly want science-based feedback.

Old MD Girl said...

But don't you understand? Doctors are just overpaid medication dispensers bribed by the pharmaceutical industry, and nurses are merely servants. God, haven't you learned anything?

Nurse J said...

what treatment options DID the dummy want then? or ALLOW you to treat him with?

Mark p.s.2 said...

re"I don't understand it. If you don't want my help, then why did you come see me?"
Why
My opinion, the people who refuse medical advice from a doctor feel a need to be the one in control. Like those that can not fly in an airplane.

Hopefully the guy with the pneumonia will admit he was wrong, he can trust a doctors opinion before he dies from the pneumonia.

RehabNurse said...

Yes, folks, you are our customers, but you are also paying for our advice.

In the stock market, if you do something other than listen to your stockbroker, all you can lose is your money.

Here in the medical arena, you can lose your life.

Your call...

newnurseinthehood said...

Indeed. I like one of our MD's theories that we need to just let people buy all prescription meds over the counter like they do in mexico, so if they think they're smart enough to treat themselves at home they can go ahead and do it. That way when they come to the ER they'll actually be ready to be treated BY A DOCTOR. Also, laughing my ass off at magicalhealingpowerofunicorns.com

minimedic said...

Wait, someone who DIDN'T want antibitoics? Dude, you never told us that you were working in an alternate medical universe!

So, what did he want?

Danielle said...

It was very much frustrating on the side of the professionals who have their respective degrees. But, I like the question asked by Grumpy. Why do people keep on seeing them, asking for their prescriptions if the patients do not want their help? I you can get your prescription through the internet. And these is a good question that needs an answer.

Danielle

Order taking service

Nurse K said...

Do you Canadians have the wonderful tool known as the AMA/Against Medical Advice form?

People tend to change their mind when they have to sign a form stating that they're okay risking death or septic shock/multisystem organ failure/need for ventilator, etc.

Maybe that alternative cure for pneumonia won't sound so attractive.

Of course, you always have to mention that "dude, there's TV up on the floor with 40 cable channels. What are you gonna do if you go home? Probably lie around on the couch too weak to do anything and watch TV...." That has convinced people to stay.

Anonymous said...

I have worked ER for 12yrs, I will never understand why people come to the hospital, but refuse treatment.

@Nurse K, yep, in Canada we have the same wonderful AMA tool...I have used this many times.

Interestingly, I had a young guy come in, and diagnosed with a ruptured appendix, who was an out of country student. Upon hearing his diagnosis, he decided he would rather fly home to his country of origin to see a doctor there. We tried to impress upon him the severity of the situation (even with the help of a translator, which he didn't really need) but he insisted he was going get on a plane and fly home. He signed out AMA, and went back to his apartment, where he called his mom back home to let her know what was going on...his mom, however, worked as an RN in his home country, and told him to get his dumbass back to the hospital. He came back, and got his surgery.

From the corner of Crack and Hood. said...

Yes, AMA and see ya later buddy

Rhonda said...

OH MY GOODNESS! I totally agree!! I work in my hospitals in-house dialysis unit and the people we get coming in from the ED with SOB due to fluid overload, is crazy. Then they act all bitchy and hostile, like we took them off the streets and made them come in! Then, they dont want to stay for their treatment! I tell them that i dont care if they stay or not, my life doesnt depend on their dialysis, theirs does. Why do people waste their time and our's by coming into the hospital, but refusing care? I will never understand that.

StorytellERdoc said...

Hi Maha...what a great post. Dr.s Wiki and Google--how fricking funny! Anyway, I do find that knowledge is power but somewhere along the line, this knowledge is being twisted more and more often to suit a patient and what they want to hear. Makes me nervous for them to be so staunch in favor of or against what we tell them.

I hope you have a great weekend, friend.
Jim

TracyKM said...

What DO you do with these patients?

Lois said...

Who was it who said, "A little information is a dangerous thing"?

BTW, I love your "magicunicornhealingpower.com"...I assume / hope you made that up? lol!

Adrian said...

I have said this to a few patients.

"Mr/Ms/Mrs X, I hate to inform you that this is a hospital. It is not McDonald's."


"If you feel that your being here is a waste of time, you are free to leave... as I cannot legally or morally detain you...excuse me, for leaving now but I have many ill patients to attend to...."

Guess what happens next.. :)

The patient sure changes his or her tune rather promptly....

I usually follow it up with....

"I understand your concerns and can see you did a good deal of research, however I need to rely on my expert clinical judgement and the unbiased evidenced based practice of medicine....to provide you with the best care possible...so tell me when did you notice yourself starting to get sick?"


This usually allows me to get away with the smack down :) and the patient is gracious come discharge day.......

Hate to say it but at times one needs to revert back to the good old 60's and paternalistic medicine minus the in-office cigarettes and endorsement of such things...LOL

Keep up the great blog entries.

Scrubs said...

It's nice to have others who know what you're going through. It sounds like a stressful day, and I bet you were glad to hang up your scrubs at the end of the day. Thanks for sharing!