My Very First Difficult Patient

It's not that unusual a story for family medicine. A guy calls, describes symptoms that are pretty clearly viral in nature (stuffy nose, sore throat, productive cough, yellow sputum) and demands an antibiotic from his family doc (my preceptor). The doc sends a message back through his office staff that the man should treat his illness symptomatically and recommends a decongestant and a cough syrup. The man calls back and angrily demands an antibiotic since 'that's worked for him before'. The doc sends another message through his staff that if the guy feels that he needs an antibiotic he should come in for an assessment. The guy called back a third time, made a fuss, but agreed to book an appointment.

Somehow, I ended up seeing him. He was an older guy, gruff, and confrontational as hell. He wanted an antibiotic and asked for it by name. Apparently, they give it to him at the walk-in clinic whenever he asks for it. I examine him... swollen lymph nodes, red throat (no white exudate on his tonsils), ears clear, chest clear... clearly viral. I explain this to him, as well as the dangers of antibiotic overuse. He doesn't want to hear it. He's being rude and condescending, and keeps calling me 'honey'. I am seething. I want to tell him that I find being called 'honey' offensive and that I would prefer if he would call me by my given name. I want to tell him that if he thinks that he knows more about medicine than I do than he's welcome to prescribe his own damn antibiotics. I want to tell him that he's an ass. But I smile and nod, and try to reason with the bonehead.

Finally, I give up. He's obviously not taking my word for anything, since I'm just a little 'honey' who clearly doesn't know what she's talking about. So I have my preceptor come in, who repeats all the same stuff that I just said. The man leaves without antibiotics.

Will he simply go to a walk-in clinic to get what he wants? Maybe. Did I chicken out of the confrontation by having my preceptor come in and tell the guy that he didn't need antibiotics? Probably. Will I handle this differently next time? Most likely. I just haven't figured out how yet.