The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, January 11, 2006

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.

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10 Comments:

Anonymous ron said...

i deal with alot of old 'farts' that like to have things there way. try to learn to ignore their name calling, they probably aren't meaning it in a nasty way, they just call all young women that. (some DO mean it in a derogatory way though). Old guys REALLY like it if you can joke around with them. And/or say things to compliment them. (thats asking alot i know..ha) and when you refuse to give him what he wants, make sure you say "WE will not presribe antibiotics for that" dont use "I"... in the end, you may have to call the "male" doctor in the room..some old farts just wont listen! take that for what its worth..

9:52 PM

 
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

10:01 PM

 
Blogger DrPak said...

That's never a problem in Pakistan. Over here, in the land of the patient, the doctor is king.

However that attitude is also has its drawbacks... Medicine is still in the paternalistic era over here. I'm not sure if that will ever change, of if that's necessarily a bad thing when you've got patients like you had, coming in and DEMANDING a certain drug. Many more, I'm sure come in armed with reams of print paper of websites that tells them exactly what they need to get better. I guess dealing with ever-growing patient autonomy is yet another skill you must master.

11:04 PM

 
Blogger doctor T said...

I don't understand this whole demand for antibiotics thing. You totally did the right thing, but the fault isn't with the patient -- it's with the doctors who will actually prescribe him antibiotics, and also with the previous doctors who never explained the risks of overuse of ABs and gave them to him just to shut him up.

On a related note... have you seen the new commercials that encourage people not to take antibiotics for viruses? They should be directed at the doctors PRESCRIBING unnecessary ABs -- it's not like I can just walk into a clinic and get an AB whenever I think I need it. Or maybe I am fortunate enough to have responsible Dr's.

3:54 AM

 
Blogger Couz said...

Sorry Mimi!

I had to delete your comment because it had way too much identifying information in it. I'm trying to fly under the radar here!

I did get your e-mail, though. I'll be in touch soon!

12:45 PM

 
Anonymous Anonymous said...

Drcouz -- I'm sooooo sorry about that, I wasn't thinking when I posted. My apologies.
-m-

1:37 PM

 
Blogger Nikki said...

Argh. How frustrating. I worked with a doc this summer who used this (admittedly slightly condescending) schpiel, telling the patient, "well, I know you're a sensible person, so of COURSE you know all about the problem with antibiotics being overused for viruses and I'm SURE that's not a problem that you what you would want to contribute to, of COURSE, so we'll just treat it symptomatically, okay dokey?" It worked sometimes, not so much others...but it was pretty entertaining. ;o)

4:42 PM

 
Blogger Nikki said...

Oh, and another one, while I'm thinking of it!

A different doc in the same practice would do the exam and then say, "Well, I've got great news. You don't need an antibiotic." Then he'd explain all the reasons that it was clearly viral. At that point, it's kind of hard to argue that you would have preferred the bad news.

4:43 PM

 
Anonymous charlotte said...

Oh my, your post struck a chord with me. Abuse of antibiotics (heck, abuse of the medical system) is a very strong issue for me. I hate it when people go demand anitbiotics when they don't need it! Apparently it's really bad in my parents circle of friends who winter with them down in Texas - any time my parents had a slight cough they exclaimed "Go to Mexico and get cheap antibiotics! That'll clear it up!!" Le sigh.
Luckilly my parents know not to treat colds with antibiotics and recovered just fine without them. :)

7:12 PM

 
Blogger The Platypus said...

I meet a lot of people who say they've been taking someone's else's abx, usually Keflex. Not only are they taking meds without a clue, their friends or family who initially got the scrip didn't follow the instructions and take them all.

As far as Grumpy, I'd give him a nice big shot of Ceftriaxone in his shoulder. He wouldn't be back after that.

1:29 PM

 

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