Troublesome patients, troublesome job

“We are not witch-hunting, this is only a learning experience, please dont take it badly...will the houseman and mo responsible for the patient please stand up”

You’ll hear this a lot from our HOD of Medicine during our Friday mortality meetings and whenever there is an issue, or a mistake made...
Make no mistake, I believe the HOD is a good man, and he means what he says, and believes it to be true.and it is..It usually really is a learning experience, and not once did any mistake got out of that meeting unless it couldn’t be helped. Our medical department really does protect their doctors.
The only problem is, no matter how you cushion it, or cover it with sugar, spice and everything nice, it’s still putting blame on someone, and I doubt anyone who gets up likes it.
Fortunately I haven’t had that rather uncomfortable experience – yet.

An interesting thing that happened in our recent meeting was when he produced some actual complaints from ex patients or a powerful relative..
One such criticized the referral letter done by a HO. It was badly done, as the HO had just started, didn’t really ask, and the MO didn’t notice.
Another one was an email sent straight to the MOH, and incredibly stated the name of the HO the patient was complaining about. It was about the unethical ill-mannered way a HO handled the patients in the dengue wards. The houseman wasn’t there, was already scheduled to leave the department the next day, was already a 3rd or 4th poster, and later denied ever taking care of the patient more than blood taking once, without even an exchange of words. But that particular HO could only deny that point, as the HO was known to be brash, and at times ignited the ire of not just the patients.
At that particular moment, the HOD couldn’t even get himself to read the letter, so he asked someone else to read it. The moment the email was about to mention the HO’s name, probably all the HO and maybe some of the Mos held their breath or skipped a heartbeat, including me...everyone had a skeleton in their closet they’d never want to recall.

At one point in my work, I developed that tendency to get mad at every patient complaining of pain/sob all the time....even to the point of patronizing them for disturbing my and the nurses’ work. A patient I once admonished expired during the weekend about two months ago...nothing medicolegal or complaints happened...but it was a painful lesson in a way. Now the worst I could do is be indifferent, but the old temper can still be ignited if rubbed the wrong way, so I became careful. Now I almost don’t sleep during my calls, and I keep going back late, double checking to see if everything’s well. Thankfully my experience the past few months helped me a lot in deciding on management issues.

In another point of view, some patients are troublesome in itself. Those ‘manja’litis patients, or those afraid of needles, or those who even have the nerve to refuse and even get angry at the doctor trying to get a line (which is sometimes hard,depending on the HO’s experience and the patient’s condition). These are the guys whose drug charts would state brenula required instead of the usual initials signifying some iv treatment had been administered. And the MO the next day would have a headache and if on a bad day, would scold the houseman.
Sometimes it’s the relatives that are the problems..the ones nurses complain that they think they’re so important they deserve every minute of the nurses’ attention. Quite frequently these are relatives who are doctors , and they would quite often question the decisions the doctor in charge makes, especially if they know he’s a houseman, and a first poster like me, although they know it’s unethical and they shouldn’t interfere in the relative’s treatment
Usually it’s with these patients I let go of my reins completely. I become really indifferent, I’ll nod at every suggestion, but never really follow them, because that’s what they really want, for me to follow instead of decide. Usually in this case I’ll let the MO decide even the simplest decision, as apparently, that’s what these relatives really want. Of course if they want to do the blood taking, I let them. Less work for me, and less chances of needle prick or another unsatisfied or patient in pain for me.
Not that I couldn’t manage. I have every confidence that I can, to a certain degree, manage simple cases on my own. To disagree with them would only incite anger in me, and just further misunderstanding. To follow their opinions blindly would be stupid. I let the MO discuss and handle the situation.
Of course what would you do if it was your parent in the ward, right?
I try to keep that in mind in every case I handle. But humans can forget.