Beware the patient you don’t like

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He’s not on my ward, nor is he ( I imagine to our mutual happiness) darkening the door of my clinic. But if he was, I would not look forward to seeing him. 

Generally speaking, I like all of my patients and care deeply for their well being, I also get a lot of satisfaction from looking after them and making them feel cared for. Some of that caring is tied up in my responsibility for their well being, but I genuinely do care for them, 99.9% of them. Sometimes you get a patient that you don’t like. It doesn’t happen often and it usually doesn’t matter as the appointment or the consultation is over rapidly and forgotten quickly. It becomes more of a problem when you have an inpatient that you don’t like.

One of my great leaders (who is in fact married to a nurse) likes to say that if the nurses like you all the time then you aren’t doing a good job;  this is true, my recent frustration with a ward’s inability to record a daily running total of a fistula has meant I have had to “have a word”. I’m not here to be popular and many of my male colleagues are not popular at all or particularly liked, but they are respected and admired. This doesn’t work so well for me, or most women, and whilst I don’t require to be adored by all those I work with and operate on, I struggle to cope with people I dislike or dislike me.

Patients disliking me doesn’t cause me too much bother, I can hide behind extreme frosty professionalism and generally have the upper hand. Pissing off the nurses (rarely) or radiology (weekly) also doesn’t cause me too many problems. Patients that I don’t like cause me problems for many reasons mainly because I don’t want to go and see them, and when I see them I want it to be over quickly. These two things in combination are doubly dangerous and bad and lead to mistakes.

Having insight into this is something that they never teach you at medical school, they don’t even mention it. Beware the patient you don’t like; the man who makes lewd comments when you examine his abdomen, the racist patient who insulted your colleague, the patient who refuses to wash, the lazy one who won’t get out of bed, the angry man who isn’t coping with his diagnosis. They deserve the same service as the rest, maybe even a better service, because they are the ones where you will miss a problem or a complication.

You will fail to detect trouble in the earliest stages that in your pet patient you would have picked up 12 or 24 hours earlier. It might not affect the outcome but it will make you feel terrible and it doesn’t do your patient any good. So if you feel a heaviness in your heart when you see a dreaded name on your clinic or postpone and put off until last on your ward round the one you don’t like, put that feeling aside and go and see them.

The GMC has the following advice:

Establish and maintain partnerships with patients

You must be polite and considerate.

You must treat patients as individuals and respect their dignity and privacy.1

You must treat patients fairly and with respect whatever their life choices and beliefs.

You must treat information about patients as confidential. This includes after a patient has died.10

You must support patients in caring for themselves to empower them to improve and maintain their health. This may, for example, include:

    1. advising patients on the effects of their life choices and lifestyle on their health and well-being
    2. supporting patients to make lifestyle changes where appropriate.

     

    You must work in partnership with patients, sharing with them the information they will need to make decisions about their care,15 including:

     

    1.  their condition, its likely progression and the options for treatment, including associatedrisks and uncertainties
    2. the progress of their care, and your role and responsibilities in the team
    3. who is responsible for each aspect of patient care, and how information is shared within teams and among those who will be providing their care
    4. any other information patients need if they are asked to agree to be involved in teaching or research.9

    You must explain to patients if you have a conscientious objection to a particular procedure. You must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs. If it is not practical for a patient to arrange to see another doctor, you must make sure that arrangements are made for another suitably qualified colleague to take over your role.17

     

    Show respect for patients

    1. You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.12
    2. You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.17
    3. You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should:
      1. put matters right (if that is possible)
      2. offer an apology
      3. explain fully and promptly what has happened and the likely short-term and long-term effects.

     

    There are very few problems that don’t seem better after you have done a ward round.

     

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