A sample bedside conversation alone with a patient:
Patients are *notorious* for changing their stories, invariably making you look stupid. As if 3rd years need help with that.
Me: "Hi, how are you feeling today?"
Patient: "Oh, just great. Thanks for asking!"
Me: "So you don't have any pain today?"
Patient: "What pain?"
Me: "The pain that brought you to the hospital."
Patient: "Oh, that went away a long time ago, I took some medicine and it went right away."
Me: "So you're not having any pain? At all? Are you sure?"
Patient: "No, no. No pain."
Half an hour later with the attending and the whole team watching:
Attending: "So I hear your pain went away?"
Patient: "Went away?!?! My God, it's never been worse! In fact, I think I'm having a heart attack right now!"
Patients are *notorious* for changing their stories, invariably making you look stupid. As if 3rd years need help with that.
5 comments:
I'm guessing this was an older patient, and a man. I say that because my Father was Famous for this when he was dying from cancer.
I went with him to his Doc's office - we knew he hadn't been able to eat in two days and couldn't keep food down.
He sits down next to young female nurse who asks - "How are you sir?"
Dad launches in with "I'm OK, not too bad, hon, how are you doing?"
Fortunately since I was with him in this case I was able to interject and say - "No dad, she's not being social - she's asking for you to explain your medical status so she can pass it to the doc. You haven't been able to eat in 2 days - tell her that."
Don't give these people a chance to be social if you want the truth - or do and then come back in 10 minutes with a more clinical attitude so they'll drop their social habits.
Good luck with your continued training.
Instead of staring off with the sociable sounding "How are you?" why not start with the medical professional sounding "Why have you come in to the clinic today?" "How are you" comes out of our mouths without us even thinking about it. And so does "Fine, thanks".
We are trained from the get-go to be warm and ask open-ended questions... how silly is that...jmm,...,gdss Pardon Brownie, she's our little brown seal who wanted to help type this comment.
Agree with you, you have to be warm and friendly on the first visit - but you know if someone's in a bed and isn't asking to leave and haven't given you a good reason to stay... your only defense is once the patient has gone down this path on your first visit, remain warm. Then stop back a second time (after the next patient) and say up front you need to collect some clinical infomation... Have a chart in hand and make it a point of tapping the pen so the patient isn't on a greeting but on recording their status. My Dad was totally willing to explain his status he just refused to accept that the nice young lady wanted to hear about all his complaints - he wanted to be nice and have a nice conversation.
I've heard of patients lying in bed before, but patients *lying* in bed?
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