A THERAPEUTIC TIRADE
I am fresh off of a 75-hour stretch of hospital work within the span of five days. I am slowly emerging from my zombie-like state and brimming with stories that are wacky, wild, and weird. Doctoring is a role where many people unreservedly hand you their crazy and expect you to do something with it. If you don’t have a firm handle on your own crazy, then you will lose your center of reality and find yourself entrenched in the fruitless task of attempting to solve problems that aren’t yours to solve. Patient shenanigans have been at an all-time high lately. It would be impossible for me to capture all of it in a single blog entry so I will share some of the highlights:
§ The eighty-year-old Italian man who felt the need to repeatedly tell me how much he loves black women. “They drive me crazy!” he said repeatedly as he stroked my gloved hand. “If you know any single black women in their 70s or 80s, give them my number, would ya…unless, of course, you’re interested…” Classic DOM syndrome (Dirty Old Man). Yuck.
§ A young lady who drank a bottle of antifreeze then took a photo of the empty bottle and sent it to her mother because she was angry with her. When asked why she did it she would say things like, 'It was an accident,' 'I didn’t know it was dangerous,' and 'I just wanted to know what it tasted like.'
§ A patient whose wife cussed me out because I wouldn’t prescribe her husband home oxygen. The man is a dialysis patient with amputations of both legs and chronic lung disease who got sick with COVID. He was fortunate enough to recover quickly with antiviral medications and steroids. Rather than celebrate this she became furious that he didn’t qualify for home O2. That wasn’t my opinion, it was an objective fact after completing the home O2 qualifying test required by all insurance companies in order to cover the cost. I wasn’t about to risk my license committing insurance fraud just to appease her. She looked ready to take her earrings off and settle things in the street. Instead, I walked out in the middle of her shouting at me and directed the nursing staff to have security escort her out.
§ This one is a doozy. An 18-year-old girl with multiple autoimmune diseases including diabetes and cirrhosis. The poor girl looked like Mr. Stay Puft even after we drained 2 liters of fluid from her abdomen. The day she got admitted she asked me if she could get discharged to get married in a few days. I gave her my usual spiel about her not being medically cleared but that she was welcome to discharge against medical advice at any time and reap the consequences. She seemed resigned to remaining in the hospital after that. She spent the next few days cramming her pie hole with cake, cookies, and McDonald’s that her mother and fiance would bring to her. She would then try to overmedicate herself with insulin to account for these high carbohydrate ‘meals.’ As I was about to round on her Saturday morning, I noticed a few gentlemen standing outside of her room dressed in tuxedos. I knocked on the door and found her in the process of dying her hair Kool-Aid red. “Could you come back in a few hours? I’m about to get married.” She said this matter-of-factly, the same way you would say ‘I’m about to go to the grocery store to get some Chex mix.’ Never mind that she couldn’t stand or walk from the profound swelling and needed IV narcotics to control her abdominal pain. I made a note to recheck her ammonia levels later on. No way this girl was in her right mind. ‘Sure thing. I’ll just come back after I’m done seeing everyone else.’ I stopped short of offering an insincere congratulations. ‘I hope things go well for you,’ I finally said. Now that statement I truly meant. The following day, she signed out of the hospital against medical advice, I presume, to take her honeymoon. I was left wondering if COVID and COVID-related precautions have had the unintended consequence of causing widespread, clinical insanity. I’m a decent writer but I couldn’t make this stuff up if I tried.
Doctors need their own regular sanity checks and therapeutic interventions just like everyone else. I am a firm believer in the therapeutic rant. Most of my frustrations are easily abated by some good old-fashioned, no holds barred, healthy ranting. Full disclaimer: the remainder of this post will involve extensive ranting. If you don’t like ranting, stop reading now. I mean, right now. I am about to go hard on a number of things that patients do that drive me bonkers. If you walk away feeling offended after reading this, you will get zero apologies from me. Consider yourself thoroughly warned.
As follows is my top 10 list of things that patients do that irritate their doctors, in no particular order:
10. Family members who speak for or constantly interrupt the patient despite the fact that this person is fully capable of speech and comprehension. Somehow, said individuals, are capable of diagnosing the patient despite a lack of medical training and a medical license. Then they end up monopolizing the remainder of the visit by prattling on about their own medical issues. Super inappropriate. There is a difference between advocating for your loved one and taking over their visit. Most doctors will ask for your input or clarification if it is needed. Unless the patient has dementia, is under sedation, or is extremely confused from illness or medication, they should be permitted to interact with their doctor directly. If you feel the need to interject with important information, then have the courtesy to request to do so. Please stay in your lane and let us do what we are trained to do. If you’re unhappy or uncomfortable with the care then speak with the office manager, complete a patient satisfaction survey, or express your concerns to your loved one privately.
9. Patients who consult Dr. Google for every minor symptom they have. They then get freaked out about worst-case scenarios that also happen to be pretty unlikely and then expect you to blindly do whatever Dr. Google recommends rather than utilize your many years of education and expertise to make an accurate diagnosis. We get that you’re going to Google stuff. We do it too. But Google doesn’t know your personal medical history. Google can’t do a physical exam and order the pertinent tests that you need. Google can’t do a follow-up assessment to see if an intervention was helpful, consult the appropriate specialist, or order more sophisticated testing. Do us a solid and park Google (as well as WebMD and other related websites) at the office or hospital door. Avoid the urge to print out 35 pages and then bring them in to review with the time that we don’t have. I beg of you, please just let us do our jobs.
8. Patients who lie about taking their medication. Not only is this counterproductive, but it’s also downright dangerous. I recently had a patient in the ICU with blood sugars persistently in the 40s and new onset kidney failure. He was confused out of his mind and was found wandering around the airport after taking a trip from Iowa to NC by himself. After speaking with the patient and his wife, it was revealed that he hadn’t been compliant with insulin for years but kept telling his primary care doctor that he was taking it. As a result, his dose kept getting increased. About a month prior to this, he decided to start taking the insulin, which was now a whopping 100 units every morning. This was way too much insulin for him and because he was in kidney failure, it was taking days for him to fully clear it from his system. The same can happen with blood pressure medications and other medications as well. We also have other ways of assessing compliance with medication, like lab work and reviewing pharmacy data that tells us how often you are actually filling the prescriptions that we write. If you don’t want to take your meds, just be honest about it. We will probably want to know why and tell you it’s not a good idea to do that, but we mostly function in an advisory role. Ultimately, you can do whatever you want as long as you are not posing an immediate harm to yourself or others. But we need to be provided with honest information so that we don’t compound the problem.
7. Patients who lie about how much (or how little they eat) and/or how much they exercise. Ma’am, you can’t seriously expect me to believe that you got to 360 lbs with a BMI of 60 by rarely consuming carbs or sweets. You rolled in here on an electric scooter and could barely get out of it to sit on the exam table but you expect me to believe that you walk 5 miles a day? Why lie???
6. Patients who lie about misplacing their narcotics. Here are some of the lamest excuses I have ever heard to explain misplaced narcotics: ‘My prescription blew out of the window while I was driving. I accidentally flushed my pills down the toilet. Someone broke into my house and stole them. My dog/cat ate them. My dog/cat threw up on them. My baby ate them.’ No kidding. It’s safe to assume that most docs are reasonably intelligent human beings. If you’re going to lie, at least put forth the effort to be convincing and consistent.
5. Patients who lie about taking street drugs and/or alcohol use (Why is there SO much lying???). I cannot stress this enough. Most physicians are not stupid. You do not reek of marijuana because you walked into a room where everyone was smoking but you. Don’t tell me you last consumed alcohol six months ago when you are visibly intoxicated and smell like you went swimming in a pool of vodka. We have various tests that can check for all kinds of street drugs as well as commonly abused prescription drugs. If we really want to know the truth, we can just order these tests. Lying about this is unhelpful and hinders our ability to help you. I feel like a broken record.
4. Patients who get angry at us for recommending certain medications/vaccines or for following the rules of our particular institution. If you don’t believe in taking prescription medication, why see a doctor who practices western medicine? I will admit that some docs are entirely too quick to prescribe medication. But if you don’t believe in taking any prescription medication for any reason, then you probably need to see an herbalist or a naturopath. You’re taking up a visit that someone else who doesn’t have those hang-ups might really need. Don’t get uptight with me because I encouraged you to get vaccinated. That’s part of my job. Just politely decline and move on. Having an adult-sized temper tantrum over mask mandates in medical facilities is just plain silly. I shouldn’t have to tell u that frail elderly people and cancer patients with immune systems that have been wiped out by chemotherapy are sharing the same space with you. If you feel the need to grumble or roll your eyes in disagreement, I’m fine with that. But you’re 50 years old, Sir. Why are you throwing things? Better yet, why is this conversation even necessary?
3. Patients who say things like, “I don’t want to take up too much of your time” and then proceed to do just that. I have found myself trapped in my own office, at the grocery store, or on the phone with a patient who wants to talk extensively about things entirely unrelated to their health. They tell bad jokes, or one long-winded tale after another, or rehash most of their life story. They tell me incredibly personal details that I didn’t ask for and don’t need to know to appropriately address their medical conditions. Don’t say “I know you’re busy” and then run your mouth 20 minutes past your appointment having a one-sided conversation. The fact that you know I’m busy doesn’t mean jack to me if you don’t actually care that I’m busy. Don’t act like you weren’t just sitting in my crowded waiting room tapping your foot impatiently because I summoned you two minutes late. Why put on the pretense that you are a considerate person when you are clearly a selfish, time-manipulating oaf? Your motor mouth just cost me my lunch break (which really doesn’t qualify as a break since it mostly involves me shoving food down my throat in between typing frantically). You just guaranteed me an extra 30 minutes of work I wasn’t planning to take home. Thanks for that.
2. Patients who seek medical attention only to refuse or buck heavily against all testing, medication, procedures, and sound recommendations. I see this a lot with genuinely sick people. Type 1 diabetics who keep eating badly and not taking their insulin frequently show up in extreme blood sugar crisis only to leave as soon as they feel slightly better. People who have had strokes and heart attacks from cocaine use repeatedly show up with stroke-like symptoms or chest pain and inevitably test positive for cocaine on their drug screens. Patients with cirrhosis show up with several liters of fluid stretching their abdomens uncomfortably and exhibiting signs of alcohol withdrawal or painful pancreatic inflammation. Patients who make a suicide attempt and then get angry when they are involuntarily committed. Are you seriously asking to go to a hair appointment or worried about not making it to work right now? Did you try to take your own life or not? Being placed on psychiatric hold is not meant to be a good time. I’m not sorry that you can’t have your cell phone, a plastic knife, or any visitors. Don’t make attempts on your own life and you won’t find yourself in this position again.
1. Patients who have unrealistic expectations. Some patients expect you to be their everything; parent, nanny, best friend, lawyer, parole officer, banker, personal assistant, personal trainer, dietician, therapist, life coach, herbalist, schoolmaster, supplement expert, fortune teller, and more. Allow me to set the record straight: doctors do not and will not ever know everything about everything. We do not have a well of endless resources and capabilities. We are not responsible for your poor decision-making and questionable judgment calls. We are incapable of shielding you from well-deserved consequences. It is not our job to rescue you from yourself or your circumstances. Like you, we enjoy sleeping, having a tasty meal, spending time with our families, and the freedom to relax from time to time. My need to cancel your annual physical because I’m being scheduled for an urgent, high-risk pregnancy induction has nothing to do with you. Me taking 12 weeks off for maternity leave is not the worst thing that has ever happened to you. Leaving work early because my kid is sick isn’t an occasion for you to verbally abuse my staff. Regardless of whatever delusions of entitlement you may be suffering from, we cannot pick up your medications, take them to your home, cram them down your throat every day, and then drag you to your follow-up appointment a few weeks later. Parenting my children is hard enough. Parenting adults is insufferable and unnecessary. When I spend two hours of my life combing through your medical record, admitting you to the hospital, updating your family, fielding messages from your nurse, and ordering a plethora of labs, imaging, and medications to thoroughly and safely address your illness, you better believe I am not going to spend even more of my time trying to convince you not to leave the hospital AGAINST MEDICAL ADVICE. Good riddance, Sir or Ma’am.
Thus ends my rant. Man, that was such an incredibly cleansing and satisfying process! If you have made it this far, I thank you for bearing with me. If it sounds like I hate being a doctor, rest assured that this is most certainly not the case. It is precisely because I love being a medical doctor that I rale against the factors beyond my control that interfere with the pure joy of providing excellent care to a sick person. I have written and spoken many times about the broken systems and unjust circumstances in which my colleagues and I are forced to practice. Interacting with the patient and their families should be the best part…and most of the time it is. But it only takes one problematic patient or family to derail your entire day, week, or month. The best patients fill our cups with validation and purpose; the worst patients drain us of our self-worth and sanity. Don’t be that guy…or girl. Cut your doctor a break by not being a shameless jerk. Much love.