I was recently asked to assess a very old man who had been admitted to the ward with an exacerbation of his COPD. He also had a background of cardiac conditions. When I approached the patient he was resting in bed and was originally quite happy to have a chat with me. However, as the subjective Ax progressed the patient became increasingly frustrated. I finally convinced him to ambulate with me and he managed about 10m with his W.S before he turned around and headed back to his room. When I asked him why he had turned around he snapped at me and said "here, why don't you try walking for me." I know, it didn't really make sense but as the patient was obviously quite angry I decided to leave him alone until the next day.
When I walked into the patients room the next day he said "oh not this bl**** sh** again." As the patient was lying in bed again I decided there was no way I was going to let him push me away so easily. So I asked him why he didn't want me to help him. I think that stumped him and he realised that I was truly only trying to help. He then stated that he felt ill and wanted to rest. When I asked him why he felt ill he calmly replied that he had a crushing central chest pain that he had never had before. I then alerted the NS and the appropriate management was initiated.
This made me realise that you really can't afford to let patients dictate the way they want to be treated and when they want to be treated. Being in hospital is not an enjoyable time and I think they just have to realise that they are there to get better and its our job to do that, no matter how annoying.
In future I won't be easily persuaded to leave a patient and just treat them later. Although this might help build a better rapport, it may not be giving that patient the most optimal treatment.
What do you think?
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3 comments:
I find this actually really impressive. It is amazing the difference it can make by just re-wording your sentence a little. I'm sure if you had asked "why don't you want to come for a walk with me?" rather than "why don't you want me to help you?" you wouldn't have had near the same outcome. This is a good one, I will keep it in mind in the futur, that really is what we are doing, helping them, not just taking them for a walk!
Adam i was wondering if your alerting them to his chest pain resulted in changing his medical management?
What has he been like since?
Suse
I agree with Sarah, very well put to him! I've had similar 'difficult patients' and have found it hard at times not to just leave them alone. I think it's a fine balance though...If they really are too fed up no matter how hard you try they won't do anything, but if you can carefully spur them on like you did and make them see that you are there for their benefit then you've done a good job!
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