Don't come to the hospital if you don't want treatment!

[monkey68]

Just saying, if you don't want to be treated, and refuse to be examined and treated by every doctor that walks into your room, don't bother coming into the emergency department. And then don't be surprised when we can't find an admitting physician to accept you as a patient with your non-emergent case.

 

[glitterkittyy]

Interesting. Maybe a family member forced them to come? Can't imagine why else you'd waste your time unless you have a mental illness or something.

 

[smkiya]

Interesting. Maybe a family member forced them to come? Can't imagine why else you'd waste your time unless you have a mental illness or something.

You'd be very surprised...

I see tons of people who are noncompliant at home, who come into the hospital with a legitimate emergent illness. Once they become 'stable', they don't want this, they won't take that, they want double meal portions, and if we don't discharge them fast enough or follow their treatment plan, they leave AMA (against medical advice). Then 2 weeks later they are back with the same problem. It happens all the time!

I think it's lack of education that makes people apathetic about their care. Not even 'school education', but health education. Health education is severely lacking in this country and very few people seem to care.

 

[Disney Doll]

You'd be very surprised...

I see tons of people who are noncompliant at home, who come into the hospital with a legitimate emergent illness. Once they become 'stable', they don't want this, they won't take that, they want double meal portions, and if we don't discharge them fast enough or follow their treatment plan, they leave AMA (against medical advice). Then 2 weeks later they are back with the same problem. It happens all the time!

I think it's lack of education that makes people apathetic about their care. Not even 'school education', but health education. Health education is severely lacking in this country and very few people seem to care.

And don't forget, they also "know their rights"...

 

[supercarrie]

I had the opposite problem last week. Went to the ER with pain resulting from a kidney stone. Had a HORRIBLE doctor who refused to provide any treatment (she just gave me more codeine pills, exactly the same as the prescription I have and had taken already) and told me to come back the next morning - if I was still in that much pain then, they would consider giving me meds. Her argument was I had no signs of bleeding so it couldn't be a stone - despite my previous bouts with them not always showing signs of bleeding.

I ended up passing the kidney stone in the hospital bathroom so luckily the pain subsided and I could go home.

Needless to say, a complaint has been filed and I doubt I'll be going back to that ER the next time I have kidney stone pain. (I had a stone in my right kidney and one in my left is still there - this was confirmed on a scan a few weeks ago, so it is not like I was making it up to get pain medicine!)

 

[disney1990]

Sounds like you had a hard day -- sorry!

 

[MizTink]

people are just weird.........

 

[honugirl]

Some patients actually do know what they want and what they need. I tend to know more about my condition and what I need than many of my doctors do (my primary care physician has never dealt with another patient like me). I have explicit written instructions from my dedicated Cushing's specialist of what to do in an emergency and it is to be followed to the letter. If I'm in the emergency room, I KNOW what's wrong with me and I know how to fix it, please, just listen to me!!!!!!!!!!!!! I even have to tell the phlebotomist how to do their job because one of my blood tests is so specialized, they don't realize they have to do special things with it (I can even tell if they've drawn it in the correct tube or not). Sometimes health care providers just need to LISTEN to the patients. We know what we're talking about... Some of us are educated...

 

[smkiya]

You'd be very surprised...

I see tons of people who are noncompliant at home, who come into the hospital with a legitimate emergent illness. Once they become 'stable', they don't want this, they won't take that, they want double meal portions, and if we don't discharge them fast enough or follow their treatment plan, they leave AMA (against medical advice). Then 2 weeks later they are back with the same problem. It happens all the time!

I think it's lack of education that makes people apathetic about their care. Not even 'school education', but health education. Health education is severely lacking in this country and very few people seem to care.

Some patients actually do know what they want and what they need. I tend to know more about my condition and what I need than many of my doctors do (my primary care physician has never dealt with another patient like me). I have explicit written instructions from my dedicated Cushing's specialist of what to do in an emergency and it is to be followed to the letter. If I'm in the emergency room, I KNOW what's wrong with me and I know how to fix it, please, just listen to me!!!!!!!!!!!!! I even have to tell the phlebotomist how to do their job because one of my blood tests is so specialized, they don't realize they have to do special things with it (I can even tell if they've drawn it in the correct tube or not). Sometimes health care providers just need to LISTEN to the patients. We know what we're talking about... Some of us are educated...

There are patients who do know, like you what they need. I am not referring to your particular situation or others like you who know what's going on with their treatment and care. You are proactive, and I appreciate that! I've actually learned quite a bit from some of my patients, because I do listen. But there are not enough people like you who really know about their conditions. I care about all of my patients, and want to see all of them improve. What I get frustrated with is...

The person that comes in with a COPD exacerbation (short of breath, can't breath, change in mental status because hypoxic) and when we stabilize them, they sneak off the floor to grab a cigarette. Refuse to take their nebulizer treatments because "that *bleep* doesn't work"....

The person who comes in with a CHF exacerbation (Congestive Heart Failure), can't breathe because lungs filled with fluid, over 30lbs of extra fluid in the body. They become stable, have received the education about decreasing salts and fluid restrictions and they have family members bring in bottles of water, juice, soda, fill up their water pitchers, McDonald's french fries & burgers, etc.

The patient admitted with hyperglycemia who takes an extra tray or two of dinner, sneaks off the floor to get snack cakes from the vending machines, demands the doctor change their diet to include double portions.....

I could go on and on and on... but that's what I'm talking about. They are in and out of the hospital for an exacerbation of the same condition.

 

[honugirl]

There are patients who do know, like you what they need. I am not referring to your particular situation or others like you who know what's going on with their treatment and care. You are proactive, and I appreciate that! I've actually learned quite a bit from some of my patients, because I do listen. But there are not enough people like you who really know about their conditions. I care about all of my patients, and want to see all of them improve. What I get frustrated with is...

The person that comes in with a COPD exacerbation (short of breath, can't breath, change in mental status because hypoxic) and when we stabilize them, they sneak off the floor to grab a cigarette. Refuse to take their nebulizer treatments because "that *bleep* doesn't work"....

The person who comes in with a CHF exacerbation (Congestive Heart Failure), can't breathe because lungs filled with fluid, over 30lbs of extra fluid in the body. They become stable, have received the education about decreasing salts and fluid restrictions and they have family members bring in bottles of water, juice, soda, fill up their water pitchers, McDonald's french fries & burgers, etc.

The patient admitted with hyperglycemia who takes an extra tray or two of dinner, sneaks off the floor to get snack cakes from the vending machines, demands the doctor change their diet to include double portions.....

I could go on and on and on... but that's what I'm talking about. They are in and out of the hospital for an exacerbation of the same condition.

Sorry, I'm jaded against the medical profession based on my experiences. If you truly listen to your patients, then you are a gem among healtcare providers! It would be a pleasure to have you take care of me.

I laugh and shake my head at the people with O2 tanks that are smoking out front the hospital.

It's hard. Some are long time habits that are really hard to break...

 

[monkey68]

Some patients actually do know what they want and what they need. I tend to know more about my condition and what I need than many of my doctors do (my primary care physician has never dealt with another patient like me). I have explicit written instructions from my dedicated Cushing's specialist of what to do in an emergency and it is to be followed to the letter. If I'm in the emergency room, I KNOW what's wrong with me and I know how to fix it, please, just listen to me!!!!!!!!!!!!! I even have to tell the phlebotomist how to do their job because one of my blood tests is so specialized, they don't realize they have to do special things with it (I can even tell if they've drawn it in the correct tube or not). Sometimes health care providers just need to LISTEN to the patients. We know what we're talking about... Some of us are educated...

You're not the type of patient I'm talking about, you're proactive, which is great, especially since not too many people are familiar with Cushing's. But you also have to appreciate you are not the general public that we're talking about. Most people do not have issues like these, but rather have common problems but are otherwise healthy, or they have problems that you see all the time that drive you crazy. I went on another consult where the patient had a partial small bowel obstruction. The treatment is initially nothing by mouth. As soon as we told him he can't eat anything, he ran off. So instead of staying in the hospital, where he can be monitered to see if he develops a full obstruction and may require surgery, he ran off because he would rather eat that Big Mac and then vomit it up. Sorry, I think I'm just getting bitter.

But again, I'm not venting about the patients that truly know what they're talking about, because you're right, the patient may know more about what's wrong with them because you live with it everyday. We've had patients who were physicians in other countries come and tell us what's wrong with them, and they're usually right. One memorable guy comes to the ER, tells the ER staff he thinks he may have an incarcerated hernia. Of course he's right. He also has some other issues, and required a transfusion. We noticed he spiked a temp. We go into his room and he tells us he spiked, but he thinks it was related ot the transfusion. He makes our job very easy. I'm sure you would too. It's the people that have no good reason for acting the way they are that drive us crazy. It's the patient that insists on interviewing all the surgeons on staff and not allowing the house staff to examine her who drive us crazy, the people who bolt as soon as they hear they can't have anything to eat, the people that are smoking from their trachs and then come back to the hospital with a COPD exacerbation that drive me crazy.

Sorry for the rant, but it was a long night, and I always feel crappy on the post call day because you never get enough sleep. I was essentially awake for 27 hours straight, and then I couldn't sleep much when I got home, because if I do, then I don't sleep at night and I need to wake up early tomorrow morning.

 

[NEVERENOUGHWDW]

Some patients actually do know what they want and what they need. I tend to know more about my condition and what I need than many of my doctors do (my primary care physician has never dealt with another patient like me). I have explicit written instructions from my dedicated Cushing's specialist of what to do in an emergency and it is to be followed to the letter. If I'm in the emergency room, I KNOW what's wrong with me and I know how to fix it, please, just listen to me!!!!!!!!!!!!! I even have to tell the phlebotomist how to do their job because one of my blood tests is so specialized, they don't realize they have to do special things with it (I can even tell if they've drawn it in the correct tube or not). Sometimes health care providers just need to LISTEN to the patients. We know what we're talking about... Some of us are educated...

I wouldn't assume you always know what's wrong.
I also wouldn't assume all health care providers don't have the ability to listen.

I do have an ounce of advice, take it or leave it......ER professionals really get ticked when their told how to do their job.

 

[honugirl]

You're not the type of patient I'm talking about, you're proactive, which is great, especially since not too many people are familiar with Cushing's. But you also have to appreciate you are not the general public that we're talking about. Most people do not have issues like these, but rather have common problems but are otherwise healthy, or they have problems that you see all the time that drive you crazy. I went on another consult where the patient had a partial small bowel obstruction. The treatment is initially nothing by mouth. As soon as we told him he can't eat anything, he ran off. So instead of staying in the hospital, where he can be monitered to see if he develops a full obstruction and may require surgery, he ran off because he would rather eat that Big Mac and then vomit it up. Sorry, I think I'm just getting bitter.

But again, I'm not venting about the patients that truly know what they're talking about, because you're right, the patient may know more about what's wrong with them because you live with it everyday. We've had patients who were physicians in other countries come and tell us what's wrong with them, and they're usually right. One memorable guy comes to the ER, tells the ER staff he thinks he may have an incarcerated hernia. Of course he's right. He also has some other issues, and required a transfusion. We noticed he spiked a temp. We go into his room and he tells us he spiked, but he thinks it was related ot the transfusion. He makes our job very easy. I'm sure you would too. It's the people that have no good reason for acting the way they are that drive us crazy. It's the patient that insists on interviewing all the surgeons on staff and not allowing the house staff to examine her who drive us crazy, the people who bolt as soon as they hear they can't have anything to eat, the people that are smoking from their trachs and then come back to the hospital with a COPD exacerbation that drive me crazy.

Sorry for the rant, but it was a long night, and I always feel crappy on the post call day because you never get enough sleep. I was essentially awake for 27 hours straight, and then I couldn't sleep much when I got home, because if I do, then I don't sleep at night and I need to wake up early tomorrow morning.

I can totally see where you're going. Yup, I've seen those people too. I usually laugh at them because I know where they're going to end up... Some people will definitely drive you crazy.

It's hard to be in my position too 'cause medical people tell me I don't know what I'm doing, I don't know things, etc. Or we end up with bizarre things happening and docs just look at you like you're growing 3 heads. I can't count the number of times I've told docs, no vicodin, I'm allergic and what do they try to give me? Or I've told them, no cipro, it can cause tendon rupture in a patient like me. What do they insist on giving me? Cipro.

Guess it's not easy to be on either side of the coin at times...

The general public could educate themselves a lot more. Maybe because I've got a rare disease and had to fight for my diagnosis (I knew I had it, but docs denied it for YEARS) that I had to educate myself. I think when you have something common, people think it's no big deal, or those complications won't happen to me, one little cake won't matter, etc. I know that I trashed my body pretty bad when I was first diagnosed (I still do it on bad days) because I was so ticked at it for letting me down. I used to be an athlete, now I'm lucky if I get out of bed and run a few errands during the day. I gave up caring about my body because I figured I wasn't going to live long enough for it to matter. I also had in my mind that it won't matter since no matter what I do, I'm not going to lose weight and I'm going to be fat anyway, so why not eat what I want? I'm really trying to change that. It's the control factor, trying to control a life that's so out of control. Ignorance plays a factor too. If I don't think about it, it's not there...

 

[honugirl]

I wouldn't assume you always know what's wrong.
I also wouldn't assume all health care providers don't have the ability to listen.

I do have an ounce of advice, take it or leave it......ER professionals really get ticked when their told how to do their job.

OK, I guess I should say, I don't always know what's going wrong, but if I do have a certain constellation of symptoms, then yes, I can almost 100% tell you what the first 5 or so things you should do for me and the letter from my endo applies in ALL situations, no matter what. Time can be of the essance, an adrenal patient can go downhill faster than most people expect. So give me the meds, sailine, check the elecrtolytes, etc. After that, you can do whatever you want.

I don't say that ALL health care providers don't listen, but a good majority don't. I gave all the puzzle pieces to my docs for years, they just didn't listen or take the time to put them together. I've beat my head against walls for years dealing with medical professionals. Like I said in a PP, I'm really jaded. Nonetheless, I'm generally very polite and courteous when dealing with docs, nurses, etc.

 

[laurie31]

There's 3 different types of patients being discussed here. The "Honugirl" type, I happen to like both because they DO make it easier (I'd rather hear that I'm putting a lab in the wrong color tube than have to go back and redraw it later - and I'm sure the patient would too!) and because they do know themselves and their bodies. I have seen co-workers get upset thinking they were "telling me how to do my job" when that's not it at all. People like this really DO know!


Then there's the pure and simple noncompliant type. The ones sneaking food when they shouldn't eat anything, the diabetics who never check their blood sugar, and the ones smoking while on oxygen. Yikes. These people are just frustrating, because you know no matter HOW well you take care of them, no matter how long you spend trying to explain what they need to do and why - in a way they can understand, they are going to go off and do whatever the heck they want and slowly kill themselves, and it's hard to watch. It makes you wonder why you bother.

Them there are the types I believe were mentioned in the OP. The ones who come into the ER with non-specific symptoms and demand you help them, but they don't want to be examined, they don't want any tests, but yet someone is supposed to magically figure out what's wrong with them. These are the ones that we think to ourselves "WHY ARE YOU HERE?????" Maybe they're afraid of the diagnosis, or the bill, or who knows what, but if they won't allow any treatment, then why do they bother coming in at all?

Get some sleep, monkey!

 

[Disney Doll]

Some patients actually do know what they want and what they need. I tend to know more about my condition and what I need than many of my doctors do (my primary care physician has never dealt with another patient like me). I have explicit written instructions from my dedicated Cushing's specialist of what to do in an emergency and it is to be followed to the letter. If I'm in the emergency room, I KNOW what's wrong with me and I know how to fix it, please, just listen to me!!!!!!!!!!!!! I even have to tell the phlebotomist how to do their job because one of my blood tests is so specialized, they don't realize they have to do special things with it (I can even tell if they've drawn it in the correct tube or not). Sometimes health care providers just need to LISTEN to the patients. We know what we're talking about... Some of us are educated...

But that's not what the OP is about. The OP is about that patient who doesn't let you do anything, not about the patient who knows what they need and tries to work together with the healthcare people.

 

[monkey68]

There's 3 different types of patients being discussed here. The "Honugirl" type, I happen to like both because they DO make it easier (I'd rather hear that I'm putting a lab in the wrong color tube than have to go back and redraw it later - and I'm sure the patient would too!) and because they do know themselves and their bodies. I have seen co-workers get upset thinking they were "telling me how to do my job" when that's not it at all. People like this really DO know!


Then there's the pure and simple noncompliant type. The ones sneaking food when they shouldn't eat anything, the diabetics who never check their blood sugar, and the ones smoking while on oxygen. Yikes. These people are just frustrating, because you know no matter HOW well you take care of them, no matter how long you spend trying to explain what they need to do and why - in a way they can understand, they are going to go off and do whatever the heck they want and slowly kill themselves, and it's hard to watch. It makes you wonder why you bother.

Them there are the types I believe were mentioned in the OP. The ones who come into the ER with non-specific symptoms and demand you help them, but they don't want to be examined, they don't want any tests, but yet someone is supposed to magically figure out what's wrong with them. These are the ones that we think to ourselves "WHY ARE YOU HERE?????" Maybe they're afraid of the diagnosis, or the bill, or who knows what, but if they won't allow any treatment, then why do they bother coming in at all?

Get some sleep, monkey!

I think you nailed it right on the head. I was definitely annoyed by the third type the other night. I think we can add a 4th... although it's not exactly the patient's fault. The stupid consult patient. We got consulted on a guy yesterday who is in the cardiac care unit, with a trach and a PEG tube (bad combo since it usually means a bad prognosis). He had complained of some abdominal pain and vomited once in the CCU, so they do an ultrasound. For some reason, the radiologist decided to say it could be acalculous chole, even though the gallbladder was read as looking normal. Since they said that, the CCU team almost had to call a surgery consult. They apologized when we showed up, because they knew there was no way this guy was going to survive a trip to the OR. They didn't think that he would survive the transfer from the stretcher to the OR table, let alone the operation. At least they apologized for that consult. But it's a very painful consult, especially when it happens at 1 am.

 

[laurie31]

I think you nailed it right on the head. I was definitely annoyed by the third type the other night. I think we can add a 4th... although it's not exactly the patient's fault. The stupid consult patient. We got consulted on a guy yesterday who is in the cardiac care unit, with a trach and a PEG tube (bad combo since it usually means a bad prognosis). He had complained of some abdominal pain and vomited once in the CCU, so they do an ultrasound. For some reason, the radiologist decided to say it could be acalculous chole, even though the gallbladder was read as looking normal. Since they said that, the CCU team almost had to call a surgery consult. They apologized when we showed up, because they knew there was no way this guy was going to survive a trip to the OR. They didn't think that he would survive the transfer from the stretcher to the OR table, let alone the operation. At least they apologized for that consult. But it's a very painful consult, especially when it happens at 1 am.

Yeah, that one isn't the patient's fault. It's more a system problem. In the same catagory, there are the "stupid pages."

For example, I had a patient who DEMANDED cough syrup in their IV. Yes, a pneumonia patient. (No, we do NOT give cough suppressant to someone sick enough with pneumonia to be hospitalized. That is a BAD THING). But not only did this person want the cough suppressant that could have made them sicker, they did not want to have to TASTE it, so they wanted it IV. I tried and tried to explain that this was not possible, you can't put cough syrup in an IV but they DEMANDED I call the physician and get an order. So I finally had to call (because I'm a lousy liar - I couldn't tell the patient I'd called when I hadn't) and apologize all over the place for bothering the MD for something so ridiculous and then listening to her say, "They want WHAT??" Then, after I told the patient I'd talked to the doctor about it, they called their private MD *at home* to ask the same thing. Wow.

 

[bumbershoot]

Have you ever asked the people, kindly not combatively, why they are there? What they want???


I was forced to the hospital against my wishes. For no solid reason based in reality, just "you ran out of time" reasons. Oh and I was lied to about the reasons for being there. And didn't realize it until it was way too late.

It is REALLY too bad none of the nurses or doctors stopped to just say "why are you here?" Because if they had done that, I could have answered, we could have figured out that it was not the best place. They could have figured out why I didn't want them to DO anything to me, wanted them to just leave me the heck alone, and I could have figured out that they were not interested in NOT bugging me. If they'd asked that, or if I could have worked out a way to just STOP everything and talk to them....things would have been quite different.

I do have an ounce of advice, take it or leave it......ER professionals really get ticked when their told how to do their job.

Aw, poor things....

I do not, no, I CANnot, feel sorry for ER employees who get patients who maybe don't want the treatment. If someone doesn't want what you have to offer, just take a breath, and just let them be. Move on to the next person. Maybe they'll want what you have to offer.

 

[NEVERENOUGHWDW]

Have you ever asked the people, kindly not combatively, why they are there? What they want???


I was forced to the hospital against my wishes. For no solid reason based in reality, just "you ran out of time" reasons. Oh and I was lied to about the reasons for being there. And didn't realize it until it was way too late.

It is REALLY too bad none of the nurses or doctors stopped to just say "why are you here?" Because if they had done that, I could have answered, we could have figured out that it was not the best place. They could have figured out why I didn't want them to DO anything to me, wanted them to just leave me the heck alone, and I could have figured out that they were not interested in NOT bugging me. If they'd asked that, or if I could have worked out a way to just STOP everything and talk to them....things would have been quite different.




Aw, poor things....

I do not, no, I CANnot, feel sorry for ER employees who get patients who maybe don't want the treatment. If someone doesn't want what you have to offer, just take a breath, and just let them be. Move on to the next person. Maybe they'll want what you have to offer.

Why would you assume someone from the staff didn't ask there "why are you here"?