when a patient gets upset

[VivaRN]

Had a situation recently where I was seeing a walk-in for what was supposedly an acute problem that turned into a request for refills on pain meds.

There was a note in the chart from the patient's PCP saying do not refill pain meds. Unfortunately the patient had been seen before as a walk-in by another provider who DID refill these meds. I was therefore bad guy #1 for saying I would take care of the acute problem, but since I don't know your history I could not refill these meds, we'll get you in with your PCP.

What followed was an eruption of epic proportions. I had introduced myself as a nurse practitioner and the patient was now demanding to see "A DOCTOR who will take care of me, ALL of me!!!," saying I was useless and uncaring, get me someone else, when can I see A DOCTOR, and various personal attacks. The response to my efforts at empathy and de-escalation were aggressive at best.

I handled the situation but after it was over was surprised to find myself shaken and blinking back tears. I know better than to take these things personally but it felt like being punched in the kidney.

Have you had an experience like this? How do you handle it when the patient becomes upset (for whatever reason) with your plan of care? Is management available to support you or are you there on your own just saying no?

Thanks

[zenman]

You just ran into your typical drug-seeking patient. Be very firm but don't waste time arguing with them and get backup because they will do everything they can to buffalo you.

A legit pain patient should have a well established relationship with a PCP and backup plans.

[sandnnw, BSN, MSN, EMT-B, APRN]

Oh no, don't waste you time! I've learned these folks usually have *one thing* on their minds, *don't take* their insults, you are not a chef.

I usually offer a smile/handshake and tell them to, "have a nice day" meaning...get the hell out of my office. If they don't then I tell them, "now get the hell out of my office and go find that real doctor." Remember, you are a PRIVATE company! 911 works, use it if you have to.

[BCgradnurse, MSN, RN, NP]

I run into this situation at least once or twice a week. It's incredibly frustrating, especially when a colleague has ignored or hasn't bothered to read the chart. I stay polite and firm.."I understand you're upset but I am not going to prescribe the medication you're asking for". I tell them to go back to their PCP or refer them to a pain mgmt practice. Then I tell them the appointment is over and leave the exam room. We have a system of page codes we can announce if we need help from security. I also ask security to come to the floor before the appt. if I know I have a difficult patient scheduled.

I've recently switched from urgent care to primary care in my clinic, so now I am the PCP. We have a great pain mgmt practice in the area so I refer a lot of patients there. They're wonderful about keeping us pdated on the status of the patients we send them so there won't be any "double dipping" from the pain clinic and our clinic. I honestly don't have the expertise to manage these patients, especially when there isn't a distinct physical cause for the pain. The few that I manage on my own are required to sign a pain mgmt contract. Any violations mean they no longer get controlled substances. No second chances. I've become very tough on this matter. The city I work in has a huge opioid problem and I don't want to contribute to it. These patients can suck the life out of you. You have to learn to keep the appt. short, be polite but firm, and be ready to walk out of the exam room and call security if necessary. It'll get easier as time goes by. And yeah, I got the whole "I wanted to see a real doctor, not some nurse...not some LPN!" speech the other day. My response...."I'll be happy to switch you to an MD for your primary care needs", all the while thinking "Yes!!! I'm rid of you, you jerk.." LOL

[VivaRN]

Thank you all so much for your replies and advice. I've had drug seeking patients in the past, but this was the first one who kept going off about it even after I felt I had made myself clear. It was like, what do I do now? lol. Next time I will leave the room, tell the patient the appointment is over, and if that doesn't work call security. You are right, no one should have to sit there and be insulted.