My aunt, who had a stroke about 3 years ago was recently admitted to the hospital twice because she fell twice. The stroke has left her limited use of her right side and her eyesight is all but gone. While in the hospital the last time, the decision was made that my aunt should stay in a nursing home temporarily. My aunt has family to visit her and do things for her, but there is no one who lives with her.
When my aunt was told that she was going to the nursing home by her doctor, my aunt leaned toward the doctor (she probably couldn't even see her), shook her finger at the woman, and yelled "I'm not going to the nursing home, and you can't make me." She probably said some more stuff, but she never cursed and she certainly didn't put her hands on anyone. (By the way, it was my mom who told me about this story, I live 200 miles away from my family).
My mother, who is my aunt's younger sister, was able to convince my aunt that this would be in her best interest and that she should go. Going to a nursing home temporarily would be must better than continuing to fall around her home. When my mom went to go get the doctor, she refused to talk to my aunt. The doctor was so upset that my aunt had raised her voice and shook her finger that she refused to talk to her anymore. Well, I have read many of you all's stories on this site, and you all have dealt with A LOT more than that, and still did your job. I am not saying that my aunt was right for shaking her finger and raising her voice, but I can understand why she was upset. I think the doctor should have understood too. My aunt is:
1) Being told that she can't live in the home that she has lived in for the last 60 years or more. She went to the hospital and is told she can't go home (even if it is temporary).
2) She is losing even more of her independence than what she already lost.
3) If she goes to a nursing home she is losing more of her privacy.
4) With losing numbers 2 and 3 you also lose at least part of your dignity.
5) Nursing homes are under more laws to be good nursing homes, but nobody still really wants to be there. Things still happen in nursing homes.
6) She has spent the last 50 years being a grown woman and now she has people telling her what she can and cannot do and she can't do anything about it.
I know the nursing home is certainly for her own good, but I understand why she was upset. I just think the doctor was a little thin-skinned. What do you think? Was the doctor right for being so upset that she didn't want to talk to my aunt? Are the doctors you all work with like that?
Thank you for reading and responding. I know this was long.
I'm so sorry that your family had an unpleasant experience on top of the stress you were already dealing with.
Taking offense when a distraught and elderly patient reacts negatively helps no one. It would have been better for all concerned if she could have said, "I'm so sorry, Mrs. X. You were hoping to go home right away. Let's get you the help you need to move back safely. You can be mad at me if you want. But my main concern is for you to get better."
I hope your aunt will be back in her familiar surroundings soon. She is blessed to have family members that care about her.
Maybe the doc felt that further discussion with the aunt would upset her further? Maybe the doc was a little rattled because they were swamped and really didn't see the need to go back and see the patient again. I would have had to be there to judge the doc's demeanor.."Upset" can be interpreted in many ways..
My MOTHER had no problem with the doctor. My MOTHER did not shake her finger in the doctor's face. That is not like my MOTHER at all. My mother was actually mad at my aunt (her older sister) for shaking her finger in the doctor's face. My MOTHER actually sided with the DOCTOR! It is my aunt who was going to the nursing home, got upset and shook her finger in the doctor's face. My mother has diabetes and cancer helps take care of my aunt, but can only do so much. Mom was there (I was not) and actually got on my aunt about her behavior and convinced her that the nursing home was better than continuing to fall at her house every couple of days.
For some reason it was the nurses who went to the doctor when my aunt changed her mind. Mom was told the doctor was to come back when my aunt changed her mind. My mother was not demanding for the doctor to come back. I'm not saying my Mom is a complete saint, but you would have to do something VERY BAD for her to shake her finger or go off on a health professional.
Not to get off subject, but guess what my mom did for a living in the early to mid 1980s? She was a nurse's aide in a nursing home!!! She was the primary care giver to 2 husbands until they died (one of them being my father). She understands both sides, but she understands how patients can act.
Maybe the doc didn't feel like there was anything more to discuss. Pt yelled and shook finger and said mean things to doc after doc gave professional opinion of what needed to happen. Later (what, that day?), family member approaches doc and says pt has changed her mind about the nursing home. Great. What more needed to be discussed? Frankly, if the doc had other, more important things to attend to (seeing pts sicker than your aunt, getting pts who needed to be discharged out, that sort of thing), why would she come in to see your aunt again? So that your aunt can get mad at her again? What exactly were they going to talk about, that the doc was right and your aunt was wrong? What exactly did you expect the doc to do?
Was this your aunt's assigned doc, or someone who was covering? If it wasn't her regular, assigned doc, I can understand the doc thinking, I said all I needed to say, the pt can agree with me or not, and I don't need to go back in there for anything, much less to be treated disrespectfully again. Let her regular doc deal with that.
Third hand stories are just that; third hand stories. Who knows what all the details were. Maybe your aunt has a history of being a disagreeable, verbally abusive patient, so the doc felt there was no reason to go back. Maybe your aunt frequently changes her mind and her story, so the doc felt that going back in there might just agitate her again and give your aunt the opportunity to get worked up and change her mind about going to the nursing home. Maybe the doc had already initiated a social work consult regarding helping your aunt evaluate her options, and felt there was nothing more for her personally to do in the situation. Maybe the doc honestly had better things to do than repeat her recommendations to an angry patient. Maybe your mom doesn't know the entire story, and doesn't realize the true nature and scope of your aunt's interactions with her caregivers.
I've heard before from families that I didn't evaluate the patient all night (uh, really, because I was in there giving meds every two hours). That I told a patient he couldn't get up to go to the bathroom and had to "p&ss in the bed" (no, I told him he was too unsteady to get up independently and needed to use the call light to ask for help with walking to the bathroom). That I refused to let a patient eat, because she was too fat (your mom is NPO for a scope, for crying out loud). I've been told by family members that their mother couldn't possibly be as violent and awful as I said she was (really, because everyone else on this floor heard your mother use terms that would make a sailor blush when she attempted to use all her power to pull out her lines and foley. I have the bruises and scratches on my arms and back to prove how awful your mother is, and I don't feel the need to go in there any more than is necessary to provide her with good care).
So I'm skeptical that your third hand story is cannon. Was your mother there at the interactions between the doc and your aunt? If not, how do you know exactly how the aunt spoke to the doc and whether she made any threatening gestures? Was she there 24 hours a day, to see what sort of history your aunt has with the staff? And what purpose did your family think another visit from the doc served? If the plans were in place and wheels in motion, what point is there to having the doc come in again?
Finally, maybe your aunt will learn to treat people with respect. Sorry, but if she's in her right mind (and I have no idea if she is or not, based on your info), whether she's upset or not doesn't give her the *right* to yell, call people names, and put a finger in someone's face. If she were in her right mind, and I didn't *have* to see her for any treatment issues, I'd probably refuse to see her again, too. My time's too valuable to be taken up with unproductive interactions with rude people.
I know my post was long, and I appreciate each and every comment, but I think you missed out or misread some key points.
Maybe I did. I was trying to provide the physician's perspective, on why she might have decided not to see your aunt again that day.
So, did any physician at all (or someone else like a social worker--they make all these arrangements at my facility) see your aunt for follow up later? Or did the doc actually fire your aunt?
I don't know if the doctor is still involved. I know my aunt is currently in the nursing home (and has made friends with her roommate). I believe it was a social worker who made the arrangements.
Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
If i were the doctor i would not have gone back in. Sounded like the patient needed some cooling down time and to wrap her head around the nursing home idea. The doctor probably referred the manner to the discharge planner who can assist the pt and the dpoa--may have more time to discuss the alternatives. It's called delegation. Why should the doctor further annoy an already angered patient? Probably would have gotten yelled at again.
Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
I don't know if the doctor is still involved. I know my aunt is currently in the nursing home (and has made friends with her roommate). I believe it was a social worker who made the arrangements.
Most likely the doctor is not involved. Your aunt probably has a doctor who is assigned to that particular nursing home. It's good that she gets along with her roommate. Sounds like the doctor did well by not going back in the room to further annoy your aunt. Sounds like the doctor appropriately delegated the nursing home discussion to a discharge planner who was able to place your aunt in a nursing home.
I know my post was long, and I appreciate each and every comment, but I think you missed out or misread some key points.
Actually, I agree with the many of that post's points and, yes, I did read your thread.
Do I agree that the MD may have been rattled, and that optimally should have been able to return. Perhaps. At the same time, we do not know the length of relationship that this MD had with the pt, or previous interactions.
Often if both/either side is upset and/ or abusive (and the pt was indeed abusive, and if in her right mind, intentional so), it is best for BOTH parties to step back for some time to cool off. And I strongly believe that may have been what the MD did.
You also don't know what else was going on. If there are some near codes, critical issues, or she has to tell someone that they are terminal. Knowing that your aunt has been inappropriate to her, the MD knows that she will have to take an extended period of calm, uninterrupted time to speak with her. This is difficult to do with many issues possibly going on. It will be best to wait until she has that time to address a stressful situation with a pt that has demonstrated a certain amount of difficulty accepting an issue.
And it really does not matter what care you mother or any relative has provided in the past. Relatives and friends always see pt care issues through very different eyes when it is a loved one lying in the Pt bed. I have seen MDs, RNs, act like Atilla the Hun, and outright misrepresent things when it involves family. Just because Mom been a caregiver does not mean she has full knowledge of what has gone, or is going on in the facility at that time. It also makes this second hand account, wherein we do not know all the details.
As an aside, after a recent shooting, in many cases, legal has advised that greater care is taken to allow people to calm down when behavior escalates, before returning to converse with an irate pt. Hospitals are no longer safe places- I have seen disabled elderly mace, scratch, gouge, break a vase and threaten with it, try to abuse their roommates that didn't want to watch the same TV show, spit on people, etc. As healthcare workers we shouldn't have to deal with this, but unfortunately we do. People should plan for the possibility of longterm care as responsible individuals but don' t, and then behave badly to those that are the bearers of bad tidings. If the MD was upset ( and given that the public wants us to be compassionate, warm, feeling people - they can't expect us to not be hurt) It would be the right thing to do, to cool down before reentering a potentially volatile situation.
The other issue is what is the purpose of this post. Is it to validate that the pt can abuse the healthcare worker, and the HCW needs to take it with a smile on the face, and immediate tolerance and forgiveness in their hearts. Or is to validate complaining against this MD.
If your family does not wish this MD to continue caring for your Aunt, please feel free to seek another MD. Somehow, I think that the MD would be okay with that.
No, the physicians I work with are not like that, but they are busy and don't have time to try to reason with 'unreasonable' (whatever the underlying cause) people. It is your family's job to help the pt determine the best d/c arrangement, and it would always be done by a SW, never by a physician. Sounds like the physician was just maintaining boundaries to me, and that you do not understand the role of the physician or the other professionals working with your aunt.
Actually, I agree with the many of that post's points and, yes, I did read your thread.
Do I agree that the MD may have been rattled, and that optimally should have been able to return. Perhaps. At the same time, we do not know the length of relationship that this MD had with the pt, or previous interactions.
Often if both/either side is upset and/ or abusive (and the pt was indeed abusive, and if in her right mind, intentional so), it is best for BOTH parties to step back for some time to cool off. And I strongly believe that may have been what the MD did.
You also don't know what else was going on. If there are some near codes, critical issues, or she has to tell someone that they are terminal. Knowing that your aunt has been inappropriate to her, the MD knows that she will have to take an extended period of calm, uninterrupted time to speak with her. This is difficult to do with many issues possibly going on. It will be best to wait until she has that time to address a stressful situation with a pt that has demonstrated a certain amount of difficulty accepting an issue.
And it really does not matter what care you mother or any relative has provided in the past. Relatives and friends always see pt care issues through very different eyes when it is a loved one lying in the Pt bed. I have seen MDs, RNs, act like Atilla the Hun, and outright misrepresent things when it involves family. Just because Mom been a caregiver does not mean she has full knowledge of what has gone, or is going on in the facility at that time. It also makes this second hand account, wherein we do not know all the details.
As an aside, after a recent shooting, in many cases, legal has advised that greater care is taken to allow people to calm down when behavior escalates, before returning to converse with an irate pt. Hospitals are no longer safe places- I have seen disabled elderly mace, scratch, gouge, break a vase and threaten with it, try to abuse their roommates that didn't want to watch the same TV show, spit on people, etc. As healthcare workers we shouldn't have to deal with this, but unfortunately we do. People should plan for the possibility of longterm care as responsible individuals but don' t, and then behave badly to those that are the bearers of bad tidings. If the MD was upset ( and given that the public wants us to be compassionate, warm, feeling people - they can't expect us to not be hurt) It would be the right thing to do, to cool down before reentering a potentially volatile situation.
The other issue is what is the purpose of this post. Is it to validate that the pt can abuse the healthcare worker, and the HCW needs to take it with a smile on the face, and immediate tolerance and forgiveness in their hearts. Or is to validate complaining against this MD.
If your family does not wish this MD to continue caring for your Aunt, please feel free to seek another MD. Somehow, I think that the MD would be okay with that.
Did I mention that my Mom agreed with the MD? Yes I did. She is the one that convinced my aunt to go to the nursing home. I think I have typed several times that my mom was upset with my aunt for her behavior and AGREED with the MD being upset. I don't know what you are talking about there.
The purpose of my post was in the last 2 sentences of my OP. I am not validating abuse of patients or MDs. Good grief Charlie Brown!! I am saying that if a patient doesn't give you a high five when you tell them that they are going to a nursing home the health care worker shouldn't be surprised. I am NOT saying my aunt was right, but I understand how she felt.
rn/writer, RN
9 Articles; 4,168 Posts
To the OP:
I'm so sorry that your family had an unpleasant experience on top of the stress you were already dealing with.
Taking offense when a distraught and elderly patient reacts negatively helps no one. It would have been better for all concerned if she could have said, "I'm so sorry, Mrs. X. You were hoping to go home right away. Let's get you the help you need to move back safely. You can be mad at me if you want. But my main concern is for you to get better."
I hope your aunt will be back in her familiar surroundings soon. She is blessed to have family members that care about her.