I've had a patient all week (I'm on my second clinical rotation of an ABSN program) who gives everyone a different story about his alcohol consumption. Yesterday, he told me it was 8-9 shots/ night and a dozen beers. His intake said 18 oz and a dozen beers, but listed no time frame. This morning, the resident d/c Ativan because "pt does not drink daily."
With whom is the patient truthful? Nursing staff or resident MDs? Or, did the resident not really assess the patient and see the visible signs of withdrawal (hand tremors, confusion, and lack of pupil contriction) that my instructor and I both noted over the past few days?
Overall, do you think patients are more likely to be honest about social habits with nurses or docs?
I find that the fact that I spend 12 hours at the bedside, and a doctor 15 minutes gives me a better change to see how best to relate to a patient. Patients become more comfortable and open up about thier habbits. Especially when I ask... "how many packs of smokes a day?" vrs... "do you smoke?"
Between a doctor and nurse whom the pt has never met, he/she is much more likely to confide in a nurse. However, pts can be very truthful about sensitive issues (e.g. substance use, sexual history, etc.) with their primary care docs esp. if they have built good rapport and continuity of care.
I have to agree with a lot of the posts mentioned above regarding it all has to do with the person who they feel they have the best rapport with. When it comes to Alcohol consumption especially when a pt. is placed on ETOH withdrawal protocol I find stories can often change to best facilitate the pt. scoring additional doses of Lorazepam (or whatever benzo they are being given for sx). I work in psych so this puts a spin on things but often times we see people with no deisre to quit drinking and with the knowledge that no alcohol will be available to them for at least 24 hours they want the next best thing and will say what they need to to get it. Just a thought...
Maybe this patient wasn't being honest about his habits with the doctor, the nurse or even himself.
As someone previously pointed out, getting a medical history from a patient is treated as a real skill in med school. This is where medicine is more art than science. Some doctors are really good at communication, rapport building and speaking in a way that patients understand.
Some nurses have this skill in greater amounts than others too.
Working in hospitals for the past 15 years, I have never had a patient volunteer information about their drinking, drug or sexual habits.
I think the patient will communicate more openly with the person they feel they can trust. It may be nurse, or it may be the doctor. If they have a mean nurse, they probably won't open up as much.
I also think part of the reason people don't openly disclose drugs or alcohol could be because they really don't understand how that information is directly related to their care. Not everyone knows drug interactions. I'm sure some people are embarrassed too.
It's all about creating a judgment free environment.
For example, was told in report pt A drinks 2 drinks a day but is in ETOH precautions, receiving ativan q2 due to withdrawls. I ask pt A, "So I can correctly dose your medication, I need to verify how much you drink a day." Pt A responds "2 drinks". Me - "What kind of drink?" Pt A "Vodka" Me - "By a drink do you mean a shot?" Pt A "No a bottle."
Great point--I definitely need to remember that what I consider "a drink" may not be how everyone measures!
Thanks for all of your responses. This gives me something to chew on tomorrow in clinical, if he is still there.
Hi i'm storklady and i have found that pt's will be more upfront with thier nurses. i think that the informatio0n that we recieve from that pt that is medically pretent to his care should be told to the md if pt is not being honest with the md......storklady
I've seen it work both ways; some will tell the truth to the doc, some to the nurse. I think it depends on whom the patient trusts - or, whom they think they can fool most easily. I used to work in a community health center and the patients were sometimes more truthful w/ our lab tech than they were with either doctors or nurses.
how do you know??, not to question you, but to learn
Zookeeper3
1,361 Posts
I find that the fact that I spend 12 hours at the bedside, and a doctor 15 minutes gives me a better change to see how best to relate to a patient. Patients become more comfortable and open up about thier habbits. Especially when I ask... "how many packs of smokes a day?" vrs... "do you smoke?"