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Difficult pts

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by tobyboby tobyboby (New) New

How do you talk to a pt who thinks that everything is wrong with them and they keep self-diagnosing? What is the ethical thing to do?

mom4josh

Specializes in onc, M/S, hospice, nursing informatics. Has 11 years experience.

Tell them to bring it up with their physician when they seem him/her next!

mamason

Specializes in cardiac. Has 5 years experience.

I would explain to them their diagnosis and what they are currently being treated for. I would correct them if they were misunderstanding the information. In a very sweet and polite way. I've found that pt's who are like this are really just scared to death. They lack information that is critical to their care when they get home. This is were pt education comes in. I make sure I explain their symptoms, how we treat them, their medications, and side effects. What's the norm and what isn't the norm. If a pt is sure that they are suffering from sort of disease that they don't have, I then refer them to their doc. I explain to them that they should ask as many questions as possible. Then, there are some people that no matter how much teaching you do, they just can't comprehend. So, you just have to keep trying. I find that I repeat myself a lot with these type of pts. But, we also need to listen. I had a lady yesterday who had a list of previous conditions on the Kardex a mile long. She supposedly is considered a frequent flyer by othe staff members. She was manipulative. Other staff members stated that the pt likes to ask for a lot of pain pills, treatments, etc. SO, ok........I go in and assess her. Talk to her for a little bit. Come to find out, she states that she takes Vicodin at home and has for years. Ok....she has tolerance issues. She explains that they don't work as well as they used to. Makes sense to me. I give her Dilaudid by her request. She then states she's having a difficult time describing her pain. She stated that is was a deep, dark, constant, and looming pain. OK....now I'm thinking. SHe had a breast biopsy done. Went to go check her labs and they were really bad. CEA was elevated. SHe had CA....SO, what she was saying made perfect sense to me. Anyway, the moral of the story is .......we need to take the time to listen a little bit more, I guess. It's easy to get caught up in trying to get things done. Especially on a very busy shift. And sometimes it's darn near impossible to find that extra time to do. :smokin:

aeauooo

Specializes in neuro, ICU/CCU, tropical medicine. Has 18 years experience.

This is where the "therapeutic communication" we learned in nursing school comes in (at least, I was taught "therapeutic communication" in nursing school - later in ministry training it was called something else, but the techniques were the same)

A patient who "thinks everything is wrong with her/him" is usually frightened and needs to voice her/his concerns.

I would pull up a chair, encourage the person to talk, ask clarifying questions, listen actively, and try to give information to correct misunderstandings.

geekgolightly, BSN, RN

Specializes in MICU, neuro, orthotrauma. Has 7 years experience.

This is where the "therapeutic communication" we learned in nursing school comes in (at least, I was taught "therapeutic communication" in nursing school - later in ministry training it was called something else, but the techniques were the same)

A patient who "thinks everything is wrong with her/him" is usually frightened and needs to voice her/his concerns.

I would pull up a chair, encourage the person to talk, ask clarifying questions, listen actively, and try to give information to correct misunderstandings.

Seconded.

Because I'm currently working in an excellent hospital, I have time to do this. My ratio is max 5:1 med surg, and usually 4:1. I do have the time to pull up a chair and really talk to patients. But when working in a facility that staffs poorly, this patient population is not treated effectively. Unfortunately.

locolorenzo22, BSN, RN

Specializes in Ortho, Neuro, Detox, Tele.

sometimes that's all a patient wants...someone to talk to....Often, I will let a patient talk while we are walking after back surgery, when we are ambulating between chair and bed, when I'm just fixing up the room for them and setting things for the night.....

aeauooo

Specializes in neuro, ICU/CCU, tropical medicine. Has 18 years experience.

I do have the time to pull up a chair and really talk to patients. But when working in a facility that staffs poorly, this patient population is not treated effectively. Unfortunately.

Tell me about it! We're trained to give the best care we can, but we're put into situations where we have to cut corners just to get through the day.

Yesterday I opened up to my wife about why I hate my job so much - I'm a darned good nurse, but I can't give the care I want to give where I work - I just don't have the time.

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