Impossible patients/pt. family members

Nurses General Nursing

Published

How do you deal with those types of people that just won't listen to reason? People who are convinced they know more than you do, say "you don't know anything since you're not a doctor," and are rude and insulting about it? I'll be the first to admit that I'm overly sensitive, but man a patient's mother sure did a number on me my last shift! She was speaking loudly and angrily, making outrageous claims that my facility and me personally (?) are fraudulent and taking advantage of her daughter (the 19 y/o patient) by ordering "unnecessary tests" and that I was a "useless idiot" because I refused to tell her the doctor's name who ordered the EKG I was about to perform or why, recite the contents of the patient's chart for her, or tell her how much an EKG costs. I ended up asking her to leave the room several times and threatening to call security before she did. There was just no reasoning with this lady. Her daughter is 19. Mom doesn't have any say in the daughter's medical treatment (btw, patient was beyond embarrassed and totally compliant with the EKG and being in the hospital).

I was really shaken up by the tone of voice and accusations. If I weren't in a patient's room about to run an EKG, I probably would have cried. Now, I know there was not much I could have said in that situation that would have helped, and I know I'm a big baby when it comes to being treated like crap, but I also know that I'm going to encounter a lot of rude and unhappy people in my career in healthcare (and life in general). For fellow overly-sensitive-types: how do you deal with patients and family members like this? Both in the moment when you're talking to them and after, if you get angry/upset/hurt. Do you get less overly-sensitive?

I've had my share of AMS/disoriented or psych patients that are non-compliant and angry about all sorts of things, but that's totally different. :(

BTW, I did talk to the nurse caring for the patient, the nurse talked to the patient to make sure she was okay and make sure she knew the mother doesn't have to be here if she comes back and we can prevent her from being here, and I reported the incident to our house supervisor.

Experiences? Advice? Other than "grow a pair," please. :lol2:

I don't think I have any advice for you except to know that you are not alone. They preach all of this empathy stuff to us but when you are being completely attacked it's hard to think "oh this poor woman must be so anxious and that's why she's calling me and idiot." I will admit to crying when a patient's wife did that to me. *Hugs*

mamamerlee, LPN

949 Posts

Specializes in home health, dialysis, others.

Never argue with someone who is being rude. Leave the room, taking your equipment, and call the supervisor.As you leave, tell the fam. member that you will be back later when it is quieter, as you know the test will not be accurate during the chaos. (Don't say the chaos part!) Call whatever supe you need to, or security if you feel you need to, then do another task so you aren't just hanging out doing nothing.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Create a personal button called "ignore."

Push on it when you are surrounded by trash like this.

Don't give them your energy...they don't deserve it....

Kymmi

340 Posts

Specializes in CVICU-ICU.

I know you probably dont even know how much a EKG costs and it is not your place to tell her whats in the chart but why did you refuse to tell her what doctor ordered the EKG?

I would have told her the doctor that ordered it and then told her you do not deal with billing/insurance issues and that you suggest she speak to the MD about test results and chart content.

rn/writer, RN

9 Articles; 4,168 Posts

I was a little confused by your post as it initially sounded as if YOU were the nurse (nurses perform EKGS in some facilities). But your profile clarified that you are a cardiovascular tech. In that case, you did what you could by reporting this mess to the nurse and the house sup. You might also confer with your own supervisor.

You don't have to stand there and take outright abuse, but there are a couple of things that might help you to defuse someone who is on the edge and could go either way.

A few of the people who act this way are mentally unbalanced across the board. Many of the others are freaked out over circumstances they can't control. When I saw that this confrontation took place over a 19 yo daughter, what immediately came to mind is the very normal power struggle that occurs when a mom and a daughter both recognize that the mom can't make the daughter do (or not do) anything anymore and one is scared spitless (and perhaps angry) and the other is a bit excited (and perhaps also scared spitless and perhaps angry).

Even with the truly disturbed, it's very rarely personal. If you weren't the one getting yelled at, someone else would do quite handily. That doesn't make this kind of behavior right. It does, however, release you from the pressure of taking their diatribes to heart. I like what another poster said about having an ignore button. That doesn't mean you ignore the person totally (lest they turn up the volume even more). It means you recognize that their blather is not worth getting upset about.

If you feel unsafe, ask the person point blank (and in a very calm voice--not a threat) if you need to call security. If you're asking like this is a genuine inquiry rather than an intimidation tactic, sometimes that lets the other person know that you really do want to know if that's necessary.

Do let the floor nurse know about this kind of behavior. She may need to call for a social service consult if there are "issues" that are interfering with the patient's care. She would also be the one to decide if the patient wanted her mother to know which doc ordered the EKG. Sometimes d/t group practices and consults, the patient may not even be certain who ordered a procedure.

Finally, if you know you have some weakness in this area, see if your facility has an Employee Assistance Program. This is exactly the kind of thing they can help with. Teaching people how to manage conflict on the job or off is right up their alley, and you could do yourself a big favor by asking for their direction. This is a life skill that has many, many applications.

I wish you the best.

rngolfer53

681 Posts

Some people are unprepared to be educable or reasonable. Keep your temper, do your job, and advocate for your Pt. Let the chips fall where they may.

A couple months after I started working hospice, I was w/a Pt who was SOA, in pain, and clearly pretty imminent. The DPOA refused to let me medicate the poor man, because he read on the Internet that morphine and Ativan would make the Pt sedated, and he needed to sign some legal papers that day. :uhoh3:

No amount of trying to explain that no competent notary would accept the signature of a barely responsive man made a dent. As my primary responsibility is to the Pt, I kept at it (other family members present agreed with me). The DPOA finally ended up telling me to leave the house.

Today, I'm about 15 months more experienced, and the outcome might be different...........I'd last about 5 more minutes before getting tossed out. :lol2:

juliaann

634 Posts

Specializes in ICU.

Thank you all for taking the time to comment, I really appreciate the advice and feedback. :) And yes, I'm a CV Tech, not a nurse. From 3p-11p I'm the only one doing EKGs, and I do them for the whole hospital (minus ER) since there's never any stress tests going on, and only rarely a cath.

I know you probably dont even know how much a EKG costs and it is not your place to tell her whats in the chart but why did you refuse to tell her what doctor ordered the EKG?

I would have told her the doctor that ordered it and then told her you do not deal with billing/insurance issues and that you suggest she speak to the MD about test results and chart content.

Kymmi, I actually didn't have my copy of the order with me at the time. It was a STAT EKG, so I was paged, and I came straight to that floor without going by to get my order off my order printer (on another floor, don't want to waste time going to get it if it's really a STAT), grabbed a sticker off the chart, asked the nurse if there's anything I need to know/if they're looking for any changes in the patient's rhythm, and went into the patient's room to do the test. The sticker has the attending physician's name on it, but it's very unlikely he was the one to order the test, since this was after 7p shift change (I work 3p-11p) and the nights house officer might have written it. Or one of the bajillion residents. Or it might have been a verbal order from who knows. I didn't answer her because I wasn't sure, and also because she is not the patient, and doesn't have a "need to know" anything about the patient's care. Anything the mom wanted to know about the daughter's care she needed to *first* get the patient's permission, and then ask the nurse or doc. I was not going to tell her anything, and the only thing I knew about the patient was what was right on the sticker in front of me (same as on the pt. armband if mom really wanted to know the name of the attending) and that the nurse told me the patient was hypokalemic.

If you weren't the one getting yelled at, someone else would do quite handily.

I've been thinking this over a lot, and I think you're definitely right. The mom didn't give anyone else a hard time. She left the floor while I was doing the EKG, and would have had to walk past the nurses station to get to the lobby, but apparently she didn't say anything to anyone, which makes me think she was just taking her frustrations out on me, and then was done. I was really expecting so see her getting into it with a nurse when I returned to the nurses station after doing the EKG. Maybe she just really needed to vent? Maybe I was a good target for her frustration because I wasn't "fighting back"? Maybe I just walked in on a mother-daughter strained relationship and ended up the worse for it.

Thank you for your advice and the suggestion of an Employee Assistance Program. I'll ask HR when I go in today, and if we don't, maybe someone in the education department can help me. I've taken great courses through them on precepting and time management, they might have something about conflict, too. Or maybe they'd be willing to offer one if they don't already.

Lisa, MA

67 Posts

Specializes in Medical Assistant, Peds.
Her daughter is 19. Mom doesn't have any say in the daughter's medical treatment (btw, patient was beyond embarrassed and totally compliant with the EKG and being in the hospital).

First of all, I totally agree that you shouldn't have to take any "verbal abuse". Walk out. Call a supervisor...etc.

That said, even though the daughter was "19", she came in with her mother. She didn't deny her involvement and if the mother is paying the bill "ie: has the child on her insurance"...she does indeed have a say in what is going on.

CT Pixie, BSN, RN

3,723 Posts

My mantra when dealing with outragous family members or patients (and working LTC I have my share, believe me) I recite in my head..quite loudly as if to drown out the family/patient..."I REFUSE TO HAVE A BATTLE OF WITS WITH AN UNARMED PERSON!!"

juliaann

634 Posts

Specializes in ICU.

That said, even though the daughter was "19", she came in with her mother. She didn't deny her involvement and if the mother is paying the bill "ie: has the child on her insurance"...she does indeed have a say in what is going on.

First, the patient is 19, so I'm not sure what your quotes around her age are all about. And the patient was not on her mother's insurance. The patient is self-pay. The mother is not listed on the patient's face sheet as a guarantor or emergency contact. Yes, that does give a lot of insight as to why mom was all upset about the financial issues (no one wants to see their child amass a large hospital bill with no insurance), and she may in fact end up "footing the bill" down the road, but the patient is an adult and the mother has no say in the patient's care decisions unless the patient wants her to. It wasn't clear if the patient wanted mom to have information, so I withheld what little I knew and directed mom to some people who might be able to help her understand the situation and give her cost information (nurse, billing department in the morning, etc.). I was trying to protect my adult patient's rights. And just because she's 19 doesn't mean she's financially reliant on mom. And just because she's self-pay doesn't mean she shouldn't receive treatment and testing for the issues that she was admitted for. I did make sure she knew that she can refuse the tests if she wants to, but to discuss it with her nurse first. I also made sure to ask her after her mother left if *she* wanted me to do the EKG, and she said yes.

And from what I gather (I wasn't in the ER when the patient came through) the patient did not come in with her mother, her mother was clearly opposed to her receiving treatment and was encouraging the patient to leave AMA. I'm assuming the patient came to the ER on her own because she was concerned about her health, as any adult worried about their health might. I got the impression the mother had just arrived, hours after the patient had been admitted, and was angry at the patient for consenting to being admitted, and at me for carrying out the patient's ordered test.

Honestly, at my facility we get a lot of uninsured patients (~35%), and I've never run into this before. I'm sure it's *very* scary to think what kind of bills you're accumulating, but more often our patients and their family members are more worried about making sure they get their health issues taken care of first, and then take up financial concerns with our billing department and financial counselors or case management closer to/after discharge time - they certainly don't attack poor EKG girl who has NO control over the costs of tests or how/why they are ordered. :(

RNperdiem, RN

4,592 Posts

When I have patients and families like that, it really is not personal.

They probably do not even know your name, will not remember your face.

You are simply a representative of the organization and an audience for theatrical tantrums.

The issues and power struggles go way back before they entered the hospital door. Stand back and do not get sucked in.

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