Patients making me feel dumb

  1. I work at a outpatient clinic as an ambulatory care assistant, I basically assist the doc in procedures, vitaling and putting patients in rooms, and paperwork. Well, I give one of the patients a list of medications we recieved for her to update. She asks me what a specific med is because she's not sure if she's taking it. and at this point we're extremely busy, just after lunch, i have five charts/patient to prep to be put in rooms, its clearly past their appt times and docs are angry. Instead of looking her med up for her, I simply tell her "I'm sorry, I'm not familiar with that drug, maybe its something you might want to speak with the doc about when he see him". She proceeds to reply with a "well you SHOULD know". This made me so angry. Its not my role to be familiar with all patient meds, I'm not a nurse, and I don't deal with medications. I do clerical work and vital patients. I wanted to say "no, YOU should know, if i was taking medications you can be damn sure I would know what they were". Instead, I just apologized. What would you have said to a patient like this, patients who expect you to know things beyond your scope of practice and get mad when you don't. another instance was today during gyn exam, I was assisting the doc. Fixing paperwork and getting supplies ready for the doc as he was doing the exam. He tells me he's needs to do a vulvar biopsy, so I proceed to get the supplies and paper work ready. The patient asks me where the biopsy was going to take place and I explain to her the region. Well she thens asks me which side, and I didn't know left or right because I wasn't watching the exam, I was getting things ready for the doc as he needed it. She then tells me, "isn't that your job" in a condescending type of way. I told her that I was not looking when he was examing and that my back was turned. Afterall, its not a collaboration, nor would i expect the doc to scoot over just so i can see , he does his thing and I do mine. I really wanted to say "no, its not my job. I was doing my job, sorry if I did not share the interest in scrutinizing your vagina!" I just never know what to say to defend myself in these situations with patients, so i end up feeling dumb or like i'm not doing my job over things that aren't my fault.
  2. Visit kmokay profile page

    About kmokay

    Joined: Jul '06; Posts: 9; Likes: 2

    15 Comments

  3. by   ktwlpn
    Quote from kmokay
    I just never know what to say to defend myself in these situations with patients, so i end up feeling dumb or like i'm not doing my job over things that aren't my fault.
    "there are no victims-only volunteers" Don't let the ignorance of some people get you down..Does your name tag clearly state your title? Nothing wrong with a fast description of your duties and a reminder to the pt that they should always speak to the doctor regarding their concerns....In the first instance you could have very professionally reminded the patient that SHE is responsible for knowing her meds -generic names,too ...In the second instance you could have reminded the patient that it is appropriate for her to address her questions to the doctor prior to the procedure and explained that you are not a nurse.I'm inlined to cut her more of a break-she probably heard the word "biopsy" and then went partially deaf with fright.Still no excuse for rudeness....
  4. by   nursingisworkRN
    As a nurse, I always default to the "what did the Dr. say?" response. If they are unsure, then I will follow up with the Dr. or I will instruct them to ask the Dr. before the procedure. If they are dissatisfied with that and start to push me, I simply state it is outside of my scope of practice and that my knowledge of _____ procedure is very limited to that of the Dr., and that the Dr. is most qualified to discuss it with them. If I know the answer and am comfortable discussing the plan of care, then I will. Otherwise, it is better to be safe than sorry. Don't ever feel dumb. It is always better to admit not knowing something than to proceed in error because you were worried what others thought. It also helps to set limits with your patients. Smile, do your job the best you can, and realize that often all they want is reassurance. I have at least one pt attempt to put me down everyday. It used to get under my skin. But the reality is often they are in denial and lack knowledge about their own medical condition. Consider the source. You know what is and isn't in your job description. JMHO
  5. by   catlady
    It sounds like you handled the rude patient well. It's ok to admit that something is outside your area of expertise, and then offer to find the right person to answer the patient's questions. Even we nurses sometimes have to give that response and go find the doctor or whoever can really address the concern. You know you're doing your job, so you have no need to defend yourself.

    I do wonder if some of the confusion comes up in ambulatory care/doctor's offices because the patients tend to think (or sometimes even be told) that the person attending them is a "nurse," even if they're not.
  6. by   TazziRN
    The biopsy pt: "I'm sorry ma'am, but it really isn't my job. I can ask the doctor for you, though."

    The med pt: "Ma'am, I am not a licensed staff member and medications are outside of my scope of practice. That really is something you need to discuss with the doctor."
  7. by   SaraO'Hara
    There is one resident at my work who never fails to make me feel rather awkward, usually over changing a disposable brief. Essentially..

    "Ma'am, I need to change your brief."
    "What?"
    "*holds up new brief* Your brief might be wet. I need to change it."
    "I don't understand what you're talking about."
    "Er... you might need clean underwear?"
    "*fishy stare* I don't want it."

    Generally, I end up feeling like a bit of a pervert for having to ask so many times. Yesterday, I asked the charge nurse to accompany me, and she was able to put a bit of RN muscle into convincing the resident that brief changes are, in fact, a good thing. Sigh.
  8. by   TheCommuter
    Quote from kmokay
    What would you have said to a patient like this, patients who expect you to know things beyond your scope of practice and get mad when you don't.
    Simply state, "That's not within my scope of practice since I am unlicensed. Please ask a licensed staff member such as a physician or nurse in order to obtain an answer."

    Many patients of clinics are fully unaware or unconcerned that the majority of the staff is unlicensed; therefore, they expect you to know everything. Plenty of 'old-school' patients come from another era when medical assistants did not exist and only an RN or LPN assisted the doctor.
    Last edit by TheCommuter on Aug 19, '06
  9. by   MIA-RN1
    I might say something even simpler and just say "I am sorry, I am not a nurse. You will need to speak with a nurse or a doctor about your medication. Let me get him/her for you." Talking about licensed/unlicensed won't mean a thing to a patient who is not familiar w/ the insides of the medical field.
  10. by   ERNurse752
    I also agree with telling them that you aren't a nurse, therefore can't answer their question....I think they may think you are, and that's why they're so irritated when you don't know things. And then offering to get the MD/RN, or putting a note on the chart or something that the patient has questions about a procedure/meds/etc.
  11. by   SharonH, RN
    A very simple and matter of fact "I don't know, I will ask your physician" or "I will let him/her know of your concerns" should suffice. You are under no obligation to cater to rude behavior . In the case of what is or isn't your job, you can enlighten them with "no, as a matter of fact it isn't" with a cold smile. You absolutely should not apologize.

    And remember, there is nothing wrong with not knowing. There have been times I didn't know and I just say so, simply and without embarassment and I certainly don't offer any apologies. I have also seen physicians say "I don't know". That's just the way it is, there is not always an answer for the 1001 questions some of these people have.
  12. by   DaFreak71
    From a patient perspective:

    I use to go to a NP for my health care needs and she was assisted by a LPN. The woman in charge of the paperwork and sometimes helping gathering supplies was frequently in and out of the exam room while I was trying to discuss personal issues or being examined. I did not like this at all. She was not a health care worker and therefore should not have been privy to my conversations. Even if she handled the paperwork and knew about my concerns after the fact, I still didn't think she should be allowed to witness my exams or hear my first hand accounts of my problems.

    If I had been a patient getting a gyn exam and the office worker walked in, I would have thrown a hissy fit. I think what is happening is that the patients assume that you are a licensed health care worker otherwise you would not be in the room during these times. (specifically with the gyn exam). Is this really an unrealistic assumption on the part of the patient?

    I now go to another NP who is more professional. When I am in the exam room either being examined or talking to him, he is the only one in the room with me unless my husband accompanies me. To think that a clerical worker could just pop in whenever (even if the NP or MD) doesn't mind, I mind and I would imagine that most patients would too.

    What happens if a nurse or doctor violates HIIPA? They could lose their license. What happens if a clerical worker violates HIIPA? They could lose their job, but not their profession. This, in addition to the personal privacy issues, are why I do not think it is appropriate for a non licensed health care worker to be present when certain exams are being done or when priveleged conversations are taking place.

    Of course I do not mean to insinuate that the OP would violate HIIPA or that the OP has ever done anything wrong, I am just speaking from a patient perspective and expressing my preferences in my health care experiences. I believe that the patients in the OP's office assume that he/she is a licensed health care worker otherwise they would not be that intimately involved in the patients visit/face time with the doctor. And considering that this is the patients assumption, they would be rightly surprised to learn that you weren't familiar with medications, etc.

    I'll bet if the OP started telling the patients that he/she was not a licensed health care worker that the patients will be very uncomfortable the next time the OP shows up during a gyn exam.

    Basically I'm just saying that it sounds like in the case of the particular office where the OP works, the lines between clerical workers and LPN's, CNA's, RN's are obviously blurred if the patients don't know the OP's job function.
  13. by   kmokay
    Quote from lostdruid
    From a patient perspective:

    I use to go to a NP for my health care needs and she was assisted by a LPN. The woman in charge of the paperwork and sometimes helping gathering supplies was frequently in and out of the exam room while I was trying to discuss personal issues or being examined. I did not like this at all. She was not a health care worker and therefore should not have been privy to my conversations. Even if she handled the paperwork and knew about my concerns after the fact, I still didn't think she should be allowed to witness my exams or hear my first hand accounts of my problems.

    If I had been a patient getting a gyn exam and the office worker walked in, I would have thrown a hissy fit. I think what is happening is that the patients assume that you are a licensed health care worker otherwise you would not be in the room during these times. (specifically with the gyn exam). Is this really an unrealistic assumption on the part of the patient?

    I now go to another NP who is more professional. When I am in the exam room either being examined or talking to him, he is the only one in the room with me unless my husband accompanies me. To think that a clerical worker could just pop in whenever (even if the NP or MD) doesn't mind, I mind and I would imagine that most patients would too.

    What happens if a nurse or doctor violates HIIPA? They could lose their license. What happens if a clerical worker violates HIIPA? They could lose their job, but not their profession. This, in addition to the personal privacy issues, are why I do not think it is appropriate for a non licensed health care worker to be present when certain exams are being done or when priveleged conversations are taking place.

    Of course I do not mean to insinuate that the OP would violate HIIPA or that the OP has ever done anything wrong, I am just speaking from a patient perspective and expressing my preferences in my health care experiences. I believe that the patients in the OP's office assume that he/she is a licensed health care worker otherwise they would not be that intimately involved in the patients visit/face time with the doctor. And considering that this is the patients assumption, they would be rightly surprised to learn that you weren't familiar with medications, etc.

    I'll bet if the OP started telling the patients that he/she was not a licensed health care worker that the patients will be very uncomfortable the next time the OP shows up during a gyn exam.

    Basically I'm just saying that it sounds like in the case of the particular office where the OP works, the lines between clerical workers and LPN's, CNA's, RN's are obviously blurred if the patients don't know the OP's job function.
    well no, we're not licensed, but we are patient care providers. My job is to assist in procedures, there are only a handful of nurses in the entire clinic that sees 700-800 patients daily. Without us, I don't see how the docs would be able to get very much done. So do have the right to be in the room. yes I do clerical work, but there is also direct patient care involved. And in the case that there is direct patient care is involved, I don't think there is any violation of hippa. but then again the rules of hippa are abundant. really i think that most of it comes from the fact that I look 15, I don't see my co-workers being spoken to this way. atleast not that i'm aware of, but then again i could just be oblivious.
  14. by   DaFreak71
    Quote from kmokay
    well no, we're not licensed, but we are patient care providers. My job is to assist in procedures, there are only a handful of nurses in the entire clinic that sees 700-800 patients daily. Without us, I don't see how the docs would be able to get very much done. So do have the right to be in the room. yes I do clerical work, but there is also direct patient care involved. And in the case that there is direct patient care is involved, I don't think there is any violation of hippa. but then again the rules of hippa are abundant. really i think that most of it comes from the fact that I look 15, I don't see my co-workers being spoken to this way. atleast not that i'm aware of, but then again i could just be oblivious.
    I think whether or not you have the "right" to be in the room depends on the patient. If the patient knew you were a clerical worker would she have felt comfortable with you present during her gyn exam? I know I sure wouldn't. I realize your job duties include you being in the room, but that is more a result of your particular employer keeping their eyes on the bottom line by having clerical workers act as assistants. There is certainly no legal reason why you should not be in the room unless the patient does not want you there. I do wonder about the fact that many of us "old school" patients think that if you are assisting during a private exam or present during a private conversation, that you are a health care professional. It never really occured to me until my last experience at my old NP that anyone could enter the room regardless of what was happening. I didn't realize that I had to question the credentials of the staff in order to ensure I was only being tended to by professionals who were legally bound to uphold my right of privacy.

    I'm sure you are very good at your job and you deserve to be treated with respect. As with any job that includes being around the general public, you're going to encounter rude people more often than if you worked in a lab setting, etc. I do believe that the patients who are responding to you as though they expect you to have basic information (like meds, procedures, etc) actually believe that you are a health care professional (as in licencensed and educated). The root of your problem is that the patients in your busy office assume you are licensed and educated in the field of health care. If they knew you were a clerical worker they would be less inclined to discuss highly personal issues with you present and most people would not be willing to undergo any type of exam that required nudity with you present. I believe that is not only well within the right of the patient, but extremely reasonable as well. In fact, it bothers me that most patients are under a false impression as to your role. I believe the patient has the right to know that you are not bound by any legal obligation to protect their privacy and that their conversations and exams are being witnessed by a clerical worker. This is clearly not your fault, it is a problem with big clinics utilizing people who will do the job for less pay than a health care professional. It's money baby.

    As I said before, I don't doubt your integrity or your adherance to privacy issues. This is not personal against you. I'm sure you're a great employee. The problem is your employer who doesn't mind hoodwinking their patients by having clerical workers assisting with gyn exams just so they can save a few bucks. Ok, maybe alot of bucks.

    Perhaps I give the general public too much credit for being consumer savvy. Maybe alot of them would not care to expose themselves to the clerical workers, but I will promise you that a good number of them would freak out hardcore and feel betrayed by the office/doctor/nurse.

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