I recently had a patient in the ED who did have a lot of pain from her 1mm kidney stone. Understandable. However, the drama and borderline traits exhibited by her and her husband were highly disruptive to the staff and surrounding patients in the ED especially as we had a crashing patient who went into septic shock with a BP in the 50s before our eyes. The patient and husband were highly disruptive because of the perception that we were ignoring the patient and not taking care of her needs. I called security and the police who escorted the husband and another visitor out of the ED. I did not approach the husband as he was making a scene. We were all afraid he would come back with a gun. I did go back to the patient to give her more pain medication. This didn't stop the high drama from the patient. Besides for yelling about the pain, the patient was yelling that we didn't check her labs or urine (we did). She was also upset that we did not offer her a tampon or pad after we did her pelvic exam because she was bleeding. We never offer pads and I have never heard such an angry outburst over a pad.
Is there a one liner that you have in your back pocket that will help the patient and or visitors recognize their childish behavior and that we will not help them if they continue with this behavior.
Would something like this work? (Of course have security officer with you)
To the husband: Mr So and So, I can see that you are very upset. However, nobody deserves to be spoken to the way you are speaking. The other patients are disturbed by your outburst. If you want to be helped, you need to calm down and stop yelling. Yelling will not get you help faster. The doctor is with a critical patient at this time. I cannot give your wife a third dose of pain medication until there is an order from the doctor. I will have the doctor come check on your wife as soon as she is available. Is there anything else I can help you with?
To the patient: I can see you are very upset and would like more pain medication. As soon as the doctor puts in an order for more medicine I will bring it to you. The doctor is with a very sick patient at this time. Would you like and ice pack or some warm blankets to help manage your pain until we get an order? I will ask the doctor for some more medicine as soon as she is available. Is there anything else I can help you with?
This may not be helpful at all but I would just keep being polite and empathetic no matter how dramatic the patient is. I can tell that you do have empathy and this patient was just really acting out. Whenever I have difficult patients I always refer back to an experience when I was a patient in the ER.
I was 16 years old and I was there with lupus nephritis flare.. I'm always very patient and quiet when in pain because I deal with lupus pain every day and I am used to it. There was a girl in the next curtain area with suspected appendicitis who was refusing NG tube, refusing lady partsl exam to r/o any other issues. Refused scans. Just wanted pain meds. She was really acting out and I got really frustrated and complained to my dad about her and called her nasty names (not to her, but was telling my dad).
my dad said to me, "I've never seen you be so in-compassionate. Do you know what appendicitis feels like to someone who doesn't know how to deal with pain? This may be the worst pain she ever felt"
And I realized he was right. I didn't put myself in her shoes. And when I did I wasn't as frustrated with her and was able to tolerate her dramatics a little better.
Anyway she finally started cooperating because her nurse just kept being very stern and polite and showed compassion. Sometimes this works and sometimes it doesn't. But I learned that putting myself in others' shoes does make me cope with the angry patient a lot better, even if they are still not cooperating.
Sometimes you can't just make the patient less dramatic with one line and sometimes you will have to just "put up with " so to speak, or do what you did with the police escort which was the right thing to do.
though you feel vindicated by your response to that patient; you were way off base. She is there needing help, and you let her down. In that state of mind (when in pain)-even though she was rude-you were her nurse. Complain in private-but treat her right, even if she isn't.
"Kidney stones hurt like few other things. I know how much pain you are in and I will give you whatever I have ordered to help it. I can't make you pain free but I can knock it back to what I hope is tolerable". (Lowers expectations)
"I can see that what we are giving you is not working so I think we should start looking at non-narcotic options. Or if you think it is working we can give you more in x minutes". (They usually scramble backwards at this option)
People have unrealistic thoughts that we can magically remove pain.
Oh...and I would call security to deal with the family. They are NOT my patient.
Specializes in Mental Health, Gerontology, Palliative.
Excuse me this is the ED. You my dear, are not an emergency. We have attended to you. There are people in here that are emergencies. If you think being annoying is going to get you more attention, you are correct. I am calling security right now and you will get that attention. Probably not what you are really wanting but you are bringing this to yourself. So put a sock in it and sit back and relax.
I'd tell you where to stick if I was on the recieving end of that.
That does not diffuse, it exacerbates and ignores the fact that to the patient, their issue is very real and very much an emergency whether we see it as such
Specializes in Mental Health, Gerontology, Palliative.
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There is not a shred of evidence, NOT ONE, that shows anyone has EVER died of pain, EVER.
....
There is plenty of evidence to suggest unresolved pain can have a huge physiological impact on the human body and can impede a persons recovery.
That said, just because no ones died from pain, doesn't mean we shouldn't be doing our best to advocate for our patient and ensure they have adequate pain management.
There is plenty of evidence to suggest unresolved pain can have a huge physiological impact on the human body and can impede a persons recovery.
That said, just because no ones died from pain, doesn't mean we shouldn't be doing our best to advocate for our patient and ensure they have adequate pain management.
Uuugh, I still can't get over that statement you quoted, Tenebrae.
Describing a personality disorder is a lot more complex that describing a physical syndrome such as measles. Similarly someone can be described as depressed without being diagnosed with major depressive disorder. I used "borderline traits" as an umbrella term.
What some posters have pointed out is that you would be wise to be very cautious about using a psychiatric diagnosis to describe behaviour.
Borderline personality disorder is often misdiagnosed and should not be used as an "umbrella".
%D#2
298 Posts
This may not be helpful at all but I would just keep being polite and empathetic no matter how dramatic the patient is. I can tell that you do have empathy and this patient was just really acting out. Whenever I have difficult patients I always refer back to an experience when I was a patient in the ER.
I was 16 years old and I was there with lupus nephritis flare.. I'm always very patient and quiet when in pain because I deal with lupus pain every day and I am used to it. There was a girl in the next curtain area with suspected appendicitis who was refusing NG tube, refusing lady partsl exam to r/o any other issues. Refused scans. Just wanted pain meds. She was really acting out and I got really frustrated and complained to my dad about her and called her nasty names (not to her, but was telling my dad).
my dad said to me, "I've never seen you be so in-compassionate. Do you know what appendicitis feels like to someone who doesn't know how to deal with pain? This may be the worst pain she ever felt"
And I realized he was right. I didn't put myself in her shoes. And when I did I wasn't as frustrated with her and was able to tolerate her dramatics a little better.
Anyway she finally started cooperating because her nurse just kept being very stern and polite and showed compassion. Sometimes this works and sometimes it doesn't. But I learned that putting myself in others' shoes does make me cope with the angry patient a lot better, even if they are still not cooperating.
Sometimes you can't just make the patient less dramatic with one line and sometimes you will have to just "put up with " so to speak, or do what you did with the police escort which was the right thing to do.