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 sound like a simple reply and I will admit it took some time for me to really let it sink in and help me to relax.....but I just think that at some point I get to go home to the relaxing and peaceful sanctuary I have made for myself, some of my patients will go home and continue to be angry, negative and generally unhappy with their lives no matter where they are or what is going on. Knowing I have something (peace, happiness or whatever) that they have no apparent grasp on somehow makes me more adept at handling their fleeting bulls@#t. It helps me to almost understand why they are so frustrated trying to manage in a world that might not be kind to them for whatever reason.
^ You nailed it. that's what we were taught in clinical by my excellent clin instructors. At the end of the day, we get to go home. These patients do not have that simple luxury. we should be more empathetic to their needs...it's what we signed up for. I'm still floored by some of the comments posted in this thread.
Specializes in Med/surg,orthopedics,emergency room,.
Very true and some time it is the spouse that perpetuates the madness. I would just take a deep breath, clear my face of any emotion( hard to do for me but I'm learning!) and address the patient., oh are you still in pain? Okay can I offer you something?(anything!) the key is to keepYOUR cool and the patient will keep theirs. At least some of the time!
If I come to the ED with a kidney stone, I want my pain meds. NOW. No "one-liner" would work. Just tell me when the meds are coming, what you are doing to get them, etc.
I think some of the suggested answers you've gotten here would never work - because they.just.want.pain.meds.now. Understandably, in this situation. I wouldnt want to hear empathy, how you "understand how much they hurt" ....because unless you've had one, you dont.
I think the real challenge is the family thinking it's McDonald's and getting pain meds happens very quickly....when it doesnt. So good luck explaining that to a family who's already stressed to the max. So - less words, more action is my $.02
P.S. I saw my dad cry ONCE. He's a tough old farmer. A piece of machinery fell on him recently, cut off part of his finger. Not a tear. But in 6th grade I saw him with one tear going down his face - kidney stones. That was over 30 years ago. Never forgot it. Just get the meds!
Julius Seizure
1 Article; 2,282 Posts
Great resource. Thanks for the link!