when you ask them how their pain started.
Posted Oct 31, 2019, 1:52 AM UTC
26327
Patient I saw in the ED for chest pain went from "sharp pain" to "That's the type of football Woody Hayes coached in the 50s" in less than a minute.
55
like, theres only so much "Gentle redirection" I can do. At some point im going to interrupt you at every chance I get. This guy today literally looked at me sideways when i interrupted him for the 12th time to get him back on track.
34
Therapeutic listening is honestly part of our job
-10†
Kinda hard to do sometimes when you've got other patients to see, consults to make, orders to put in
37
I would love to sit and chat and eventually get to the point. I find its literally the easiest way to build rapport. But sometimes... yeah, we got a lot of work to do and not enough time. Its one of the reasons why I prefer clinic over the ED or Urgent care. Hell its the biggest reason why I prefer the wards over clinic. I can arrive early, and spend much more time with my patients...
30
It is but only to an extent, when people are getting seriously off track you need to redirect them or interrupt because you have other work to do. The exception I make is when I go talk to my patients that are acutely dying, I let them talk about whatever they want. Also when I’ve finally made a breakthrough with someone with regards to abuse, etc. But you best believe I’m cutting off/redirecting the guy in the ER I’m trying to admit trying to talk to me about the White Sox instead of his chest pain.
22
So are boundaries.
14
Yes. Sort of. I do think it’s appropriate to interrupt patients and get the important details though. Depends on the situation.
8
Transfer to psych for treatment of new-onset Bipolar Disorder, current episode, manic af.
6
This is how my pain just started.
25
The "I don't like facebook" really got me.
23
I had a patient + his wife that literally would not stop talking. I was only going back after to show them his CXR because they were interested, but I couldn't get out of there politely until a rapid response was called and I had to go, "Oh, gotta go, someone's crashing!"
16
Yeah if i know I'm going to get stuck in an endless conversation loop that I don't have time for I get my resident to page me in a set amount of time and then tell the patient that I need to respond to this urgently.
7
AOx0
didn't even get her name right
15
Is it possible to be A&Ox-1? I’m less oriented now because of this person
17
It’s the most beautiful thing to have a patient who answers questions directly and allows you to get through your H&P without interruptions. They’re the real MVP’s. I love chatting and getting to know my patients when I get some spare time and will always kens a ear...but sometimes it’s just music to your ears to get through to the meat & potatoes first.
10
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9
YES!
2
This is so accurate- especially when addressing ROS questions. I've learned to instruct patients on answering only with yes or no
7
“Central pain”
3
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1
On a consult service, listened to a guy spend 10 minutes explaining to me how he isn't sure where his wallet is because it started off sounding like an HPI story (I was at home, having chest pain, fell to the floor). So many random details along the way. He wasn't a bad story teller but when he was getting into "and I says to my nephew, I says, well you grabbed my jeans and I didn't hear anything fall to the floor, maybe my wallet wasn't in my jeans after all?" I was like ok where is this going exactly but I didn't have anything other than this one consult to do so I just let him keep going. Turns out he still doesn't know if his wallet is at home, but it wasn't in his jeans or jacket, and he brother in law cancelled his credit card for him already and the ambulance company is searching the unit he came to hospital in. Fascinating
1
The biggest difference in how homeless psychotic patients vs homeless personality disordered patients answer questions is how interesting their ramblings are.
Could you elaborate? Which is more interesting to you?
I like the psychotic rambling. I find it interesting to attempt to follow the loose associations and try to ride that wild train of thought.
The personality addled diatribes are just full of boring psychosocial drivel none of which coming in the hospital or taking medication is going to fix.
To me, personality disorder patients are actually coherent. Overdramatic and hyperbolic, but I can at least understand them.
Had a guy with schizophrenia and was also so manic that he sounded like he had wernicke's aphasia. You can't immitate that kind of rambling. So fluent and yet so random.
The coherency is what makes personality disorders so frustrating and annoying to deal with. They are actually putting together a story and arguments that you have to pay attention to and respond to whereas the psychotic one, you're just there for the ride.
It seems like psychiatric disorders are chemical imbalance, faulty wiring, spontaneous electrical feedback systems etc. Those you fix with meds and coping therapy.
Personality disorders are the person is traumatized or just a kinda bad person. It’s not so much a disease, as the name indicates, and therefore can’t be fixed with pills but retraining through therapy how to cope or censor themselves.
So when it comes to ramblings it’s clear that one is psychotic (and I agree it’s fascinating to figure out how they think) but the other is coherent but making (pardon my phrasing) stupid obscene arguments that while logical are not probable.
One person thinks aliens took his kidneys because the commercial for cat food cane on twice during the base ball game and it was meant as a message to them to get help at the hospital.
The other guy thinks his wife wants to sell his kidneys because of how much debt they are in and she keeps knives in the kitchen.
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Hi just the crazy one, I'm dad.
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