What to do with patients-- be clear, be steady, be firm

[Guest guest]

one of the most telling lessons from residency and now solo practice i've learned is also probably one of the most difficult to balance with the range of reasons why we are doctors in the first place, among them, we choose this profession because we want to help others.patients have all kinds of lives, controlled, chaotic, bizarre, "normal", struggling with all kinds of use and abuse, many we have not personally experienced.my resident clinic was uncontrolled, and any attempts to bring order to it were sabotaged by none other than the assistant program director. i remember his exact words to this day: "i liken this to a MASH unit. i revel in the chaos." i wanted him to receive upper and lower endoscopy simultaneously right then and there, and felt like laying him out in preparation for the procedures, but refrained from doing so. after all, he had gone through residency at cook county hospital in chicago, so i knew he was already

off his rocker. i hope he's watching the military channel, and getting the relief he needs.any attempt at logic and reason to bring more organization and less chaos fell on deaf ears, even that we could see more patients and do a better job; that emergency departments and MASH units themselves have to be organized to adequately treat whatever/whomever walks through their doors, nope, nothing worked.the only way i have been able to make order out of chaos is to be in charge of my environment, what is appropriately mine, so i've drawn a circle in the sand completely around me. it's ok for others to be however they are; my job and professional obligation, in order to bring the best tools to bear to help, are based on the most fundamental concepts of organization. this is how my office works, and if there is agreement and demonstration that's how it works on the patient's part, then we can have a professional relationship; if not, then not.what

about all those where that doesn't work? don't they get care?they may, and through organizations, staff and procedures which deal with disorganization and chaos on a daily basis.no one can be all things to all people, and we need not try; one will only fail, potentially losing oneself, one's business, one's ability to survive while accomplishing nothing. carve out one's niche, and strive to do the best one can while recognizing and supporting the work others do to help those who have need, yet fall outside the circle in the sand.LLl_spikol wrote: Did you inquire specifically about sexual abuse? More common than u think. Also I use Instant Medcal History- "adolescent exam" which asks many specific questions (sexual,depression,family issues etc. > > > I have a family of 6 as patients (for about 3 years now). They have a > > 15 yr old daughter who has intermittent abdominal pain that has been > > diagnosed as IBS by peds gastro. When she first came to me at 12 or 13 she > > had to be sedated for blood draws because of what her Mom said was > > trauma caused by her previous doctor. So anyway, she came in with a period > > she says was really heavy and lasted 2 months in Dec. I had to

persuade her > > to allow labs (which showed probably PCOS based on testosterone levels) and > > wanted to do a pelvic and/or a pelvic ultrasound, which she vehemently > > refused. Her mom called later and said she wondered if we could try Yasmin, > > as a friend of hers was on it and it helped her menses and her irritable > > mood. So I agreed. I had also requested she see a gyn, she refused. > > > > So, another bit of background. These people are generally 15min late, when > > they call the Mom wants to talk forever, and I end up nearly hanging up on > > her and they are "quite prominent" in the community. > > > > Friday they came in, 25 minutes late, were told only 5 min of their appt > > time remained and that I was scheduled for more patients, and needed to > > leave on time. Of course they start into a huge

history of this issue. Pt is > > now nauseated every morning and won't get up for school until lunchtime. I > > recommended stopping the ocps or switching to another and the pt screamed > > "NO". I also suggested some anti nausea med but was concerned about fatigue > > etc.. I also said we could send to gyn and/or back to gi. She ended up > > screaming at me that she couldn't believe that was all I had to offer. Her > > mother basically sat there, then started trying to console her... At this > > point, I said I was going to go see my next patient and would return when > > she was calm. The pt then screamed "oh my god, you're going to leave NOW!" > > While in the next room I, the pt in the waiting area, the patient in my > > husband's office and the pt I was seeing could all her screaming her > > indignence at what I had

offered her. > > > > When I came back, now very late for my own appt, she said to her mother, > > "you said if she came back, you would do the talking". So we left it with > > her getting some otc emetrol, a script for reglan and another recommendation > > to try another ocp. I said to call me on Mon. and let me know where they > > were. > > > > Clearly, I can't have this kind of behavior, I know I need to do something > > and am thinking my only option is to fire this child. Does anyone have any > > ideas about whether I should talk to the mother about why? If there is > > anything else I should do? > > > > Part of my hesitation and or distress about this is after 13 years I had a > > pt contact a lawyer, this week, because I wouldn't give 90d of scripts > > without an appt, and she says I

wasn't returning her calls. > > > > What a week. Kris > > > > > > > > ------------------------------ > > Delicious ideas to please the pickiest eaters. Watch the video on AOL > > Living.<http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/2050827?NCID=aolcmp00300000002598> > > > > > > > > -- > If you are a patient please allow up to 4-8 hours for a reply by email/ > please note the new email address/ > e mail may not be entirely secure/ > MD > > > ph fax >

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.