JC, we already know where you’ll be, heh heh heh. Never you mind how we know that, or what all that code means. You’ll find out soon enough, my boy, soon enough.
Oh, and for the record, Dr.J is already something of a wall, but I think he’s about to lose his white cloud status.
Next time, cut the fentanyl in half and skip the Versed. If he actually remembers what went on then he might not enjoy it so much.
Or, you could pull the Steve Martin as the dentist in Little Ship of Horrors routine on him. 
My Og grant that there’s never an actual double code involving your Customer #1 and someone else that really needs critical care.
Good luck, doc.
doctor doctor! Help!!! when ever I go to drik my tea, I get a sharp pain in my eye. whats wrong???
DoctorJ said: “I AM NOT YELLING AT YOU!” she yelled. “Boy, you Southerners just don’t understand us. We’re just more blunt, or something.”
No, I’m sorry, you are not blunt, you are a loud bitch. I think people from all regions of these great United States and around the world would agree that you are a loud bitch.
You think we hicks can’t be blunt? Well try this–you have severe hypertension, you continue to smoke crack, and before long, you are going to die."
She’s probably a drug addict. May I suggest you treat her for the right problem, instead of criticizing her troubled calls for help?
Hostile attitudes toward patients may well generate legal suits from patients, particularly ones where it appears you may not be following an ideal treatment plan. As my doctor friends assure me, this is the last thing a doctor wants.
Actually, partly_warmer, as an internist, DrJ is treating her for all the problems he’s qualified to treat. If the woman had any interest in getting help at all, she would already be in rehab instead of throwing phone books at her doctors and screaming at her nurses. You can’t force someone to undergo medical treatment if they don’t want to, that’s why you can sign out of the hospital AMA (against medical advice). May I suggest you figure out what you’re talking about before offering advice to a professional?
Yelling at a drug addict is not a way to solve their problem. Treating the symptoms, instead of the cause is not going to solve the problem. The doc should work on getting her to see a substance abuse expert, not sniveling online about how “no one ever listens to him/her”.
Yes, you can force mentally ill people to undergo medical treatment. I’ve been there helping to stop someone get away who came in for routine psychological counciling. They came in, but they didn’t leave.
What to do when a patient is disrupting the hospital is the only thing in this situation I do not know about.
Finally, 'cause I’m not going to spend indefinite time in a pissing contest with nurses, doctors, and other health care folks, whose caring attitude I generally find very gratifying, I was pointing out something which I myself only learned about in the last year, which is how much a doctor’s pleasant attitude can keep them out of legal suits.
Wow…it sounds just like ER…you don’t have any really sexy Croatian widowers on staff, do you?
Why don’t I finish my point, and then folks can rave on. My mother was the head of her psychotherapy unit at an HMO. I went in to pick her up one day, and was asked to stand guard at one of the entrances, along with the police. The guy had decided he needed to use a knife to “cut the bad parts out of his family.” Okay?
One of my mother’s issues with doctors is that will prescribe pills indefinitely, with little or no consideration of psychological treatment. This, according to her, is a classic example of how psychiatrists are treated as “second class citizens” by doctors.
Hence my point: the woman appears to be a drug addict, and the worldly wise resident doesn’t appear to know what to do.
As for “patients never listen… blah… blah…” Many professionals feel that way about the way their advice is treated by the general public. Yes, doc, it’s a shock. Are you finished being shocked, yet?
Uh, DoctorJ never yelled at his patient.
pepperlandgirl, you’re right. I realized he hadn’t. I was saying that yelling wouldn’t solve the problem, either. I should have been clearer. Basically, if he’s not trained to deal with substance abuse types, even being calm and well-reasoned (from his point of view), won’t solve the problem.
Well, partly, I’ve been treating alcoholics and addicts for two decades, I’ve taken countless courses put on by the American Society of Addiction Medicine, and I can tell you that even calling in an addictionist is futile quite often, as any good addictionist will tell you.
Denial is the strongest part of the disease. So strong that many will die of the disease or its complications despite the best available treatment, the most caring and talented counselors, the finest 12-step programs, etc.
As a Family Physician the best advice I can give an addict is: “don’t bullshit me or yourself. Your addiction is killing you. Here’s how. You need treatment. If you don’t get it, you will die from this disease. I see no other way for me to help you.” It may not sound compassionate to you, but I owe the patient my honest assessment.
Then I have to let go, because dealing with a person with an active addiction is horribly frustrating.
And I fully support Dr. J venting here. It’s a very necessary part of the practice of medicine, where you tell someone else what you’d really like to say. Quite therapeutic, really. Hardly sniveling.
Now this just sounds incredibly arrogant. I would love to hear how you acquired your knowledge about how to deal with cocaine-induced hypertensive crises and chest pains of uncertain origin. Every patient is unique, every situation is unique, and my own treatment plan for each type of disease generally gets modified a half a dozen times in the course of the exam.
QtM, MD
Of course they could involuntarily commit this woman, but as soon as she could sign herself out, she’d be right back on the streets doing more crack. You know, why partly_warmer? Because no one can help an addict until that addict wants help. I’d think with your extensive knowledge of psychiatry, you’d already know that. Or didn’t your mother tell you that yet?
All the counseling in the world won’t do this woman a lick of good if her bp’s staying in the 200 range and her kidneys are shutting down, will it? Addressing her issues won’t stop her from stroking out or poisoning herself with her own nitrogenous wastes. This woman refuses to even try to take care of herself, so she’s gonna die, psychiatric help or no, so I think maybe her medical issues are the real problem after all.
As for the accusations of snivelling and mismanaging this patient, you seem to be the only person in this thread holding that opinion. There are plenty of folks who’ve posted in here who have a hell of a lot more medical knowledge and experience than either of us who seem to think he’s doing just fine, buddy.
Well, I can definitely tell it’s September - the month when the new R1s truly realize what’s in store for them for the rest of the year…
Smile, ** DrJ**, be patient and understanding to your gomers no matter how much it hurts, then come here to the SDMB (or another safe place) and blow off the necessary steam. Repeat PRN. And remember - in the end, the folks who are REALLY being hurt by this behavior are these gomers themselves. Lady #1 WILL die an untimely death, despite everything you are doing for her - and it will be her fault. You can’t help someone who doesn’t want to be helped. And if he undergoes enough caths, the laws of statistics predict that some day Man #2 WILL have a cath-related complication, which is punishment enough.
And you do interact with far more people who ARE grateful for your help and WILL at least try to follow your advice and take responsibility for their own care. Is just that they don’t stick out in your mind - because they’re so NORMAL.
Qadgop, yep, denial is right at the top of the list of problems. So is doctors refusing to refer psychological problems. You’re right, he’s not so much sniveling – he’s raving.
Obviously you’re an expert. So what do you recommend? The guy keep treating her without any hope of recovery until she dies?
CrazyCatLady made a blanket statement that I should “learn what I was talking about”. I replied to the effect that I actually had knowledge of the issues except that one area, where I had no knowledge. Enough knowledge to contradict his approach of trying to reason with an addict by saying, in effect “drugs are bad”. How much knowledge does one need? I’m a computer expert, would you please consult me before turning on your computer next time?
I was responding to her, not your little game shoving words into my mouth about “hypertensive crisis”.
More power to you dear. The operation was a success, the patient dies. You’re real pros.
Why do you assume she HASN’T been referred for her psychiatric problems? BecauseDrJ hasn’t mentioned it? Why should he? He’s frustrated about the difficulties he’s having in dealing with her immediate and life-threatening physical problems - difficulties that won’t go away in the time frame he’s talking about even if she’s immediately placed in a locked psychiatric ward upon her next admission.
This thread isn’t about the treatment of mental illness and drug addictions - it’s about people who bear the ACTUAL responsibility of caring for others (a responsibility that by your own admission you have NEVER held) needing to vent their feelings of frustration, feelings that are caused by being placed in situations where their repeated attempts to help are futile. Those feelings aren’t always pretty - but they’re real, and DrJ needs to air them now and then, for the sake of his OWN mental health.
Frankly, partly_warmer, turning on a computer is roughly equivalent to putting a band-aid on a skinned knee, and you know it. Unless, of course, you’re even more of an ignorant fucknugget than you come across as. You telling a doctor how to manage his patient, however, is like me telling a professional programmer how to write a program. Do I understand the general basics? Yeah. Do I know enough to tell this person how to do his job? Hell, no.
As for your insistance that this gomer is being denied psychiatric help, I don’t see anything in the OP to indicate that that’s the case. Please show me where it says, “No one has ever wasted their time and money doing a psych consult on this stupid cow” because I’m just not seeing it.
Being as how frequent flyers almost never actually pay their bills, I’d say this woman’s already had multiple psych consults on previous admissions, and the doctors who deal with her no longer bother running up bad debts for someone who clearly doesn’t want help. After all, getting three or four unpaid consults a month on this woman only drives the costs up for everyone else.
And what does the good doctor do when the local rehab unit reports that they’re out of beds; besides, that patient’s checked out of that rehab unit against medical advice 4 times before? And the senior psych resident says they’ve done involuntary commitment twice in the last 9 months, but she always gets out in 48 hours and never keeps her follow-ups? And she’s really not suicidal or a threat to others, just engaging in risky behavior? And the ER social worker actually cries when you tell her that this patient is back again? And the local free clinic won’t let her in there anymore because she steals from the other patients in the waiting room? And she’s banned from the local halfway houses for the same reason? I’ve seen dozens of patients that have just that type of history!
Do you really think noone’s tried all these things before on these unfortunate patients? That we’re just waiting for the doctor to slap himself on the forehead and say “gosh, I coulda consulted a psychologist?” Get real. I’ve seen teams of addictionists, alcohol counselors, occupational therapists, psychologists, social workers, job counselors, relationship counselors, psychiatrists, and recovering peers fail utterly to reach these addicts in their denial, time and time again.
Some people have more severe cases of the disease than others. Sometimes we just have to step back and let them suffer the consequences of their disease, and hope they become teachable before they die. A lot of times they will die first. That’s not my fault. I didn’t cause it, I can’t control it, I can’t cure it. I can only do my best to give good orderly direction. Then turn to other tasks.
And sometimes, just sometimes, miracles happen. One day these patients show up, clean, well-groomed, healthy-appearing, and apologize for all the trouble they caused. When we asked them what happened, they invariably say that they got real desperate, and something clicked, and they became amenable to change. But it rarely happened in a therapist’s office, or a hospital bed. More usually it happened in a jail cell, or on a cot full of vomit, or in a gutter. But it happens when they’re ready.
As for my other comments, you were the one to state that Dr J. was not treating her for the right problem in your first post, and when confronted on that, responded that the only thing you didn’t know what to do about in her situation was her disruptive behavior. What is a reasonable person to think? A BP of 280/150 takes immediate priority over most any other diagnosis. It is acutely life-threatening.
artemis, good point. She probably has been referred for psychological care. He didn’t mention it. So one assumed he wasn’t involved and/or didn’t think it was significant. I’ve only got his words to go on.
DoctorJ venting is fine, of course.
Q. the Magician said: “As for my other comments, you were the one to state that Dr J. was not treating her for the right problem in your first post, and when confronted on that, responded that the only thing you didn’t know what to do about in her situation was her disruptive behavior. What is a reasonable person to think? A BP of 280/150 takes immediate priority over most any other diagnosis. It is acutely life-threatening.”
No question, as far as I can see in my very, very, very limited medical experience that the most severe condition must be treated first… But he was talking about several visits, all alike.
Take an analogy to a friend who’s a dentist, who never stops complaining how patients don’t listen to her about brushing and flossing. “Why even try?” she wails. Gee. Does it occur to her that maybe her explanations are ineffective? That she should be more persuasive? Nope. It’s the patient’s fault. Leave aside that she’s the expert, and knows thousands of things the patient might want to know.
So in the OP we have a doctor being (justifiably) upset at some woman strung out on drugs screaming at him. But rather than explicitly give the problem to someone else, or resign himself that he’s tending a sinking ship, he gets angry and starts imagining screaming back at her. Not what she needs. Not what he needs. Ok, so maybe I should have just let him rave unanswered here on the board. It’s theraputic. On the other hand, maybe there’s actually a better approach.