* * Anonymous Doc

Wednesday, August 17, 2011

Crazy Patient Newsflash:

Threatening to hurt yourself is not an effective strategy to get your doctor to do what you want.

"You get me that x-ray today, or I am going to leave this hospital. Right now. And there's nothing you can do to stop me."

"You give me methadone, or I am going to go back to drugs. And I am going to use more of them than I have ever used before."

"You write me a note excusing me from work, or I am going to stand in the middle of the street until a truck runs me down."

I consistently fail to understand the logic behind this tactic.

I don't care if you leave the hospital. In fact, I prefer you leave the hospital, because it means I have one less patient to worry about. I don't care if you use drugs. You shouldn't use drugs. But you're hurting yourself, not me. I don't even like you. If you want to stand in the middle of the street and let a truck run you down, go for it. Your choice.

Why do people think I am required to stop them from being stupid? Why do they think threatening to harm themselves is going to get me to break rules for them? The only thing that threatening to harm yourself can get you is a psych consult.

You're asking for things I can't do anyway. I don't control the CT schedule. I don't cook the hospital food. I don't give away narcotics to the highest bidder. I'm not going to lie to your boss for you. I'm not going to let you stay an extra day just for fun. I don't care if you sneak out the window and run far away-- and I have no idea why you think I do.

Some people seem to believe that they're doing us a favor by being in the hospital. That we grateful to have them there, and will bend over backwards to get them to stay. "I am not going to let you poke me with that needle anymore" is not an invitation for a discussion where I attempt to bribe you with non-diabetic meals in order to get you to consent. I will explain to you why I need to poke you with the needle. And if you still say no, guess what? I'm not going to poke you with the needle. We are not going to debate. You are not going to scream at me while I hold you down. It seems like that's what you want-- and I don't know why-- but it's not going to happen. You have the freedom to leave. I will not fight you, as much as you want to provoke me.

Is it that the hospital turns everyone into a child? I think that's part of it. Patients are scared. Often poorly informed about their own condition. Often upset and irritable. But I don't know the difference between the "no!" that means I will not consent to the biopsy and the "no!" that means I want you to explain to me again why I need it. I'll try, but it can't be my job to read your mind. It can't be my job to be your parent. It can't be my job to twist your arm to let me help you.

"You get me a charger for my cell phone or I'm going to rip this IV out of my arm and walk right out of here."


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