* * Anonymous Doc

Thursday, August 11, 2011

Someone named Batman Light left a comment on a recent post:

I am currently a pre med student and I've spent some time shadowing and doing rounds as a volunteer in hospitals and all that. I think my biggest problem is going to be my patients. One of my shortcomings is that I am very impatient, especially with ignorant stupidity. How am I supposed to handle a situation like this? when I see patients like this I want to laugh and shake them until they realize how ridiculous they are being and actually doing themselves harm while I am just trying desperately to help them. ... Also from your other post- how are you supposed to help and advise someone who is hellbent on still taking cocaine if he had just suffered from a heart attack? I'm afraid that everything I think of doing/saying to these "wonderful" people will one day get me fired lol...

Mr. Batman,

One answer:

You have to remember that, in most cases, these are people who are scared, who may not be terribly well-educated, and who are trying their best. The lack of knowledge can be frustrating, absolutely. The difficulty of getting someone to understand that you're trying your best too, and that modern medicine may have ways to help them, and that they're only hurting themselves-- absolutely maddening. Balanced with the fact that no one has endless time or endless patience-- of course you want to scream. You do what you can do. In the end, it's up to them*. You explain things as best as you can, you tell them what you want to try and do for them, or what you think they need to do for themselves, at whatever level of detail you can get them to understand, you document everything, and you move on. You can get family members involved, explain things to them and let them take on some of the burden of convincing their father not to use cocaine if he doesn't want to kill himself. And then when the patient comes back three months later, in worse shape, you do your best again.

*Unless the attending decides it isn't, and you're going to biopsy that thing anyway, without consent. Yay!

Another answer:

Who's going to believe a crazy patient who says you shook them? Come on, you're a doctor, so think like one. Doctors are credible witnesses. Crazy patients who don't want to give you a urine sample because they're afraid they'll run out of urine are not credible witnesses. Do whatever you want, just don't do it in a room with a camera.


  1. If Mr. Batman is not yet in med school and he already has a malignant attitude about patients maybe medicine isn't the right career for him.

  2. My thoughts exactly when I was in pre-med. Now I don't mind patients. Don't mind is the key words, like would be too strong. Still, hopefully, going into pathology. That way, like your previous post, I can just send them back if they are still talking.

  3. I can laugh at/with my "crazy" patients and the strange stuff they do because I actually care about them. Most lay people are pretty clueless about their bodies, and there is a lot of mis-information on google. Usually if you take the extra 2 or 3 minutes to teach them what's going on, they get it. And mostly they just want to do what you tell them to do. But yeah... if your "biggest problem" is the patients then maybe you should consider Radiology or Pathology heck, even Anesthesia, maybe a PhD.

    Also, work on your "I am not impressed" poker face, it had gotten me through a lot of BS.

  4. Anonymous Doc - I think your answer shows your strong sense of empathy. It doesn't come across in every post. Taken individually, some can sound a bit like ridicule (not your tone itself so much as inherent in some of the ridiculous encounters you relate.) But having followed you a while, I had already surmised you are a good, well-meaning person and doctor. Your advice is good and it seems to be reflected in your own behavior toward some of your more clueless patients - at least based on the stories you tell. ... I am also a pre-med, but a bit older than the average. On the one hand, I am sometimes concerned about the lack of empathy in my peers. On the other hand, they haven't been out in the world. They don't realize most of our fellow citizens haven't had the benefit of upper middle class, education-focused upbringings that most pre-meds have had. I think most pre-med types are capable of learning this through experience. I also think if a person happens to know he or she is not hard-wired to get there, he/she should probably choose another path.

  5. @Steve, or I hope he has a career path in medicine that doesn't require much (if any) patient interaction, such as pathology or being a medical examiner.

  6. @Steve,
    It is not like you say, 'I have a malignant attitude towards them already'. I have been around my share of patients, of all different kinds and ages, all coming in to the ER from "I want my allergy medication" to an 18 year old girl who was 6 months pregnant and had no idea. I know the difference between someone who genuinely isn't educated and has a hard time understanding/accepting what the doctor is saying and someone who sincerely wants to make the doctors job hell by refusing to follow logic simple enough it would make a 12 year old frustrated. I am empathetic to everyone but my main concern was how to deal with these said patients who are hellbent on busting chops, making your work harder, and wasting valuable time… not all of them. But thanks for your insight- I don't know what career path I would have chosen if the coin hadn't landed heads...

  7. And this is why I am pursuing surgery. I don't have to deal with stupid people. Hopefully. Call me an arrogant bastard, but it's the truth. :)

  8. Oh, if only I thought you had the stones, Anon Md, to actually shake a patient (or better yet one of those lack luster attendings for doing something that needs to be brought up before a review board...) Oh well...