I have to vent before my head explodes.

Yes, it was a crappy day today. I saw over 30 patients during my shift, with quite a few complicated ones which needed sorting out with blood tests, referrals, calling of specialists, etc. I'm happy to report that the majority of patients I see in the ER are very nice. They treat healthcare workers with respect, value your opinions, and thank you when they leave.

Out of the 33 patients I treated today, ONE DROVE ME UP THE WALL. This was a lady in her late 30s or early 40s ( she was wearing a mask, so I can't be sure, but she has a 12-year-old daughter ).

As luck would have it, I ended up with her daughter's card, as well as hers, because they wanted to see the same doctor, one after the other. Her daughter was a quiet girl, but a little too quiet, because whenever I asked her a question, she kept turning to look at her mother, who would then answer on her behalf. For example:

Me: Do you have any drug allergies?
The girl: ( looks at her mom )
Her mom: No.
Me: Okay. It says here you're having the flu. Do you have a runny nose?
The girl: ( looks at her mom again )
Her mom: Yes, she does.
Me: Any cough?
The girl: ( looks at her mom!? )
Her mom: Yes.

And it went on and on for the next 5 minutes. The girl had already seen a private family doctor a few days ago, so don't ask me why she decided to see us when there was no change in her status. She wasn't even having a fever. Anyway, I supplemented some of her meds, and went on to her mother.

And the nightmare begins.

This lady is already confrontational to begin with. She fell down and landed on her buttocks about a week ago, and was seen in our ER by another medical officer for pain over the tailbone. X-rays of her pelvis and coccyx ( that's medical jargon for the tailbone ) were normal, and she was discharged with medications. A few days later, she returned for the same complaint and was seen by yet another MO, but also said she had right chest wall pain. A chest X-ray later showed a fracture of the right 4th rib, and again she was discharged with painkillers.
Today, she returned with a different problem -- that of lower back pain. She told the nurse at triage that she blacked out when she fell a week ago, so naturally, I asked her about that first, because I wanted to make sure it wasn't a major factor in her reattendance.

Me: Did you hit your head when you fell last Saturday?
Her: ( angrily ) Isn't it in the computer? I've been here twice already!

Anyway, I ignored that little outburst and went on to ask about her symptoms. She was having a lot of back pain, and in view of her mechanism of injury, I had to do an X-ray of her lumbosacral spine, which wasn't done during her last 2 visits ( I presume because she never complained of back pain then ). She was very angry that I was doing X-rays again, and asked for an MRI scan of her spine today. Now, this is something people with no knowledge of the public healthcare system would say, and I gently told her it wasn't possible unless she was admitted ( and even then it would still take at least a couple of days ). She wasn't too keen on staying in the hospital, so she went for the X-ray.

Upon her return, I told her the films were normal, and offered the diagnosis of a possible slipped intervertebral disc which could account for her severe pain. What followed was what I can only describe as a tirade, in which she expressed displeasure at having her condition misdiagnosed, needing to come back for different X-rays, and ( I can't recall the exact words, unfortunately ) said something about us doctors being incompetent. My patience was already wearing thin to begin with, but this was the last straw. I told her very sternly, "Okay, please don't say such things about us doctors." Then I sat there and stared at her for a full 10 seconds. She later answered, "Okay, I'm sorry." but continued on with some other complaints about her treatment. I tried explaining that this was the first time I was seeing her, that she shouldn't direct her anger at me for something that happened previously, but everything I said just went through her. Finally, I just continued typing on the computer and asked her if medical leave till this Sunday was sufficient, or whether she needed more rest. This is what happened:

Her: ( screams ) What?! How can you ask me this? You're the doctor! You should know!
Me: ( shocked but recovers quickly ) I'm asking because I've had patients who don't want me to give them long MCs. If you feel okay by Monday and want to return to work, I'll just cover you for the weekend.
Her: ( still upset ) I won't be okay by Monday!
Me: All right, then I'll give you MC for a week from today. Do you have enough medications?
Her: ( hysterical ) How should I know?! You should be the one to tell me! ( shows me her plastic bag of painkillers, which looks pretty full )
Me: Looks like you have sufficient supply.
Her: ( starts rummaging and pulling out the different packets ) Look at this! It's almost empty! And this! This is almost all gone! How can you say I have enough medications?!?!
Me: Fine, I'll give you some more then.

She tells me she has an appointment with the orthopaedic clinic this coming Tuesday, so I quickly print out her prescription and MC and ask her to go out to make payment. Before she leaves, she repeats me name, pronouncing each syllable with deliberate clarity -- "You're Dr. so-and-so, right?".

Me: ( nonchalant tone ) That's right.
Her: I don't like your attitude. ( whisks out of the room in her wheelchair )
Ditto, I thought.

Well, I'm waiting for someone in admin to call me, or for a letter to appear in my pigeonhole asking for my take on the situation. I usually try not to let unreasonable patients get to me, but this woman came during a bad day, and my blood is still boiling. ( Although I will admit, writing about it on my blog has eased my nerves significantly. :))

Anyhow, I listened to Michael Buble's "You'll Never Find Another Love Like Mine" 3 times on the way home, which also helped! And there's "Survivor: Pearl Islands" tonight. More on that and my impression of "The Bachelor 3" another time. On afternoon shift in resus tomorrow, and someone's passing me a DVD with Clay's public appearances tomorrow. I can't wait! :D