Was I unprofessional?
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Was I unprofessional?
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The Scene, The pre-operative anaesthesia assessment visit. The Patient. A man in his 50s, for intermediate orthopaedic surgery. He is obese (BMI 36), has hypertension and epilepsy controlled on
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Was I unprofessional?
posted at 22/7/2012 2:07 PM BST
on bmj.com
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Posts: 2060
First: 12/3/2010 Last: 24/5/2013 |
The Scene, The pre-operative anaesthesia assessment visit. The Patient. A man in his 50s, for intermediate orthopaedic surgery. He is obese (BMI 36), has hypertension and epilepsy controlled on drugs, smokes 10-15/day (allegedly) and has bad teeth. He also has a partner/wife with him who interjects all the time. The Scenario. I tell the man how I intend to anaesthetise him (GA, TCI, LA for post op, analgesia). I also say that I will do my best to avoid damage to his teeth, in the course of maintaining his airway. The wife cuts in, "Then we'll sue you!" I glare. "Ha-ha! Only joking! We're a bit nervous" I say that I am not joking, I take my job very seriously, and that I hope that they will too. I give a short lecture on the risks of anaesthesia with special reference to the airway. I conclude my visit, having obtained the man's verbal consent (all that we do in the UK). He arrives in theatre, calm, and his anaesthetic and operation go smoothly. But In theatre and later on the ward, the staff all ask me, "What DID you say to that woman?!?" Apparently, she stormed out just after I had gone, very clearly very angry. Reflection. She had already irritated me by her constant prodding and correcting of her husbands replies to my questions. I have been threatened before with being sued for tooth damage. Then and now, I warn the patient and document it, but no one likes being sued. She may have been worried, for her husband, and I should have made allowance. The patient was not straightforward, and I wasn't expecting to enjoy his case. so another reason for being snappy. But was I unprofessional? Should I have ignored her remark as being irrelevant to the patient's care? John |
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Re: Was I unprofessional?
posted at 22/7/2012 6:04 PM BST
on bmj.com
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Posts: 154
First: 29/11/2010 Last: 19/5/2013 |
One question please. If some irritating patient with a predetermined mindset brings in the suing stuff in to equation. Can the doctor if not found guilty put up a lawsuit or claim for damages to his reputation & peace of mind against that patient? I don't practice in the UK.So i'm not well aware of it. But it looks like an unfair game,if anyones tries to waste your time and money and escapes with no worries or consequences to face. @ topic John ,i really feel for you. |
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Re: Was I unprofessional?
posted at 22/7/2012 6:04 PM BST
on bmj.com
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Posts: 43
First: 24/11/2010 Last: 1/10/2012 |
I don't think so. You're not a machine which'll deliver a lecture and move on. You are allowed to adjust your responses to the situation. And you were right to tell them that this was a serious matter to which they should pay attention rather than making snide comments. Plus, I would think it extremely rude if one of my patients made a remark like that. We are there to care for them, not to be insulted by them. |
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Re: Was I unprofessional?
posted at 22/7/2012 7:59 PM BST
on bmj.com
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Posts: 1791
First: 7/3/2009 Last: 25/5/2013 |
We are all prone to human feelings and human reactions. Sometimes errors. I would say this: you are much more experienced with different kinds of reactions from patients and families than the patient and his family. Use that and be the "responsible adult". It is extremely difficult, especially when you are under strain and under a burden of work to be attentive to all nuances of people.Do try to ignore some irritating remarks. You are wiser and more experienced than the frightened, aggravated,pushy, sometimes rude person in front of you. Easy to say, very difficult to carry out. It sometimes comes down to "how", not the "what". In this instance the "what" was explained in detail, seriously and in length. The "how" should've better ignore the "joke" of the wife. |
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Re: Was I unprofessional?
posted at 22/7/2012 10:24 PM BST
on bmj.com
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Posts: 966
First: 15/7/2011 Last: 26/5/2013 |
In Response to Was I unprofessional?: The Scene, The pre-operative anaesthesia assessment visit. The Patient. A man in his 50s, for intermediate orthopaedic surgery. He is obese (BMI 36), has hypertension and epilepsy controlled on drugs, smokes 10-15/day (allegedly) and has bad teeth. He also has a partner/wife with him who interjects all the time. The Scenario. I tell the man how I intend to anaesthetise him (GA, TCI, LA for post op, analgesia). I also say that I will do my best to avoid damage to his teeth, in the course of maintaining his airway. The wife cuts in, "Then we'll sue you!" I glare. "Ha-ha! Only joking! We're a bit nervous" I say that I am not joking, I take my job very seriously, and that I hope that they will too. I give a short lecture on the risks of anaesthesia with special reference to the airway. I conclude my visit, having obtained the man's verbal consent (all that we do in the UK). He arrives in theatre, calm, and his anaesthetic and operation go smoothly. But In theatre and later on the ward, the staff all ask me, "What DID you say to that woman?!?" Apparently, she stormed out just after I had gone, very clearly very angry. Reflection. She had already irritated me by her constant prodding and correcting of her husbands replies to my questions. I have been threatened before with being sued for tooth damage. Then and now, I warn the patient and document it, but no one likes being sued. She may have been worried, for her husband, and I should have made allowance. The patient was not straightforward, and I wasn't expecting to enjoy his case. so another reason for being snappy. But was I unprofessional? Should I have ignored her remark as being irrelevant to the patient's care? John Posted by John D John, there is absolutely no reason here why you could be sued. As far as I can see you explained carefully to an irritating couple and your treatment was exactly correct and you explained everything carefully. If the wife/partner doesnt like it then too bad. The patient suffered no harm then there is no problem. |
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Re: Was I unprofessional?
posted at 22/7/2012 10:33 PM BST
on bmj.com
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Posts: 1181
First: 19/4/2010 Last: 23/5/2013 |
I don't think you did anything wrong. People are going to get irritated by us, they are going to hear things they don't want to hear, and they don't like, and they are going to storm out, and get angry, regardless of what we do. You did the needful, and they got the hump. You're not unprofessional as far as I see it.
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Re: Was I unprofessional?
posted at 23/7/2012 10:44 AM BST
on bmj.com
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Posts: 2060
First: 12/3/2010 Last: 24/5/2013 |
Thnak you for your reassurances. I' confident that a suit for tooth damage could be defended - it was my response to the wife, that clearly upset her, even if the husband gave no sign of concern. You can't sue for being upset (can you kirked??) but I don't want to affect anyone so much that they storm out of the hsopital. I conclude that I was professional, but 'not a nice doctor'! Anyone else care to offer a reflection? A 'meditation' on a part of our pratice, or a case. It's part of our UK revalidation process now. John |
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Re: Was I unprofessional?
posted at 23/7/2012 3:58 PM BST
on bmj.com
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Posts: 225
First: 15/5/2012 Last: 22/5/2013 |
John D: We all get entitled and demanding patients and their relatives. I think you acted appropriately and did your job professionally. The dictum is: did you provide reasonable, safe and appropriate level of care. It is clearly evident that you did. Look at it this way: perhaps, the patients wife was stressed with her husband being in surgery and probably was frightened. Perhaps she has poor coping skills. Perhaps it is a personality trait. All said, practising medicine is not a popularity contest. It is about safety, appropriate and acceptable level of care. In the process, sometimes we tread on toes and bruise egos. |
