Monday, September 11, 2006

Medical antagonism

Another of my residents told me a story I'm not sure I believe, which I was reminded of by writing my last post.

Some patients no one likes. But most of the time, the way you deal with this is by doing your job, taking care of the patient, and realizing that your reaction to the patient can tell you something about them too. It's called countertransferrence. Ok, maybe I should have been a psychiatrist. The point is, this unfortunately doesn't always happen.

So one of the residents in the program I'm checking out right now was at the local county hospital, and he was completely fed up with a patient. I don't know all the details, but I know that patients can be aggravating. This resident made a highly unprofessional decision though, and wrote an order for "Fleet's enema, q1hr, until AMA."

What this means is that the patient was to be subjected to an enema every hour until he signed out AMA. Completely uncalled for, but what is more sad is that when this story was told, almost everyone in the room laughed. Yes, it was a long day, and yes, even the best of doctors has probably had a similar thought cross his mind transiently, but to actually write the order is malpractice. To laugh at the story is is bit inhuman too. Isn't it?

I'll admit, I laughed.

Maybe I'm becoming more jaded than I thought.


zhoen said...

I think the laughter is a release. It is, as a story, very funny. As long as, in the moments after, you also think, wow, that is malpractice and utterly unprofessional, I will never ever do that. Then the story allows you to stop yourself when you get a thoroughly unlikeable patient, as you remember the story, instead of risking your license and career.

Any nurse implementing the order should refuse to do it. If that nurse values his/her licence. A nice little failsafe.

Nathan said...

Thanks. I think you're probably right, I just don't want to get to the jaded, bitter point most of my residents are at. The good thing is, it's only on my team. The others seem to be doing fine with the pressure. I count on residency being hell, but I'm willing to deal with that. For a while anyway.

And nurses can be really great that way. I love you guys. :)