One of the students working with me on L&D recently complained that she wasn't getting…
“I can see that you’re busy – I’ll come back later.”
I had a very interesting interaction with a patient today. I was down on the postpartum floor consenting a patient for a postpartum tubal ligation, when a different patient’s nurse flagged me down. The patient had just been brought down from labor and delivery after delivering twins vaginally. She asked her nurse for narcotic pain medication, which I do not normally order after uncomplicated vaginal deliveries. My standard practice is to order only tylenol and motrin for patients who have an uncomplicated vaginal delivery, with narcotics reserved for patients with bad tears or c-sections. The nurse reported that the patient was refusing tylenol because she said tylenol doesn’t work. Ok, fair enough. Time to go have a chat with the patient.
This is probably a conversation that I have at least once a month. A patient who has had a vaginal delivery wants narcotic pain medication and doesn’t want to try non-narcotic options. Usually I go down there, examine the patient, and explain about how narcotics tend to give quick relief that wears off just as quickly, leaving the patient feeling just as bad as before. I talk to them about taking scheduled non-narcotic medications for baseline pain control, as well as other interventions like abdominal binders and heating pads. If they are still having pain, they can have narcotics while in the hospital, but not to go home. They usually don’t actually want narcotics as much as they want to feel better, so they tend to agree to this plan.
Sadly, that isn’t what happened this time.
I knocked on the door and walked in with my usual intro: “Hi, Dr. Indy from OB/GYN!”
When I got past the curtain (just inside the doorway), there were about 8 people talking loudly all over the room. The patient was chatting on her cell phone – I heard her excitedly telling someone how she didn’t push very long. Once again, I said “Hello! I’m Dr. Indy from OB/GYN.” No one could hear me. One of the family members yelled at the others and everyone stopped talking, so I tried again. “Hi! I heard you’re having a lot of pain. What’s going on?” The patient looked up, cell phone still in hand, and said “Oh, I’m not having any pain.” She went back to talking on her phone. “Oh!” I said. “Wonderful! So you’re ok with your current pain medications, then?” “I ain’t havin’ no pain now, but when I do have pain I ain’t takin’ no tylenol. That sh*t don’t work.”
I opened my mouth to start talking to her about pain management options, but before I could say anything she was back to talking on the phone. My response? “I see that you’re busy. I’ll come back later.” And I turned and walked out.
The patient’s family was flabbergasted.
I went to the nursing station and told the nurse about our conversation. I told her that the patient reported no pain at the moment, asked her to page me if the patient was having uncontrolled pain on tylenol and motrin, and turned to go back to the rest of my duties. Then one of the patient’s guests stormed up to the nurses’ station, livid, insisting that I was terribly rude to the patient. I guess they didn’t like me walking out!
I’ll admit it – I was mad.
You see, this is one of my biggest patient-behavior pet peeves. Patients usually don’t know exactly when I’m going to walk in, and so it happens all of the time that I walk into the middle of someone’s phone call. The most common response is for the patient to quickly say “I’m sorry, I have to go – the doctor is here” and to hang up within seconds.
I have no tolerance for people talking on cell phones during doctor-patient interactions. You expect me to focus 100% of my attention on you, and I expect you to focus your attention on me, so we can work together to get you feeling better. That goes double when you ask me to drop what I am doing and come talk to you.
At any given moment during an average day on labor and delivery, I am responsible for 2-3 laboring patients, 1-2 triage patients, and 15 postpartum patients, plus patient phone calls and miscellaneous leftover paperwork. The only possible way for me to take care of everyone is to focus on each patient while I take care of them, then move on to the next task. When I come to talk to you, I don’t have time to wait for you to finish chatting about your delivery experience on the phone, and if you aren’t going to engage in a conversation with me about your problem, it probably isn’t important enough to you to justify pulling me away from taking care of other patients.
So, what do you think?
Where do we draw the line between providing customer service and tolerating abuse and disrespect from our patients?
What do you do when a patient continues their phone conversation after you enter a room, with no signs of ending the conversation to talk to you? How did the patients respond?