Wednesday, September 5, 2007


You learn a lot of medicine in medical school and residency. Not everything you'll every need to know, but it's a good start.

But they don't teach you much about dealing with difficult personalities. Even in a touchy-feely family practice residency. So you learn on the job.

In walks Ms. Prickly Porcupine. She can suck the beauty out of a warm spring day (and usually does.) She never smiles. She treats everyone as if their personal mission in life is to annoy her. I'm not excluded from this vast conspiracy. My last interaction with her got me this close (can you see my fingers?) to telling her to find a new doctor.

However, the doctor's best ally with difficult patients (as with all things medicine) is her nurse. And my nurse tells me the best way to handle Prickly is to prickle back.

PP: (whiny) I'm gaggy, snotty, pukey.

Dr. Smak: Pukey? How many times have you puked?

PP: (snapping now) Does it matter? You need a count?

Dr. Smak: (resignedly) Less than five?

PP: (on fire) Five? Is that the limit?

Dr. Smak: (snapping) Yes, five is the limit on Wednesdays.

PP: (surprised) How about Fridays?

As usual, my nurse was right. Prickly was quite settled for the rest of the visit. She only prickled me a little bit more. The tide had turned.

Then the winds changed. She started crying. And said all she wanted was some "love and sympathy." You could have pushed me over with a tongue depressor.

And to Prickly, love and sympathy today came in the form of an unnecessary antibiotic for her 3 days of cold symptoms with under five pukes a day.** And I learned another good patient care technique. Sometimes it pays to be prickly.

**I considered trying to explain to her why she didn't need one. I really try to avoid unnecessary antibiotics. But it's the only thing that would have made her feel cared about, and that, today, was more important.


Femail doc said...

I also try to avoid atbs to pts. with viruses but you are so right, sometimes caring is antibiotics.
What an interesting interaction!

Rob said...

Don't be too self-conscious about that. Only the hoity-toity academics would have not understood your actions. I knew exactly why you did it. You are in a business, you know.

Nice post.

Anonymous said...

The hoity toity academics can go pound sand.

PalMD said...

i like the hoity-toities...speaking of whom, one of my teaching colleagues found out i do prostate exams on my patients without a chaperone and was horrified that I exposed myself (to litigation!) like that. I don't know about anyone else, but I don't have anyone to bring 22 yo blond female MA? Im sure that makes my old guys more comfortable...

The Country Doctor said...

There does seem to be that patient type that needs conflict or "prickliness" in order to reach a level of trust with their physician. Coming out of residency I often tried to negotiate with these patients which just infuriated them that much more. Once I prickled back a few times our relationship improved.

SOCKS said...

Very entertaining and insightful post. And the trust that you demonstrate toward your nurse's judgement is "anti-prickly" to say the least.

janemarieMD said...

I agree--great story and thanks for sharing it! This is what keeps us going in primary care--you can have the most surprising interactions sometimes with patients, and sometimes they are also quite rewarding!

Next time you and your nurse will be smiling and saying that Ms Prickly has grown on you ... well, maybe not, but you know what I mean!

Dean Moyer said...

I don't think I would have had your patience (no pun intended). Interesting how being prickly back won her over. Never would have expected that.