Thursday, September 23, 2010

The Toxic Patient

"Doctor, did you see who's next on the OR schedule," the nurse asks. I take a look and let out an involuntary groan.  We all look at each other with silent dismay.  This was one of those toxic patients that every health care giver dreads.

You know who I'm talking about.  The toxic patient is one who has an endless litany of complaints.  No doctor or treatment is ever able to cure what ails her.  The patient goes through physicians as frequently as she does her antidepressants.  Doctors try to pass her along to some other unfortunate colleague because either they are tired of hearing her grievances and fabrications or the patient fires them, accusing them of incompetence. She is a living hell for the nurses on the ward.  She is constantly buzzing the nurses station making one request after another.  If she wants something that's against doctor's orders, she goes into a hysterical fit.  Then of course the nurses call the doctor to come give her a pain pill, a sedative, or both; just do something about her.

I approached the patient in preop with trepidation.  Her reputation among the anesthesiologists is well known.  She's filed many complaints against our anesthesiologists with the hospital, all of them eventually dismissed.  The only anesthesiologist that she tolerates is Dr. Shafer, and he is not in the hospital. How did I get her on my line up?

I introduce myself, "Good morning Ms. Jones.  I'm Dr. Z. I'll be your anesthesiologist today."

She looks at me with disapproving eyes. "Who are you?  Where is Dr. Shafer? He is my regular anesthesiologist."

"I know. Did you or your surgeon request Dr. Shafer?  He is off today."

"My surgeon was supposed to request Dr. Shafer.  I only want him to do my anesthesia. He is the only one who knows how to treat my pain and nausea after surgery.  You have no idea how bad I hurt after these procedures.  None of you know what you are doing except him."

"Ms. Jones, I've reviewed your old anesthesia records from Dr. Shafer.  I can give you the same anesthesia as he did. I will give you medicine to make sure you're comfortable with your pain and nausea after surgery."

"No. I only want Dr. Shafer to give me anesthesia."

Quietly elated, I page her surgeon.  We discuss her demand to only be treated by Dr. Shafer and how he is not available.  The surgeon talks to the patient and explains that her case will be cancelled if she does not allow somebody else to put her to sleep and that his next available time is two months from today. She is adamant about this and wants to go home if she doesn't get her way.  After much back and forth with the entire OR team waiting for a decision, the surgeon finally cancels the case. She then accuses us loudly of incompetence as she leaves preop holding.  "I haven't eaten all day and took time off from work to come here.  All for nothing! I'm going to write a letter to the hospital," is her final parting remarks.

Whew, I thought.  Got out of that one.  Have a nice life.


  1. you were lucky that time but what if she agreed you do her anesthesia. how would you manage her?

  2. If she had consented to be my patient, I would have treated her like all my other patients, with great care and respect. No patient deserves special treatment, whether they are VIP's or just belligerent.