Why wouldn’t my doctor or the nurse listen to me?

Dear Viki,

I was having a terrible allergic reaction to a new medicine and the nurse at the doctor’s office wouldn’t take me seriously. My skin was turning red and was burning and my lips were stinging and swelling. It took me days before anybody took me seriously. I called over and over again for three days. And then when I finally talked to the doctor, she said I should keep taking the medicine because it was important for my heart. Eventually I got an appointment with another doctor and when I stopped the new medicine, all the symptoms went away. What could I have done to get their attention?

I am so sorry this happened to you. First thing, if you are having a terrible reaction to a medication, go to the emergency room. Some allergic reactions can become fatal. Regarding your doctor and the nurse, you have a problem. This is an office that isn’t taking your complaints seriously. Either they didn’t believe you or they didn’t realize it was serious. Either way you are in trouble.

Be thankful you have found out now that this doctor isn’t a good fit for you. This doesn’t mean this is a bad doctor, just not the right doctor for you. For some reason, they wouldn’t believe you and you can’t take the chance that this might happen in the future. This could be dangerous to your health.

Even it wasn’t the doctor who made the mistake, the doctor has a nurse working for her that doesn’t respect what the patient says or doesn’t pass on the messages appropriately. You can not take that risk. What if it is truly life threatening the next time? I highly recommend that you take this as a warning and find a different office. Sometimes in life we get the gift of knowledge. Use this experience to protect yourself and get an doctor’s office that will listen to you.

Have a kind and respectful day.

Your Patients May Not Know How To Get The Help They Need.

I remember when my mom was dying and I was sitting vigil with her in the hospital on the last day of her life. My brother, who I was close to, said to me, “There really ought to be someone who can help people with this.” And what he meant by “this”, it was the dying process. I said to him, “This is what I do, I am a hospice volunteer.” My brother knew me very well and knew that I worked with the dying, but he couldn’t imagine what that meant. And if he couldn’t imagine what a hospice worker does, then a lot of people may be confused or unsure.

We can’t assume that our patients know how to get what they need. They may not even know what they need. They don’t know that there are specialists who can help them make their home safer for the patient, help them with applying for disability benefits or help them make decisions about both the short and long term plans. As professionals, you need to help them access the appropriate resources. If as a physician you don’t have the time, then make a referral to a social worker who can help the family cope with their changing life and health situation. Or find out what resources are available in your community and help them make the connections yourself.

I get called by so many people, whether it is for help during the dying process, help with figuring out what to decide when the patient can’t speak for themselves anymore or how to deal with a conflict in the hospital. You aren’t alone. I can help you when you are wondering, “Am I on the right track here? Am I doing the right thing?” You can run it by me and I will talk you through it.

Have a kind and respectful day.

Are Mixed Messages Harming Your Health?

When you are in the hospital, you are vulnerable to the problem of “Mixed Messages.” What this means is that each of the specialists come in and give you information about the part of the body they take care of. So the pulmonary doctor will say, “Your lungs are doing better.” The cardiologist will say, “Your heart is failing.” And the internist will say, “Your infection is getting under control.” But nobody is giving you the big picture. Nobody is telling you how to interpret all of these pieces of information about your health situation. So here is what happens next. The next day your internist comes in to talk to you about end of life issues. You are shocked and ask, “How can I be dying when my lungs are doing better?” You have just done what most people do. You latch onto the best news and forget to take into account the worst part of the news. Yes, your lungs might be better, but you can’t live without your heart and your heart is failing. But nobody is explaining this to you.

Nurses do the same thing. Each day, different nurses are assigned to you. And each nurse has a slightly different view of how you are doing. Or they say, “You are doing better.” What does “better” mean? It doesn’t mean better and you are going home, it means you are doing better than the worst moment you have had in the hospital. Lots of people die in hospitals that are doing “better.” Better doesn’t tell you the whole story.

So what can you do? You can ask the main doctor, called the attending, to give you an overall update about how you are doing. Not just a part by part explanation, but a “big picture” explanation. And if you are getting mixed messages, make sure you listen to the good and the bad. I know that this can be difficult but it is necessary so you can make appropriate decisions about your health. The only way you can have informed consent is if you understand all of the information, not just the news you want to hear.

Have a kind and respectful day.

Is Your Patient Being Harmed By Mixed Messages In The Hospital?

When you and your colleagues are rounding on the patient, each of you gives the patient/family an update on the patient’s condition. The pulmonary doctor will say, “Your lungs are doing better.” The cardiologist will say, “Your heart is failing.” And the internist will say, “Your infection is getting under control.” These are all true statements but the patient gets confused. Patients tend to focus on the good news you have given them and forget the bad. So when you come in later to talk about a DNR, they are shocked because patients don’t understand how the organ systems work together. This is one of the primary reasons people don’t want to sign a DNR. They don’t understand the big picture about their health. They don’t understand that your lungs can be better and you can still die because your heart is failing. And I am not even talking about the miscommunication that can occur because of language differences, medical illiteracy, language illiteracy, cultural differences and differing levels of capacity. All of these make things worse.

But you do have power when it comes to mixed messages. Make sure the attending is speaking to the patient or the family every day and giving them the big picture. The attending needs to explain how the overall view is for recovery. Some hospitals are creating a, “Captain of the ship” policy to mandate these big picture updates. This can become especially important when the patient shifts from being a surgical patient to a medical patient. It the captain of the ship needs to change, make sure the new captain now knows that they are in charge.

Nurses can do the same thing. Each day, different nurses are assigned to the patient. And each nurse gives a slightly different evaluation of the patient. Or they say, “You are doing better.” What does “better” mean? It doesn’t mean better and the patient is going home, it means that they are doing better than the worst moment they have had in the hospital. Lots of people die in hospitals that are doing “better.” Better doesn’t tell you the whole story. So, please be careful and give clear information. And you may have to give the information multiple times, especially if it is bad news. It takes much longer for bad news to sink in than good news. And it would for you too, if you were the patient.

Have a kind and respectful day.