By Rebecca Mills
It was my first F1 job. The wards had been incredibly busy that day, and practically all the patients being admitted were acutely unwell.
The patient was screaming at me and what had started as a nice, friendly chat had rapidly taken a different turn. Nursing staff had whispered to me in hushed tones that patient X had already been quite difficult, and yet I had found a charming, charismatic man smiling at me. Everything seemed pleasant enough until I told him we didn’t have the exact brand of medication he wanted. In a lightning flash, his countenance had dramatically changed.
The pharmacist was desperately trying to locate the exact drug prescription the patient insisted he needed, even though we had both exhausted a great deal of time and effort trying to explain to him that, although we may not have that exact brand of drug, we had its equivalent formula.
I drew back the curtains, only to find all heads in the bay directed towards us, closely following our exchange, nursing staff comically stopped mid-stride in the corridor. It felt as though I had become the entertainment.
Patiently I went through the steps I had enacted many times in medical school for calming an angry patient. I had already used them on the wards multiple times, often to great success. Surely if I followed them to the letter then he might stop screaming and calm down a little? Was what I was suggesting really that unreasonable?
I altered my tone of voice, my speech, my body language, in an attempt to pacify him. But to no avail.Rebecca Mills, junior doctor
I gave him time to fully express himself. After a full half an hour of non-stop yelling, he showed no signs of stopping. I went away and gave him more time to settle by himself. I returned; nope, that hadn’t helped. Logical explanations weren’t working. I altered my tone of voice, my speech, my body language, in an attempt to pacify him. But to no avail.
It was at this point that I realised: although it remains important to use such techniques to allow patients to express themselves and feel listened to, and try to identify the root cause of a patient’s anger – and in many cases this will work very well – it is also important to realise that sometimes there isn’t an answer, even though you have done all the right things. Sometimes patients may feel emotional, and it may have nothing to do with you, and everything to do with the situation they’re in. Recognise that you may not necessarily be able to change that.
Hard as that may be to accept, realise also that this places you in one of the most unique and privileged positions in society, to be able to witness all aspects of the human condition, to be privy to the full spectrum of emotions that others experience. To see people in their moments of greatest vulnerability, pain and fear, where they are more liable to lash out, and to be with them at that time – at their worst but also, sometimes, at their very best – is perhaps the most humbling and rewarding aspect of being a doctor.
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