Wednesday, 26 March 2008

Reacting to Unexpected Situations

I've been in A&E for a couple of weeks now and you can never predict who or what is going to come through the door next. It could pretty much be anyone, from any background with anything wrong with them. You can't foresee every possible situation you might have to deal with.

What happens when its not something clinically relevant, but it surprises you nonetheless? For example what if a patient, during the middle of a consultation, says something unexpected? What if they go on a 5 minute racist rant about the state of 'our' country? How do you react to something like that? Particularly as a medical student, but even as a doctor or nurse. You can't possibly sit there and agree. At the same time you can't really challenge the person's views, that isn't what you're there for. So, do you just sit there politely and let them rant until they can rant no more? Do you look at your shoes, at the patient, at the wall? Do you make your excuses and leave? Is there a difference if your patient is a 30 years old or 90? Male? Female? What about afterwards when you have to present the case to a senior and the only seniors around are of a different race? Do you warn them of the patient's beliefs? Do you pretend you'd not heard anything? Do you go for an early lunch?

Being a doctor is much more than dealing with clinical situations.


izzywizzy said...

You've definitely got it there! Today we had a tutorial discussing head injury and the neurosurgeon mentioned having to be like a police officer when dealing with medicolegal issues, interrogating from different angles to try and get the true story. Maybe it's not so different when just taking a run of the mill history too. And you have to be careful what you sayyourself too. It's a difficult balance for sure.

GrumpyRN said...

What I do in these situations is stop the patient and tell them that their views are unacceptable. They will either stop or get angry. If they get angry you try very hard to calm them down but you must also point out that they can be arrested for breach of the peace and for a racially aggravated breach of the peace at that. The courts in our neck of the woods deal very harshly with this and it is an almost automatic jail sentence. You do not have to listen to the ignorance that some people will try to tell you. However, if your patient is in their 90's or is demented there is really not a lot you can do about it but yes you do still challenge them.

Calavera said...

Whoa - that's a difficult one... What did you do?

The Girl said...

I would imagine that I would handle it similarly to the way I would handle a patient who was swearing profusely - tell them that this kind of language really isn't appropriate for that setting, and ask them very nicely to please stop, as this isn't the time or place.

Of course, it would probably depend on the nature and length of the rant, too.

It's a toughie, isn't it?