Remiss

I've been really remiss lately, getting embroiled in life around me. I've recently become focused again, "woke up" by reality of why I'm here. It's not too late, and the timing couldn't be better. Hopefully I'll peak in time for the national boards and the most important test I'll likely take in my life...thus far. Truth is, school has been really interesting and although voluminous, fascinating too. Example, a recent discussion on "angry patients"...

I was having this conversation the other day, so this is for that person, but worthwhile for anyone about to deal with patients.

I've had my share of really angry patients over the years...

* Keep your perspective straight. The anger usually isn't about you — even if the patient believes it is.

* Assess your safety. Do you need a witness? Should you leave the door open? Is this a matter best handled by security or the police?

* If at all possible, sit. Sitting tells the patient you have all the time in the world to solve this problem (although we all know you do not).

* Acknowledge the anger. "I feel like you are angry," is an honest way to start the conversation. Alternatively, "I feel our communication has broken down" can help the patient feel heard and steer the conversation toward resolution, and not just go-nowhere venting.

* Get to the real source of concern. Did the nurse have to stick the patient three times for venous access? Is he afraid he will die? Probe gently but persistently to get to the core issue.

* Then, stay silent and listen. The complaint may be 100 percent valid, completely insane, or — more likely — somewhere in between. But you won't know unless you let the patient talk.

* Ask what he would like for you to do; then negotiate. If he demands high-dose morphine PCA, offer a p.r.n. narcotic or NSAID. If he demands instant test results, offer to call and find out when the final report may be available. Don't do anything medically unreasonable or inappropriate. You are, after all, the doctor.

* Offer an alternative outlet. Depending on the issue, you may not be the appropriate person to resolve your patient's anger. The office manager can often help the patient feel his concerns are being addressed.

* Once again, remember that the anger isn't about you…most of the time anyway.

Some good applications in life too.

I'm BAAAAACCCKKKK!

Break was way to short. It always is. But I think it was the best that could be expected given the time frame. Great time with family, friends, food and foolery. Mentally rejuvenated and 10 pounds heavier. Ready to tackle even the most challenging....WHAT? A test!? The first day of class, covering everything we have ever done since we started learning? Tell me you are kidding. Tell me where the ibuprofen is!

The new term brings new students, new hopes, new fears, new schedules, new rules, new faculty, new leadership, new money...you can just feel the "newness" ooze from every wallboard pore. It's the same old island; Nothing ever changes for the most part. But the attitude and environment on campus is palpably different. We just don't know what to expect, but are hopeful none the less. I am back. And dare I say, we are back.

I hope I passed the test today. It's going to be a long haul to that infamous Step 1. I can feel it getting closer. I can see the light...but then again, it could be that train coming at me I keep dreaming about.