Thursday, February 12, 2015

Phrases that annoy me: Part 2

"You're not doing nothing, Doctor."

From time to time, I have to deal with unhappy patients or staff members. This is part and parcel of the job, and it is why we undertake many hours of communication skills training to deal with these situations effectively. Shouting, swearing and name calling I can deal but the title phrase irks me every time I hear it, and whenever I do, I always try to confront it.

Obvious double negative notwithstanding, this is the only phrase I hear at work that really makes me cringe because it is so obviously fallacious. I understand long waits and being in pain do not mix well and I can understand people's frustration but the initial consultation is not usually where I hear this phrase and if I do I tend to apologise for their wait and implement some resolution to this.

I usually hear this phrase from people with whom have had repeated interactions with healthcare professionals with repeated investigations, treatments and consultations. Now I understand people remaining in pain which hasn't been diagnosed and treated can be frustrating but telling me I haven't done anything to help hurts, as that's what I am there for.

This may not have been the best way to handle such a complaint but I challenged the assertion of the last person who told me "You're not doing nothing, Doctor."

In an effort to show the person that we were taking them seriously I presented all of their pathology, radiology, endoscopy, microbiology and histology results as well as every consultation in the notes with a HCP and every dose of pain relief, anti emetic and vital sign observation. I normally take a much more conciliatory tone but it is something in the phrase that is accusatory about our teams perceived collective laziness which is just untrue. Fortunately, this approach worked as we came to a better understanding of the others position and managed to work out where we could go next.

I sense most of these type of complaints aren't malicious and usually can be dealt with at the bedside as they stem from frustration and fear rather than a true attempt to declare our service inadequate. Most offers to speak to our complaint department are rebuffed. However sometimes, and this is only my observation, but many of the people who use the phrase are younger and have an expectation that whatever is causing their pain can be diagnosed  and sorted out immediately. The reality of the situation is sometimes at odds with a patients expectation of instant relief.

Sometimes an adequate explanation of what is going to happen at the start of the consultation can help prevent this sort of problem. For example when a patient presents with abdominal pain and the diagnosis of appendicitis is equivocal it is accepted practice to enact a period of "watchful waiting" where we measure vital signs and blood tests over 24 hours to see if there is any resolution/deterioration. This is because some things that mimic appendicitis can disappear on their own and appendicitis usually deteriorates. It helps identify patients who would not benefit from an invasive procedure (appendicectomy).

However if patients do not know that this is our plan, then they can understandably become upset when in 24 hours they only have 4 or 5 BP readings to show for their stay. This is our responsibility to ensure patients are fully involved in our decision making process.

So there are two ways I see that I can hear a reduction in the use of these phrases. Firstly, adequate communication and expectation setting by the HCP treating the patients and secondly some patient education on what they can expect from their health care system.

Phrases that annoy me

"You need to broaden your horizons."

It's nice to be able to expand on something in more detail than 140 characters, having recently finished my complete transplant onto twitter.

Somehow, over the last few years I have gained a reputation for being a bit of a home bird and not being very adventurous with travel, food or pastimes.

Over discussion today about a fish restaurant that was the venue for a work night out, I was asked what I thought. I stated I don't like fish so probably wouldn't want to eat there unless there were other things on the menu. I was quite happy to go along and eat chips and bread-sticks so I didn't derail anyone else's night. Then one of my colleagues uttered the title phrase.

"You need to broaden your horizons."

Now, I may have narrow interests and horizons but that it because I have had broad horizons and chose to narrow them, because the broad ones were rubbish and gave me dysentery. When it comes down to it, I like simple things like football, fast food and pubs.

It is one thing to be resistant to change, it is entirely another to have experienced different cultures and decide that you don't actually like it. This is something many of my friends don't understand. How can you have visited the 4 corners of the globe but want to go for dinner in the same pub in Northampton? It is very simple, I compare gastronomic experience to my yard stick (Bacon cheeseburger) and if it is not as nice I don't go for it again. I don't see why you can just do the things you enjoy, many people I know seem to do odd things just because they can. I understand, I was like that a few years ago.

I've been to every continent except Antarctica and sampled many a dish and activity. Some, like bungee jumping and guinea pig I never want to repeat again. Others, like test match cricket and tacitos I have taken to my heart and carried them on. When on my elective in South America, the group of travellers I was staying with also noticed how I was less than thrilled with some of the "experiences" on offer. One jokingly said I should write a travel guide titled "The world through the eyes of a grumpy bastard."

The example they were referring to was the description of my trip to Machu Pichu:

"A World Heritage site? It took 5 days to walk there and all I was greeted with was pepsi stands and panting tourists. Magical ruins? More like boring rocks, the church in my village is older and prettier. At least climbing up Wayna Picchu meant I could look at the site and leave the panting tourists to their angina."

I think it has some legs, but Karl Pilkington appears to have cornered the market in the genre since I went so it'll probably not make me my fortune. I have diaries of all the major holidays I have been on and some of them make me chuckle but I'm not grumpy, honestly, I just like very simple things!

So, the phrase annoys me because it assumes that I haven't experienced life enough. I have, I just choose to be boring.