Thursday, February 7, 2013

Poor Historian

If you ask for the rules of their job that they've learned by experience, every cop or attorney will usually tell you pretty straightforwardly (and really, you should ask people about their jobs, since they spend 1/3 of their lives doing them, and usually no one asks people, and you'll never get as much free education as asking someone to tell you what they're an expert at doing, but I digress...), and invariably one of the first things they'll tell you is the simplest one:

"Everyone lies."

It's not quite that bad with patients, but it's close.

I stopped counting after the 500th time I did a star-spangled full-fledged in depth assessment interview, and specifically asked all the relevant rule out questions, and had the patient confirm the critical answers, then took them to a treatment room, told the doc what the patient just said, then when the doc walks in and asks the same set of questions, gets the exact opposite answers. Sometimes while I'm standing there looking the same patient in the face.

Dear Patients: Hi, I'm your nurse. Remember me from up front? Hey, maybe no one told you, but the doctors and I, we've been doing this for a number of years, I know their kids' names, what they snack on during a slow time, and how they like all their trays set up for a dozen different procedures and which labs they're going to want before they order them. That happens after a decade with the same bunch of folks, if you pay attention. So you should know that before, during, and after your visit, the doc and I talk about you. It's called communicating patient status, and it shouldn't be a shock to you that telling flaming whoppers, or changing your story, has a direct correlation on either your mental status, or your moral status. You're getting treated either way, but it's really up to you whether you get treated like someone with a sincere problem, or like someone with a sociopathic personality seeking attention, narcotics, or a kick out the door. So please, spare me the childish behavior.

And by the way, whenever I have reason to expect that this may come back to bite someone later, especially me, I cheerfully and explicitly chart exactly what your answers are, and the time, and the doctor does the same thing. So eventually, your insurance co., your lawyer, the hospital's lawyer, and if pushed far enough, a judge, jury, God, and everybody are going to know you waltzed in and lied your @$$ off to one or both of us.

We don't swear people in on a bible in triage, but maybe it might help.

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