Archive for September, 2007
The longer I do this job, the more I realise you need to explain everything to everybody. There should be a certain amount of assessing the patients level of intelligence that allows you to know how basic you need to make things, but despite this the patients brain may not be fully functioning.
I seem to be a few sandwiches short.
I have often worried I may be seen as patronising, and try not to come across in such a way. However I sometimes think perhaps I am not patronising enough!!
My most common statement is with the antibiotic trimethoprim, one dose every twelve hours. I always point out that it’s worth making sure you will be awake 12 hours after taking the first one. I know it’s daft, but I’ve had several patients that have moaned, that they took the first tablet straight after there 3pm appointment, and then had to set the alarm for 3am for the next 3 days! Sure you want to take you medicine as soon as poss. to get it working, but no major harm would occur if you waited 4 hours!
The best example I can think of presently, was the chap who came in with decreased hearing, and was advised that ear wax was causing his problem and that he should use olive oil and then return in one week for ear syringing.
One week later and the wax in his ear was no softer and looked as if it hadn’t been treated. Now sometimes we find that the patient put the olive oil in the ear and then immediately put cotton wool in to stop the oil dripping out, which unfortunately absorbs the olive oil and leaves the wax untreated. So I asked the guy if he’d been using the olive oil, to which he replied:
“Yes, I’ve been drinking about 10mls twice daily”
Max : “Excellent….could you come back in a week, having put it in your ear canal rather than drinking it”
Was he daft? Well not necessarily, he was told to use olive oil. It’s just a case of not being given enough advice on how to use it. You can guarentee I make sure all patients with ear wax know exactly what to do with olive oil when they come and see me.
On a similar note I have known people with Eustachian Tube Dysfunctions, who have been advised steam inhalation may help, and think they needed to put the hot steam near their ears. This only relieves congestion if you can breath through your ears – stop trying!!
So I assume everybody is dim, and try not to come across as patronising, and if anyone accuses me of be patronising I’ll just say:
“Ohhh, how clever of you to notice!”
I’m still looking for spooky nursing/medical stories, as Hallow-e’en fast approaches, so if you’ve got any for me or you just wanna read, materialise here….Read Full Post | Make a Comment ( 4 so far )
One of my colleagues is regularly described by patients as “lovely” and “ever so nice”. In fact she probably is. I sometimes hear her in the corridor: “Oh hello, it is lovely to see you!”
Her patients send her flowers and cards.
MINE DON’T. Sure I’m not soooo sweet, but I do have my regulars, patients that actually ask to see me. Even a couple that won’t see anyone else. Two I can think of that actually think I saved their lives. So, why do I never get as much as a card? Is it because if I went to the waiting room and offered to hold a young girls hand I’d get funny looks? Is it a boy thing?
Well they could always buy me other types of flowers…
I don’t think it’s a bad thing, I’m just not sooo “lovely”. I do joke with my patients, but I also tell them that if they don’t stop smoking they are going to loose ten years off their life, that in real terms is ten years of their grandchildrens lives that they will unneccessarily miss. I think I know how to make a point that is relevant, rather than just a nag.
I think (and it is just my humble opinion) that us health care workers have a responsibility not to always be nice to our patients. I have often said to patients that having a consultation with me is sometimes a wake up call, and the next wake up call might be them coughing up blood or having a heart attack. OK so I’m not “lovely”, but I’m more “lovely” than sitting in the back of an ambulance.
Let’s face it: If we don’t tell our patients – who is going to? We know they ignore family and friends as “nagging”.
Perhaps I’ll try being “nice”, it might be good for me! But I’m not going to be “lovely”, because I’ll be the one that tells you – your overweight or that you are addicted to sleeping tablets, or that you drink and smoke too much and are going to cut your life short because of it, but it is lovely to see you (while your still alive).
I actually wrote this a week ago, and since then have recieved 2 presents – amazing. The first was chocolate, always a good call. Second was a kidney stone, so my diagnosis the week before was right, but a phone call would have done!
I’ve just started a facebook group, for nurse bloggers….well anyone interested in nurse blogging really, so pop by and help get the place running. It’s a Nurse Blogging Lounge.
AND HOW EXCITING…A list of the top Nursing blogs has been published. Obviously the big hitters like Kim’s Emergiblog are in the top spots….but little old Max squeezed into the top 25….Read Full Post | Make a Comment ( 8 so far )
Well we have already established that Max is listen, and indeed this is an important clinical skill, however sometimes listening is not enough. Understanding is important, and to understand asking probing questions is sometimes necessary.
Today I have been interrogating my patients, and it’s a good job I have been too!
Breezy “Hi! I’ve just come for my depo injection”
Normally the Practice Nurses do this, but short on appointments I occasionally get the pleasure of stabbing young women in the buttocks, (obviously avoiding comments like – “Just a little prick in your bum to stop you getting pregnant”
Max: How long have you been using Depo?
Breezy: Oh a fair while!
Max turns on the spot light, shines it in the patients face and interrogation begins. Turns out the patient has been using it for 12+ years. This is not ideal as it can lead to increased risks of osteoporosis.
So we get to the nitty gritty, she is not happy at the prospect of a change, but comes to terms with the fact that it might be worth trying another method. For the last 12+ years, she has come in, had a jab and gone. All happy and easy, but not today…Max is looking for a fight….
Case Two: “Wants repeat Px” comes in. Using Citalopram for depression for several months, with good effect. Probably not ready to come off just yet.
W.R Px: I get occasional headaches with them, could it be because I drink with them sometimes?
Max (Turning on the spot light again): Well you shouldn’t drink with them really. How much do you have?
W.R Px: Oh, not much.
Max sits quietly and waits. W.R Px squirms slightly and realises question hasn’t been answered yet.
W.R Px: Some occasional vodka.
Max remains quiet. Pt states about 2inches out of the 1litre bottle a night, possibly more.
Max speaks: How often do you buy a bottle?
Turns out 1-3 litre bottles weekly (Occasional drinker?!?)
Max: “Hello, could I make a referral please?”
Before the morning was over I’d also diagnosed anxiety attacks, in a woman who blatantly denied anxiety, but whose husband agreed with me, and so I ended up running 30 minutes late due to some unpresidented marriage guidence, but that’s another story…
This was just one mornings clinic. The afternoon was worse, as I’ve stated before – sometimes you just have days where everybody has complicated issues. I may not be the sweetest person to see in the surgery, but I’m not afraid to ask the questions other don’t like to, more about this next time…Read Full Post | Make a Comment ( 1 so far )