Monday, March 16, 2009

Trust Is A Huge Responsibilty

I had a patient who came to me after having a stroke. His mood was being affected and his wife was having a hard time dealing with the damage (both emotional and physical). I put him on medication which evened him out and things have been going well.

Blood pressure controlled, taking his meds, coming in for follow ups and labs... Sounds great! Normally I would be singing his praises for finally getting the health care that he needs. So many of my patients have not seen a provider of any kind in years because of lack of funds or having had a bad experience with the last provider. (Note I'm saying provider, not doctor or NP, both can be equally bad.)

Enter the patient looking grey, pasty, and sweating followed by his wife and daughter. They were upset and worried and while the nurse was getting him set up for an EKG, I was getting a 18 gauge IV in his arm with saline and O2. I was asking him questions about location, intensity, exacerbating factors, shortness of breath etc and asked why he hadn't called an ambulance from home! His wife and daughter both piped up and said, "We tried to call. He wouldn't let us because he wanted to see you first."

The patient proceeded to tell me that he wanted to get my opinion on the matter because he trusted me. He said that if I told him that it was okay to go, he would but not until. I told him that yes, he needed to go into the hospital for evaluation and that he shouldn't have come to the office to ask my opinion because he could have died. Off he went by ambulance...

Well.. after the morphine was given in the ambulance, he got combative and a little belligerent. He got to the emergency room and after he settled down a bit asked "where the hell I was." The hospital told him that I didn't have admitting privileges and that I couldn't be the one to take care of him there. Wrong answer for him!

He checked himself out against medical advice and came to the office the next day.

Oh My God!!! I told him that he should have stayed in the hospital and been evaluated for his chest pain and reminded him that he could have finished having a heart attack and met his maker sooner than he wanted. He said that he knows that he should have stayed but he didn't trust anyone else but me to care for him. "No one listens to me like you do!"

I told him that I was humbled that he trusted me so much, but I didn't want to feel like I was responsible for his falling over dead for not seeking help from other providers. I told him that if he ever got into distress again, to call for an ambulance. He promised to do that in the future.

I told him goodbye and that I would see him after his cardiac evaluation.

"Okay Doc!", with a grin!

"You know that I am a nurse practitioner and that I will always remind you of that when you call me doc."

"I know, but you're MY doc anyway."