The day is going better than usual. Your coffee was perfect this morning, it’s pay day and you are up to date on your charting (farfetched but stick with me please). You do not want to say it aloud but if the day continues like this you may get OUT ON TIME (insert victory dance)!
Stop!!! Then it happens, your workflow comes to a screeching halt. A “special” patient has thrown a wrench into your day.
This post includes the most common types of patients that can kill your outpatient workflow. What this post does NOT include are ways to overcome these hiccups (sorry). Because truthfully, life is like that sometimes (email me if you have any ideas on how to handle these patients).
1. The Naturalist
The woman that declines valve surgery and states she will be “curing” her severe aortic valve stenosis with a blend of expensive supplements from a website that you believe is selling “snake oil”. Or, the gentleman that earnestly hands you a wrinkled brochure of a home remedy that claims to “fix cardiomyopathy in 30 days”.
You try to show them the million word disclaimer at the bottom of the website or flyer but they will hear none of it. They proudly state that they have already stopped their prescribed medications, which explains their sky-high blood pressure and a heart rate comparable to a hummingbird’s.
I myself am all for making an informed decision and love natural remedies. However, somethings cannot be fixed with kombucha, ashwagandha, and beet juice.
2. The Denier
Suffice to say, deniers are difficult to treat. They typically come to appointments under the pleadings of their loved ones. These patients swear to you that they are not diabetic with a hemoglobin A1c of 9. That their nasal cannula is optional with an O2 saturation of 88%. That a cane or walker is unnecessary as they clumsily cling to the wall and chair while exiting the exam room.
They sometimes have a chip on their shoulder and blame others for their current state of health. Adding to the mix, the loved ones who accompanies them, wants to turn the office appointment into a full-on episode of the A&E classic Intervention. Yes there is nothing like having to steer arguing family members back to the reason for the visit.
3. Groundhog’s day(ers)
Like the 1993 hit movie starring the exceptionally talented Bill Murray, the protagonist that lives the same day over and over and over. Each visit with groundhog’s dayers are sadly the same and no, dementia is not the issue.
They come in with symptoms. You devise a plan that they agree with and schedule them to follow up in 2 weeks. They never pick up scripts, have labs done and even cancel the follow up appointment. Basically they ghost you.
Then they show up on your schedule again, months later….with the same symptoms and long excuse about why they did not follow through last time.
4. The Allergy Illusionist
She has an allergy/intolerance section that is 3 pages long. She ends up with side effects from the medications that are not even listed. When she has a reaction to a new medication, she has no problem going back and taking an old bottle of a previously prescribed drug “just to see if it would work this time”. I have some patients tell me they vomit up the pills seconds after swallowing.
I actually ended up recommending a patient with this problem to undergo pharmacogenomics testing to see which medications would suit her best. Lo and behold, her test results revealed she should have no adverse reactions to the previously prescribed medications. Did not matter though, she refused to believe the test results. Many times, an undiagnosed or undertreated mental health problem is the reason for the issue.
5. Lonely Hearts
Lonely hearts are my favorite workflow killers. I sometimes will note in their chart to schedule an extra ten minutes for these types. They are usually widows or widowers with no local family and most of their friends have passed away.
You sadly realize that visits to medical appointments may be their only time for real human interaction. They will discuss current events or old stories from their younger days. You sneak in questions to determine their health status.
I once recommended a partically lonely man to adopt a rescue dog for companionship. He came back for his follow up 6 months later and told me his rescue dog had terminal cancer and had to be put down (well… I tried).
Yes, there are many, many more types that will stop your workflow but I cannot list them all. And yes, these patients can be a challenge but it all comes under the hat of being a nurse practitioner. Caring for the needs of patients is why we do what we do (at least, that is what I keep telling myself).