Is this the right way to deal with an angry man?

tallaght01

I was in work the other day, when a kid came in with a sore arm.

She's 12 and has a lot of medical problems. She's well known to one of the medical teams in our hospital.

So, I saw her in A+E, and thought her problem was pretty minor. BUt it was a complication of a recent procedure, but wasn't going to cause her any problems.

I happened to notice on her triage form that she's been fast tracked. Then I saw inside her notes. It said "**** must be seen immediately upon presentation to A+E. The consultant or registrar from **** team should be informed of her arrival immediately, and they will see her straight away".

That's a bit weird, I figured. But I phoned the SR on the medical team. He turned up within seconds. He saw her. Got her an appointment witht he surgeons tomorrow, and xrayed her arm.

So, I spoke tot he med reg later. I asked why she gets seen so quickly.

He said that her dad is really angry. If she waits for even 10 minutes to be seen, he starts screaming and shouting and threatening people.

It was at this point that I regretted seeing her so quickly. I'm not into seeing someone quickly because their dad threatens to beat people up. He can threaten me all he likes, as far as I'm concerned. It wouldn't be the first time, and it won't be the last time I'm sure.

I told the reg he was a pansy. He said it was easier this way.

I disagree. i think this kind of thing makes treatment difficult in the long term. Just like spoiling a child.

Has anyone else ever seen something like this? I haven't. I'm in 2 minds about what I should do next time they turn up in A+E.

Traumadoc

Dont know about this, I feel there is more to this, perhaps there had been a error in the past and to try to placate things, fasttracking was done. Was there no warning about threatening behaviour on his card? Sounds more like he hasthem over a barrel for some reason.

I note that the in house team were to be called and not the ED staff, less chance of any communication breakdown.

Actually I wish people were more vociferous about the waits in the A&E, the brendan Gleeson rant actually makes a difference, unfortunatly people do not go to their politicians and rant on enough about the 3rd world conditions in our A&Es.
If people complained about their lives being put in danger by being treated in coridors in sorry excuses for A&Es ,the same as they did about loosing a medical cards thisgs would be a lot better.

sam34

i would not fasttrack that kid, no way. if her father gets loud, abusive and threatening, i would simply call hospital security and even the guards if necessary.
in the above situation, fast tracking him has simply taught him that all he has to do to get his way is scream and shout. if he gets away with it, he'll keep doing it.

if that kid was not in any danger and was not a medical priority, then theres no way she should be seen before sicker kids, just cause daddy's a bit of a thug.

as i said, the guards would hopefully soon quieten him down. in places i have worked, the guards tend to take a dim view of people threatening/abusing medical and nursing staff in the a&e.

seanybiker

no way would i fast track it. I was in a and e for hours years back split me head open and me elbow wasnt to healthy. Some git came in with little shiv of a child. And he started giving out and his child got seen almost there and then. Little bitch walked out 5 minutes later with nothing wrong with her

Clytus

Principles are a great idea....untill you realise its easier to forget them sometimes.

If this guy was gonna cause a massive scene and take up X number of people for X amount of time.....your gonna end up with a net loss.

Humor the nutter and get him outta the system ASAP.

TriciaDelicia

sam34 wrote: »

i would not fasttrack that kid, no way. if her father gets loud, abusive and threatening, i would simply call hospital security and even the guards if necessary.
in the above situation, fast tracking him has simply taught him that all he has to do to get his way is scream and shout. if he gets away with it, he'll keep doing it.

if that kid was not in any danger and was not a medical priority, then theres no way she should be seen before sicker kids, just cause daddy's a bit of a thug.

as i said, the guards would hopefully soon quieten him down. in places i have worked, the guards tend to take a dim view of people threatening/abusing medical and nursing staff in the a&e.

I agree with you on this one

Fionnanc

AS a complication of a medical procedure it is only right that it should go straight to the medical team. Totally disagree with giving into the man though.
I hope somebody on the wards didn't miss out on the medical reg in this case
I remember a new husband coming in with his new wife asking for a virginity check.
I told the nurses leave them as triage category 5(rightly) and I will tell them off when I get some time. When I got some time I found that a doc of their faith from up the house had performed the check , and told the hubby it was inconclusive.

sam34

Clytus wrote: »

Principles are a great idea....untill you realise its easier to forget them sometimes.

If this guy was gonna cause a massive scene and take up X number of people for X amount of time.....your gonna end up with a net loss.

Humor the nutter and get him outta the system ASAP.

tempting though that may be, all you are doing is teaching him that he can get his own way bt screaming and shouting. if this works for him once, he'll keep doing it.

tallaght01

I don't think the kid has ever been treated badly. I had a lok through her notes yesterday, and she's under the care of a very very conscientious consultant, and has been for years.

I just think it was a case of people being wussies.

It wasn't a case of a medical procedure being referred tot he medics. Itw as a case of a surgical procedure at a different hospita being referred tot he medical team in my hospital.

And this is where the problem is. This is where the learned behaviour is. The other hospital make her wait in the waiting room with everyone else. So, when she gets a minor complication of her operation, she rocks up to my hospital, because we see her straight away.

So, she turns up in front of me. I've no real clue what op she had. Our surgeons have zero interest in her. Her medical team make all the right noises.

Her dad did some growling at me. I'm no tough guy, but I just don't get intimidated by people threatening me.

So, overall, she has a surgical problems and she gets:

a clueless A+E doc.

disinterested surgeons.

a medical review of her surgical problem.

Dad thinks it's good care. But it's crap care.

As regards the comment about it taking up less time overall, I disagree. When someone kicks off, I literally tell them to come and get me when they calm down. I walk off and go tot he triage area and grab the next patient. i don't bat an eyelid about that kind of thing. It is true, though, in hospitals if you kick up a fuss, you get dealth quicker. It's very common to have a nurse come up to you, and say "Dr Tallaght01, that dad in cubicle 6 is geting very agitated at waiting so long.". Doesn't alter my stride one bit, but it does for a lot of people.

eth0_

Fionnanc wrote: »

I remember a new husband coming in with his new wife asking for a virginity check.
I told the nurses leave them as triage category 5(rightly) and I will tell them off when I get some time. When I got some time I found that a doc of their faith from up the house had performed the check , and told the hubby it was inconclusive.

Whaaaaaaaaaat?
Was this in Ireland? Can't you tell them to p*ss off and not waste the time of hospital doctors?

Fionnanc

Was going to politely tell them this is an emergency unit and nobdy in Ireland is going to examine your wife for this, but before I could a doc of their own faith saw them

eth0_

That's so ridiculous. No one can say for sure, from a physical exam, that any adult woman is a virgin.

tallaght01

course you can tell.

I mean, she might be wearing a short skirt. Or a push up bra.

She might have a stamp on the back of her hand from going to the wesley disco the night before.

Medicine is about observation, as much as the physical exam :P

eth0_

Well I was talking about her hymen but I guess you have to look at it holistically like you said, lol

Dave!

Dunno if it's the "right" or just way to deal with someone, but evidentally it worked!

Kid didn't wait => father didn't get angry and threaten people => everyone goes home happy

Most people do not get angry and threaten others, and so the minority that do will end up being seen before them. That's pretty unfair alright.

But the alternative (presumably) is to have security/Gardai there to deal with them. That creates a tense situation for everybody including those waiting to be seen.

Dunno what the answer is really,

tallaght01

It worked to the extent that the guy didn't hit the roof.

But we failed the little girl with the broken arm who had to wait en extra 15-20 mins for some fentanyl!

So, from the point of view of our actual raison d'etre, the system didn't work.

Amnesiac_ie

It's always fulfilling to diffuse a situation like that. Today a relative who was angry with me earlier for not discussing her mother's diagnosis with her without her mother's consent apologised and thanked me for being polite and firm with her and clarifying with the patient herself how and to whom she would like her results delivered. In the initial "conflict" I was polite but very firm. That was something I used to find very difficult, standing my ground in the face of anger/shouting but I think my skills have improved. Of course we all know there are cases where diplomacy and standing firm simply do not work and then if individuals are getting abusive I do think the clinician needs to walk away and security/administration need to take responsibility.

norrie rugger

i don't know about you but it is the nurses that i generally feel sorry for in the a&e. They are the "real" face of the unit for most people and seem to face the brunt of anger from patients.
Problem you are facing tallaght is, do you let the child suffer for something the parent does?

tallaght01

It's the nurses, doctors, porters, receptionists that take the brunt of it.

I take your point, but do you give in to everyone who throws a wobbler?

I reckon if his outbursts had been ignored long ago he might not be in this habit.

EamonnKeane

eth0_ wrote: »

Well I was talking about her hymen but I guess you have to look at it holistically like you said, lol

But it can be broken other ways, e.g. a serious fall. And hymenoplasties are a booming trade in Muslim countries.

norrie rugger

tallaght01 wrote: »

I reckon if his outbursts had been ignored long ago he might not be in this habit.

More along the lines of if he had been arrested long ago.

What I think that we agree on is that the child should in no way suffer. I guess that means that no matter what the parent says, the child should still be seen in rotation and not be made to wait untill the parent calms down.

I can only imagine, for the most part, that parents are not easy to deal with when their child is in pain/danger. I do not evny anyone trying to deal with that situation (and TBH I could understand why some parents get this way at times)