PDC Assignment 3

August 6, 2018
Tauhid Mahmud MS3

Before we began our morning pre-rounds, I was warned about how difficult Mr. M was going to
be with statements like: “He likes to complain…a lot,” and “He’s a handful.” I’ve heard of statements like
these before and many times they reflected on the limited time available to the provider more than
anything else.

Over the course of my third year, I believe one of my strongest skills is my ability to empathize
with my patients, and thus when I heard statements like these, I would be slightly skeptical. The third-
year medical student is usually the member of the team with the least amount of responsibility and that
allots us more time to spend with the patient; time that can be used to connect with the patient and
pick up on things that team may have missed.

Mr. M was a 54-year-old man who had a rescue ileostomy procedure completed 3 days prior to
me meeting him. Since his operation he was NPO and had a nasogastric tube placed down his esophagus
into his stomach. Mr. M was tired. He felt like a prisoner in the hospital. Not being allowed to eat and
having a tube down his throat, Mr. M. was quite understandably agitated by his situation especially
when combined with his history of anxiety. When I spoke to Mr. M, he would answer my questions but
became increasingly irritated as the conversation went on. My attempts to empathize with him would
fall flat. In this situation, I thought it was best to collect the information I needed quickly and offer him
whatever solutions I could provide. He asked me if he could go home that day, and if, at the very least,
we could take out his nasogastric tube. I stepped out of the room to ask my team if there was anything
we could do for Mr. M but before I could inform him that his tube would have to stay in until the
attending had an opportunity to evaluate him, he had pulled it out himself.

From my experience, “difficult” patients do not receive the same medical care as their amicable
counterparts. The difference in care is not the overt things like medical orders or offering the
appropriate medications. The difference lies in the unspoken parts: the truncated physical exam, the
rushed questions or the hurried exit out of the patient’s room. Mr. M felt imprisoned in the hospital and
I wish there was more I could have done, but I am glad that I didn’t let him being a “difficult” patient
hinder my interactions with him.