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Today was only roses in plastics clerkship. One 
sticks out. A thread 
A “difficult” pt has had intractable pain despite high dose IV pain meds. Everyday pt’s been getting increasingly frustrated bc pt believes continued pain= not being heard.
Pain service on board.
1/
sticks out. A thread A “difficult” pt has had intractable pain despite high dose IV pain meds. Everyday pt’s been getting increasingly frustrated bc pt believes continued pain= not being heard.
Pain service on board.
1/
Pt is Black & honest abt past drug use. Today convo gets heated. Tears, raised voices. Residents & attending vs pt.
“I’m not exaggerating. You’re putting me in a box. I’ve been respectful.”
“Your pain’s out of proportion w surgery bc of drug use we don’t know how to help.”
2/
“I’m not exaggerating. You’re putting me in a box. I’ve been respectful.”
“Your pain’s out of proportion w surgery bc of drug use we don’t know how to help.”
2/
“I’ve been respectful, I ain’t disrespect nobody. I could leave & get better drugs on the st”
“We’re doing all we can”
Team leaves in a huff. But I knew something else was up. Decision was made to consult psych. That felt wrong to me.
I asked to talk to patient 1st.
3/
“We’re doing all we can”
Team leaves in a huff. But I knew something else was up. Decision was made to consult psych. That felt wrong to me.
I asked to talk to patient 1st.
3/
I went back & sat w pt for 20 minutes.
“My name’s Lawren. I’m a med student with plastic surgery. I wanted to talk to you abt your frustration.”
Pt describes not being validated, being perceived a certain way, no one listening.
Fear.
3/
“My name’s Lawren. I’m a med student with plastic surgery. I wanted to talk to you abt your frustration.”
Pt describes not being validated, being perceived a certain way, no one listening.
Fear.
3/
So I said, “I hear you. You have every right to be frustrated. The team is having trouble finding the right combo of meds. Every person needs a different combo & we just haven’t found the right one for you. If we thought you were faking you would’ve been discharged.
4/
4/
I know it’s frustrating and you’re in pain. Plastic srgns brought in pain service bc they’re experts. They can find the right combo. And I’m sorry it’s taking so long. We want you to get better & discharged to your family...etc”
No more tears or anger. Team roles explained.
5/
No more tears or anger. Team roles explained.
5/
Psych consult cancelled. Everyone on same team again.
As med students we have the opportunity to be a liaison for our patient. We can ID when docs & pts are talking to brick walls. We have the time to sit with them & listen & sometimes that’s all they need.
6/
As med students we have the opportunity to be a liaison for our patient. We can ID when docs & pts are talking to brick walls. We have the time to sit with them & listen & sometimes that’s all they need.
6/
Sometimes “difficult” pts=ppl in pain away from family. Sometimes they just need someone to listen & explain in simple terms what is happening. It’s hard to express yourself surrounded by drs & this is where not being a dr yet works to our benefit.
7/7
#medstudenttwitter
7/7
#medstudenttwitter
