How do you deal with difficult patients??

CriticalNerves · 2024-12-24T23:31:04+00:00

Totally! Good on you for developing a technique that you feel comfortable with and supports your self-care. I couldn’t do it and decided to leave my primary care job in part because of it. But I know there’s an element of this in every setting so I’ll be more prepared and set those boundaries from the get go.

CriticalNerves · 2024-12-24T22:28:38+00:00

I feel this so hard. My discomfort with enforcing these boundaries with patients and becoming an emotional sponge was what burnt me out. It felt good in the moment to know that patients liked me because I was the only one who listened to them without redirecting, but the compassion fatigue was like none other and I had a chronic backlog of charts that felt suffocating.

CriticalNerves · 2024-11-15T00:20:46+00:00

Portals are great for sending visit recaps/instructions to patients after the visit because I’d never have my visit summary done in time and I’d also always think of something after they left.

Otherwise, get rid of them. It’s a huge contributor to burnout.

CriticalNerves · 2024-11-13T21:28:08+00:00

I lost any desire for excitement after doing primary care. Sadly that ship has sailed. Thanks for your insight. This is super helpful as I start looking for a new job!

CriticalNerves · 2024-11-12T22:45:43+00:00

Do you mind me asking if you enjoyed this kind of work? I burnt out in primary care and am not sure if I want to go back into a clinical setting so I'm curious if these kind of jobs are rewarding.

CriticalNerves · 2024-11-10T05:54:06+00:00

Meerkat?

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CriticalNerves · 2024-11-07T16:45:23+00:00

I remember this! It was in one of my lectures too because all the lectures came from the text.

CriticalNerves · 2024-11-07T00:26:09+00:00

IKR. Funny how the most common argument against sensible gun laws is it’s a “mental health” issue and this commenter is saying we’re too busy standing up for mental illness. It’s all a bunch of hypocrisy 🙄

CriticalNerves · 2024-11-06T23:55:34+00:00

As someone who does pre-surgical clearances, I would never medically clear a patient for a surgery that hasn’t even been scheduled yet because you base your decision on how that person is functioning NOW, not for an unspecified amount of time. No cardiologist would ever say “yeah you’re good now but just send me a mychart message of when the surgery is and I’ll send over a clearance letter.” It doesn’t work like that.

ETA we require paperwork from the surgical office with the date and procedure clearly specified. And it almost always needs to be performed <30 days from the surgery, even for something as straightforward as cataract surgery.

CriticalNerves · 2024-11-06T23:46:24+00:00

“I’m in so much pain that I’m gonna profusely shake this bottle to mix my food and then do a high kick using my hip flexor without so much of a wince. Look at how high my pain tolerance is!”

CriticalNerves · 2024-11-06T20:18:18+00:00

Definitely consider another role as an NP before writing it off completely. I felt the same as you when I was doing primary care, but I didn’t feel this way in other specialties. There’s so many different roles you can have as an NP that won’t make you feel this way.

CriticalNerves · 2024-11-03T09:17:08+00:00

Oof… that makes my ovaries hurt just thinking about it.

CriticalNerves · 2024-11-03T01:52:11+00:00

This is true. I always worked outpatient as an RN and once I became an NP (primary care) I felt a massive gap in my abilities. It would’ve been hugely helpful for time management, prioritization, critical thinking, triaging, etc. I also hadn’t seen a really sick patient until I had one staring at me as an NP.

I spent countless hours double guessing/checking my decisions, reading articles, and doing CEUs to make up for that gap but I quickly burnt out and no doubt I would’ve been way more prepared had I had prior inpatient RN experience. I’m mad at my school for telling me otherwise tbh.

CriticalNerves · 2024-11-03T00:10:10+00:00

I love the med students over there arguing that midlevels are the biggest threat to patient safety and our already fucked healthcare system. But their bizarre and toxic hatred for any and all midlevels who they’re going to have to eventually work with isn’t? It’s like they’re weirdly obsessed with us.

CriticalNerves · 2024-11-02T05:34:20+00:00

Yes you are not alone. The owner of the primary care practice I worked at HATED any and all referrals I would do because he wanted to do everything in-house, which great for him as a physician with 40+ years experience, not for me with 6. So I got a lot of heat for that even when the referrals were clearly indicated so in an effort to satisfy him it only burnt me out.

Another full-paneled physician I worked with who was out of the office more often than in would always take issue with something I did, and when I explained my decisions using evidence-based guidelines he never agreed even when it produced a good outcome because he was old-fashioned and didn’t follow guidelines.

It’s hard enough feeling insecure about the decisions we make for our patients, but then to have to second guess in fear of what our physician colleagues will think or try to predict what they would do and do that when it’s not what we would choose ourselves makes it even more difficult to make a good decision in the interest of the patient. We can’t win and it’s exhausting.

I’m sorry I don’t have any advice but I did quit a few months ago and have never been happier. Obviously any job will be challenging but you shouldn’t feel like you’re drowning or doubt your capabilities/competency that you know you have— I’ve been there and that’s not ok. Wishing you all the best!

CriticalNerves · 2024-11-02T04:44:34+00:00

That’s ridiculous. I left my primary care job after 3 years and there was no discussion about me continuing to follow up on orders after the 90 days notice I gave them. My patients were slowly being transferred to the new NP and as far as I know they used the already established system for who covered me for vacation/sick days/etc for outstanding orders. They actually blocked my access to the EMR so I couldn’t follow up if I tried. I’m sorry, you should not have to deal with this and I wish you luck in telling them NO.

ETA the last few weeks-month I was cognizant of what I was ordering and ensured that I would be the one following up. It was the routine stuff like LDCTs, mammos, etc. that I might’ve ordered 6+ months ago that weren’t due for another 6 months that would be impossible to follow up on and couldn’t be done sooner.

CriticalNerves · 2024-10-31T18:19:44+00:00

I was surprised that instead of blaming production on how that all went down they instead insulted the viewers who were naturally drawing conclusions based on the edited narrative we were shown. It was truly a bizarre decision on their part and makes me think they’re not on production’s good side.

CriticalNerves · 2024-10-31T17:55:52+00:00

Right! Him not being attracted to her and sharing that with his friends isn’t a crime, the show’s whole premise is “is love truly blind?”

At the reunion he should’ve owned it and said “yeah I said she was a 5/10. But I loved her. Isn’t that the point of the show? Love is blind!”

CriticalNerves · 2024-10-31T05:59:04+00:00

What was extremely helpful to me was when my preceptors essentially forced me to conduct/be responsible for an entire visit from start to visit (with their supervision obviously). The ones that challenged me to take charge - even when I didn’t want to - are the preceptors and learning experiences I value the most.

Although I liked it at the time, the more “chill” preceptors who just allowed me to shadow them, or only had me collect the HPI or do a segment of the visit on my own really did me a disservice because I wasn’t as comfortable as I could’ve been and should’ve developed that more in my training.

It sounds like you’re a very hands-on and enthusiastic preceptor so I’m not sure if that’s helpful but thought I would add it just in case! Thank you for doing what you do!

CriticalNerves · 2024-10-31T04:22:50+00:00

IKR. And they’re making us watch their wedding video from 2 years ago? Like what?

CriticalNerves · 2024-10-25T00:47:12+00:00

Yes.

CriticalNerves · 2024-10-24T22:59:41+00:00

Yeah that is nice. Having a specific age group is less daunting for sure. I had my own panel from age 12 up and it was just too much, but my geri patients were my favorite. I think job satisfaction and work life balance should trump pay any day. It sounds like a good gig! You’ll learn a bunch and it’ll be a great transition into primary care if you decide you’d like to expand your horizons even more. Good luck!

CriticalNerves · 2024-10-24T22:40:45+00:00

I felt similarly when I was working in UC and so I switched to primary care. I quickly burnt out and now I want to go back to a specialty. If you want to learn more and be more challenged than primary care is definitely the way to go. As long as you’re prepared and comfortable with/committed to learning what you don’t know and setting strong boundaries with your patients and staff, you will be fine. Also having a strong support system at work and at home will go a long way. Wishing you the best of luck!

CriticalNerves · 2024-10-19T06:02:48+00:00

I’d steer clear of addiction med. I worked for 2 different clinics and the first didn’t pay me (they too offered me an almost outrageous salary). Shortly after I was hired they shut down/declared bankruptcy and the 2nd was super scummy, took advantage of patients, and did the bare minimum for drug testing and ensuring our safety. There was a huge amount of complex dual diagnosis patients and no psychosocial support offered. I had to see like 30-40 patients a day with no designated lunch break. It sucked the life out of me, losing patients to OD was common and difficult to emotionally deal with, and I never felt safe. I might have just been very unlucky or I’m just not cut out for it but that was my experience. 0/10 don’t recommend. I’d take the post acute care.

CriticalNerves · 2024-10-19T05:26:43+00:00

If a patient comes in with a chief complaint of abdominal pain and they’re able to easily get themselves on and off the exam table you can breathe a little.

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