A patient's belligerence rattles PA by ProQuest


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									legal1108.qxp   10/23/2008     10:54 AM    Page 98

                                 LEGAL ADVISOR
                        CASE #1

      A patient’s
      rattles PA
      Would a severed nerve
      have been recognized had
      the patient been less
      confrontational in the ED?

                                                                                                                                          GETTY IMAGES
      BY ANN W. LATNER, JD                                                   young man,Mr.R,on a gurney.Blood was gush-
      Difficult patients go with the territory for every   Mr. R began       ing from the man’s left arm near the wrist, and
      clinician.They can wear on your nerves and chal-     cursing again     one paramedic was applying pressure to the
      lenge your professional demeanor.                    as the PA began   wound in a valiant attempt to stem the bleeding.
        But what if a difficult patient has a valid con-                        Mr. B and several colleagues rushed to aid the
      cern? Sometimes, as one physician assistant          to suture the     paramedics and got the patient into an exam
      found out, a patient’s unpleasant personality can    laceration.       room.The young man reeked of alcohol and was
      color your reaction to an actual complication.       “Damn it! That    yelling profanities. Mr. B glanced questioningly
        Mr.B,38,had worked as a PA in the emergency                          at the paramedic who was stanching the wound.
      department of a mid-sized hospital for close to      hurts,” he           “White male,22 years old,apparently punched
      10 years. He enjoyed the variety of cases, the       yelled.“What      his arm through a glass shower door during an
      urgency of care, and his relationships with col-     the hell are      argument with his girlfriend,” the paramedic re-
      leagues and supervisors.                                               ported. “Suffered deep lacerations and major
        But the job had two downsides: the periodic
                                                           you doing!?       bleeding.The girlfriend called an ambulance for
      night shift (he was a morning person and found       Get off of me!”   him.We’ve tried to hold back the bleeding, but
      the schedule change jarring) and the occasional                        it’s a ‘pumper.’”
      cantankerous patient. Generally, Mr. B was                                He moved his hand from the patient’s arm,and
      known for his calming bedside manner. But                              blood spurted out uncontrollably.“The guy lost a
      every now and again he encountered a patient he                        lot of blood on the way over here,”he said.
      found irritating.
        One night, both of Mr. B’s pet peeves came                            Cases presented are based on actual occurrences.
      together. He was working the night shift, and                           Names of participants and details have been changed.
      around 2 AM fatig
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