This morning I had a patient that combined several of the key ingredients for an annoying encounter. Forms that needed to be filled out TODAY? check. Chronic health condition that patient has not been proactive about treating? check. Non-specific mental illness that results in rambling, semi-coherent long monologues? check. Multiple requests for specialty referrals, medication refills and letter for parole officers? Check, check and check. To top it all off, after our 40-minute counseling session when I stood up to usher the patient out the door, he announced “Oh, I forgot to tell you that last week I lost control of my bowels for no reason and my back really hurts and my doctor said to say something if that every happens because it’s really important.” OH. MY. GOD. Are you serious? After all of this effort and time you’re going to make me work you up for cauda equina syndrome with 2 more patients waiting for me?
I asked him to wait a moment while I went into the next room. That room happened to be the staff office, where I announced to an attending physician: “I am filled with a murderous rage. A rage towards my patient. I kind of want to kill him right now.” Note to self: things that sound funny inside the brain sometimes sound crazy when spoken out loud. This may be one of those things. Maybe I won’t mention the “murderous rage” part next time.