Sometimes I find myself deep in battles that aren't worth fighting. Patients who are angry, belligerent, and agitated who have the capacity to make sound medical judgments, but are struggling with being nice. Sometimes I run into patients with chronic disease who demand therapies which are unreasonable and irrational in an inpatient hospital setting.
Take for example some type one insulin pump diabetics admitted to the hospital who request to get every 30 minute injections of fast acting insulin to replicate the insulin pump for the next 12-24 hours when their pump is not functioning appropriately. I calmly explain that every 30 minute accu checks are not a rational solution to the issue at hand. I also explain that we simply do not have the nursing staff to provide something that is not necessary nor medically indicated. And those services can only be provided at higher levels of care, which are not medically necessary.
I also explain my doubts as to the medical rational for giving every 30 minute bolus injections of an insulin that is injected every three minutes by pump. Why not give it every hour? Perhaps every 10 minutes? Maybe every 2 hours? Or every 4 hours? I explain that the kinetics of every 30 minute administration in the next 12 hours of hospitalization are not equivalent to an insulin pump.
I offer to give a bolus injection of 1/2 the daily basal requirements as a long acting insulin and to provide meal based accu checks as warranted with carb counting and sliding scale requirements as necessary.
Sometimes, anger and agitation is all I get in return. I'm left with telling them it's my way or else risk going into ketoacidosis. As a physician, some ground work must be laid into not being bullied into ordering unreasonable and potentially dangerous therapy.
Sometimes, they demand my name. I give it to them. It's Happy Hospitalist, MD. In these situations, getting a Christmas card is probably out of the question. I guess you can't please everyone every time.
