Thursday, April 7, 2011

Tales from Residency: Unsatisfied patient

It can be frustrating (both for us and the patient) when a patient comes to clinic and they only want to be treated for one thing, despite the fact that it's not what your clinic is for.

During my residency, I had an elderly male patient who was being seen in our musculoskeletal clinic for neck pain, but all he cared about was the fact that he was constipated. I told my attending that I've never heard a patient say the word "constipated" that many times in a clinic visit. At least not since my intern year.

Me: "So you're here for neck pain?"

Patient: "Well, I've been constipated for the past six months or so...."

Me: "Yes, but you were sent here for neck pain. You're having neck pain?"

Patient: "Oh. Yes."

Me: "How bad is your neck pain on a scale of 1 to 10?"

Patient: "Oh, the constipation is pretty bad."

Me: "Yes, but on a scale of 1 to 10, where 10 is the worst pain ever, what is your NECK PAIN?"

Patient: "Thirty percent."

Me: "Uh, okay."

Patient: "And this constipation has really been bothering me."

Me: "Are you taking any medications for pain?"

Patient: [reaches into his pocket] "Well, I'm taking this medication here. It's for constipation but it hasn't been working that well."

Me: "Listen to me, sir: I understand that you're having constipation issues, but all we deal with in this clinic is pain. We don't treat constipation here. You're going to have to make an appointment with your primary care physician if you want to discuss your constipation. Today we're JUST going to talk about your neck pain. Do you understand?"

Patient: "I understand."

Me: "Okay, can you show me where your neck hurts?"

Patient: "So who do I talk to about the constipation?"

When I brought the attending into the room, I was hoping he had gotten all his constipation issues out of his system (figuratively). But after we spent a couple of minutes on his neck pain, he was right back to constipation again.

Attending: "So we'll make a referral for you to get physical therapy."

Patient: "I can only remember three things at once and you're giving me too many things to remember. What should I do about my constipation?"

Attending: "As the resident just told you, we don't treat constipation in this clinic."

Patient: "Well, I'm pretty unsatisfied with this visit. You didn't do anything to help my constipation."


  1. Poor dude! Pain and discomfort on both ends with a touch of dementia is no way to go through life!

  2. Constipation. Another fine reason I'm not an internist.

  3. Hm... what if he was taking too much opioid medications for his neck pain and had no bowel regimen?

  4. Oh man, ouch. That just isn't pleasant for anyone.

  5. More than treatment and medicines, empathic listening would help to alleviate the pain of most of the patients. What ye say?

    PS: Not a physician to comment on it but a medical scribe who loves to transcribe doctor's dictations. I love your jokes, they are good.

  6. Yup. Same thing on ortho consult service.

    "I'm here about your sciatica"
    "Oh, good. Can you do something about the food, it's awful"

  7. On the plus side, I guess you must have done a great job fixing his neck pain if the only thing he complained about at the end of the appointment was his constipation.

  8. I wonder if he was really constipated...some people expect multiple daily movements and get it stuck in their heads that anything short of that, even if they feel fine, have good appetite, etc., is constipation.

    I too thought about narcotic pain meds, Clinton.

  9. I think I would have just written a prescription for Colace and moved on

  10. Clinton: He didn't have any neck pain and we didn't prescribe narcotics at our clinic, so I doubt that. To be honest, it's tough to find an old man who *isn't* constipated.

    vkn: Older men can talk for hours about their bowels. Sadly, I didn't have that kind of time in clinic, especially when I also had to address the problem I was actually consulted for.

    Adam: It's a slippery slope....

  11. So the best we can do is be patient and explain to the patient they'll have to make another appointment for the constipation?