Difficult patients go with the territory for every clinician. They can wear on your nerves and challenge your professional demeanor.

But what if a difficult patient has a valid concern? Sometimes, as one physician assistant found out, a patient’s unpleasant personality can color your reaction to an actual complication.

Mr. B, 38, had worked as a PA in the emergency department of a mid-sized hospital for close to 10 years. He enjoyed the variety of cases, the urgency of care, and his relationships with colleagues and supervisors.

Continue Reading

But the job had two downsides: the periodic night shift (he was a morning person and found the schedule change jarring) and the occasional cantankerous patient. Generally, Mr. B was known for his calming bedside manner. But every now and again he encountered a patient he found irritating.

One night, both of Mr. B’s pet peeves came together. He was working the night shift, and around 2 AM fatigue was starting to set in. He’d just decided to go to the staff lounge for another cup of coffee, when paramedics rushed in with a young man, Mr. R, on a gurney. Blood was gushing from the man’s left arm near the wrist, and one paramedic was applying pressure to the wound in a valiant attempt to stem the bleeding.

Mr. B and several colleagues rushed to aid the paramedics and got the patient into an exam room. The young man reeked of alcohol and was yelling profanities. Mr. B glanced questioningly at the paramedic who was stanching the wound.

“White male, 22 years old, apparently punched his arm through a glass shower door during an argument with his girlfriend,” the paramedic reported. “Suffered deep lacerations and major bleeding. The girlfriend called an ambulance for him. We’ve tried to hold back the bleeding, but it’s a ‘pumper.’ ”

He moved his hand from the patient’s arm, and blood spurted out uncontrollably. “The guy lost a lot of blood on the way over here,” he said.