Sunday, July 24, 2011

Arguing with Crazy People

Another nurse who argues with crazy people
The thing about the ER is that there are lots of people with mental health problems. They might not look different than anyone else (or maybe they do), and they might present with a medical complaint, but sooner or later the psychiatric issue gets mixed in with everything else.

Today in triage I found myself arguing with someone who was a little manic, a little psychotic, and very adamant that he did not need to have blood drawn. I was trying to convince him that since he had a fever, and his post-op knee was suddenly swollen, it was important that we check for infection. People are entitled to refuse procedures, but he was not outright refusing. He was just interrupting me a lot. Loudly.

We all have moments at work and in life where we realize that what we are trying to do is useless. In my experience, this often involves arguing with someone that I know I will not convince. Sometimes I get so emotionally invested in the argument, and I am so convinced of the logic of my opinion, that I continue to belabor the point long past the time when I should have moved on to something else.

What I hope to learn someday soon is how to identify these situations and extract myself from them.  It will probably require swallowing my pride and letting the other person have the last word (not my strong suit AT ALL). Being willing to pick your battles and not browbeat someone else to make your point is a more mature, common-sense approach. My desire to be right is not helping me accomplish anything great. And getting into impossible-to-win arguments is not part of a simple life.

In this example, I finally got fed up with arguing and sent the man to x-ray. I basically told him that the ER physician would see him in a while and at that point he could let the labs be drawn as ordered or leave Against Medical Advice. A little ER tip: if you go in seeking care, you do not get to pick and choose what diagnostics will be done.

The point is that my 10 minute argument with that guy didn't accomplish anything except getting my feathers all ruffled and preventing me from triaging the next patient. It would have been better to document the refusal of blood work at the beginning and move on.

What situations have you encountered at work or in your personal life that involve a battle you can't win? Did you take the intelligent, mature way out, or did you find yourself in a yelling match in the ER waiting room?

Until next time, KISS (keep it simple stupid), and don't argue with crazy people. No one ever wins that fight.

Shameless mixing of Jack Nicholson images

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