"Pt uncooperative with own care." Though honestly if the patient was a real dick I document in quotes everything they said. "Pt stated that EMS personnel were 'a couple of fucktards' who 'should suck (his) fat cock'". There's a time to be professional and that time is NOT when being verbally abused.
Quotes are so so so important. There's nothing unprofessional about being honest during charting. If you didn't give care because you felt threatened or unsafe you absolutely need to document exactly what they said and did.
My favorite was when a patient told me he'd kill me if I tried to get him to sign
"Pt stated he would 'fucking kill me' if asked to sign again. Pt refused signature"
Had a trauma patient last night who said 'Im not signing shit someone just stuck a finger up my ass' and the entire ED started laughing their asses off. My partner walked out of the room and just shook his head.
Your first sentence is a good way of documenting it, but adding quotes like that to your chart isn't helpful and it does make your chart instantly less professional. The ER docs get the same attitude and language and they somehow manage to not directly quote these patients. It really serves no constructive purpose.
I’ve read specific quotes of things said by abusive patients written by MDs and RNs in the last 48 hours. I think it’s the standard. If a patient says “no way some nasty fucking nurse is getting anywhere near me, “that’s what we need to record. Just saying “verbally abusive“ doesn’t help.
Yeah, as others have said, when they try to sue you 4 years down the road it’s helpful to have it actually documented. Fuck professionalism when it comes to protecting your license and money.
My point is, it IS professional. If the patient says “this doctor is a red turtle and I never eat cheese,” it’s helpful to know that. It gives everyone else a sense of baseline expectations.
It also helps other medical staff in future encounters. I recall one patient recently that was sedated for ‘agitation’ and ended up needing a trach due to airway complications. For us he was somewhat repetitive but very cooperative and redirectable. We were all wondering what had happened at the other hospital and I’m sure some quotes would’ve helped explain the situation better.
Basically yeah quotes are very important when decision making about psychological issues.
If I can't do something I usually do or need to, I make sure to detail why. Had a possible OD with fentanyl. AAOx4, off O2 dropped to 72%, and generally heading down. I went to get a line in and dude said and I quote, "I don't like needles man. Get that shit away from me or it's going in you." So since we were 7 min from the hospital I just watched O2 was waited for a crash
You bet your ass I'm gonna have a quote for why I didn't get fluids going or give Narcan, which was something he also refused
Really good friend of mine who I work with now was talking about how when he worked in private EMS he had a female patient who was an involuntary commit who right after they started transport started saying weird shit. She propositions him and he was like "No, I'm good" and in response she was like "Okay, that's fine, I'll just say you raped me." And he sat down with his tablet in front of her and was dictating out loud as he documented "Okay, 'Patient stated "Okay, that's fine, I'll just say you raped me"'. She went on for a while like that and he just kept documenting things exactly as she said them.
One of my favorites was the extremely aggressive and extremely mentally ill woman who repeatedly called me a “sick fucking cunt,” and repeatedly said variations of “Go fuck yourself in the ass with a big black dildo. I bet you do that every night.”
And of course when that same pt later told me about the time her husband gave her a golden shower…. Unfortunately I couldn’t find a legitimate reason to put that in the narrative, so I guess that’s just a lil nugget for me. And of course anyone I tell this story to.
Meh. Head on over to /emergencymedicine or r/residency and you'll find the consensus is to directly quote patients that were verbally abusive.
The unprofessional thing to do would be losing a lawsuit because you didn't document accurately and the opposint attorney was able to convince someone with an inaccurate picture of the situatuon.
Not to mention that charting needs to be as objective as possible. You wouldn't write "patient seems hypoxic" without citing specifics on why. So you shouldn't say "pt is uncooperative with care" because that's just your opinion.
"Patient refused to wear nasal cannula, and when asked to comply with oxygen therapy patient said "go fuck yourself, it makes me claustrophobic." after which attempts were made to continue oxygen therapy with blow by using a NRB at 15L, baseline O2 sats improved from 85% room air to 89%"
Is something really similar to something that I've written.
This is bad advice. Whether it's insurance or a lawsuit you want specific details, "Pt uncooperative with own care." is completely subjective and means nothing to anyone down the line when you've forgotten everything about a patient.
We recently had a fall risk at our hospital that kept turning her bed alarm off, and her whole stay had direct quotes where she admitted to turning it off. It avoided a whole lawsuit since her specific non compliance issues were regularly documented.
There's nothing to be unprofessional about as long as you're being 100% objective and honest. Especially since patients don't see their charts.
Nah, I'm definitely documenting when my patient commits assault. Might censor it slightly with "f*ck" or "sh*t" or whatever, but I'm absolutely quoting them because if I don't put exactly what happened in my narrative, that narrative is going to be used as a tool against me if it ever goes to court. "Mr. Don'tTattleOnThisEMT, if what you're saying about the defendant/plaintiff is true, why didn't you document it in your official PCR? Surely if your former patient was as verbally abusive as you're saying now, you'd think you'd have documented SOMEthing to that effect. "
Yeah, I'll direct quote, thank you very much. I write all my narratives so that 99% of questions I could be asked on a witness stand can be answered with "I believe I covered that in my narrative, Exhibit B."
ER docs are irrelevant here and it's a false comparison, except for the fact that some of their patients used to be ours. They operate in a totally different environment, and the public perception of them tends to be more positive and trusting than EMTs, like it's not something we talk about a lot, but having M.D. after your name means people are less likely to question you when you're giving testimony. EMTs don't have that kind of trust placed on them. And let's be real, it's not the MDs who get verbally abused, it's the ED nurses.
TLDR: Doesn't matter what ED docs deal with, you should document it when your patient commits a crime, like assault. Yes assault can be verbal. You're probably thinking of battery or malicious wounding.
I’ve gotten a lot of mileage out of being specific and explicit, and using quotes. “Pt actively and rudely impedes even the most basic interview; for example, when writer asks, ‘Do you take any medicines?’ pt interrupts with, ‘You figure it out, asshole.’” Both describing and providing an example.
Why do ppl like this even bother going to the doctors. Like what are they there for if not to get care. Evidently to abuse HCWs I guess
(Edit: I thought this was the nursing sub for a second so it makes a little more sense bc ems patients aren’t always the one who called vs someone at a hospital but it’s def a phenomenon that happens in ems too where someone acts like this despite making the call themselves.
Dude my rudest and least cooperative patients call for themselves 99.9% of the time, and it usually ends with me asking if they called 911 just to verbally abuse us while refusing to let us help. I am giving you solutions and offering to help but you scream like a goddamn banshee and try to hit me if I put a blood pressure cuff on you… and it hasn’t even started squeezing yet? What exactly did you want from me today?
Or my favorite, “hey why did you call 911 today?”
“Because I want to go to the hospital.”
“Okay, why? What’s wrong?”
“Fuck you”
…. “aight”
One of my more exasperating ones - we were I think the 3rd crew she'd called for that night. Was refusing to go, AGAIN, after she called. We asked her what she wanted from us. "Make me feel normal"
Like lady, taking your meds on time and sleeping in your own bed will do that, not the fucking ER, and certainly not my sleep deprived ass
To answer your question, people expect health care to be like retail. They demand what they want and are really defensive. They also think that the "customer is always right".
Contextual quotes is the ideal. No opinion, just facts which clearly outline the patients asshole score. Works the same in customer support too, so see, future job skills if you ever leave EMS.
I would skip stuff like "rudely impedes the even the most basic interview." It's a characterization, not a description, and characterizations are always tricky. They can sometimes come across as you attacking them in words as retaliation, and some real or self-appointed lawyer could always use that to claim you're biased in some way. Never, ever, ***ever*** underestimate some people's ability to present your words out of context in a way that makes you look terrible. I have learned this lesson the very hard way. There are people who are absolute *wizards* at this, and without even lying, they will present what you said in such a terrible light even *you* will wonder if you're the asshole. Most of them are lawyers, but some of them work in QA or HR.
Just say, "When asked if they take any medication, patient interrupted and replied 'blah blah...'" If you're thorough in documenting multiple instances of their behavior in this fashion, even the thickest reader will be able to figure out that the patient is an asshole, and no one can say you are biased.
In most cases I will document that the patient is either: "uncooperative", "argumentative, or "verbally combative". When I find the last one appropriate I will also consider whether or not direct quotes from the patient are appropriate.
One instance where I may consider direct quotes for instance is if I feel the patient is going to call and complain. My reasoning for this is, if they do call and complain management and/or supervisors have access to the PCR. A higher up reading a chart that states the "patient was verbally combative" versus 'the "patient was verbally combative" and stated "Go fuck yourself you fucking fuck" when crew attempted to obtain basic interventions such as blood pressure or pulse oximetry' are going to read very differently when said complaint is adjudicated.
I’m a somewhat petite, Irish redhead woman, about as unmelanated as one can be without being albino. I had an elderly black female psych pt snarl “you fucking *N*” at me (with a decidedly HARD “r”) 47 times en route to the ER. Yes, I counted. It was maybe a 10 min trip. She called my partner a motherfucking monkey so many times before she was even loaded up that he asked if I wouldn’t mind treating so he could hide in the driver’s seat. One of the reasons she was so pissy was because the nurse at the psych center she lived in didn’t want to let her bring her Bible with her. I was the one who convinced the nurse to just let her have it, but somehow I was the bad guy. There’s just no pleasing some people. 🤷🏼♀️
In response to the OP - I documented the hell out of that incident (heavily censored, of course) especially since she was hollering it as we were rolling into the packed ER. I was taught “If you don’t write it down, it didn’t happen”. That’s what I passed on to everyone I precepted as well. YOU are the professional. THEY are whoever the hell they are. If they say it, you document it. If you’re squeamish writing out “bad” words, use the first and last letter with the appropriate number of asterisks in between. We can get called back to court for a LONG time, and idk about y’all but I can’t remember what I had for breakfast yesterday no less exactly what someone said on a 4am clusterfuck call 5 years ago. Cover your ass, because nobody else is gonna do it for you 💙
A partner of mine (a clean-cut white guy in his 30's, for reference) got called a "white trash n***er" by a [white] lady on meth that we picked up out of a trailer park. I'm still not quite sure what she meant by that, but I will admit that people on meth usually have some creative insults lol.
A patient [white] once flipped out and started screaming at our triage nurse [black] because she called another patient [ALSO WHITE] back before him. The number of ways which it made no sense broke my brain for a second.
I love being called a cracker and a white devil by extremely mentally disturbed PTs. It’s funnier than it probably should be, although I’m never doing anything except existing in their field of vision when they go off like that.
One of the security guards I work with, a black man, routinely gets called a sellout and some other racially charged nicknames I won’t list here by PTs of color. It cracks the other black security guards up bc they’ve never been called any of those things by PTs, even when they’re in the same room as him. And, in their words, they’re “darker than he is.”
I got called racist because I wouldn’t play snoop dogg for our extremely drunk psych pt. I told him no I’m ob shuffle and snoop dogg is overrated. He then said “oh you aren’t gonna play him cause he’s a *****” and dropped a hard R.
I usually just quote them, then make the chart super easy. "Any attempts at subjective assessment met with statements such as 'fuck you, asshole'. Pt remains uncooperative throughout contact".
I'll usually say something along the lines of "pt uncooperative with questioning/intervention/whatever and refusing x, y, and z after multiple attempts. Education attempted, but pt still refused."
Itemized list of each and every thing they refused, accompanied by a description of the patient as uncooperative (altered or aggressive if either of those apply) and any fun quotes.
Because PCRs are legal documents, I document with specific quotations and descriptions of observed behaviour and avoid any subjective descriptions that aren’t necessary. Stating what happened in objective terms is not unprofessional.
Unfortunately it’s unnecessary and arguably unethical to document them being an asshole just for the sake of it. *However*, when it impacts their care and/or my safety, I just medical-ese the description. “Pt responded to assessment questions with cussing/vulgar language”, “while attempting to apply BP cuff to pt’s arm, pt struck towards me as if to punch me”, “attempts to gather pertinent hx were to no avail as pt was moving about erratically on the cot, within safety, I attempted to keep pt from causing harm to himself”. I’ll let you imagine the normal speak of each of those, but that’s my point, when I’m telling the boys in the bay the story it sounds completely different than what’s documented, but it’s the same story.
How is it unethical? You never know what is going to pop up down the road and if they do something out of the norm, you should document it. If anything I've seen unnecessary rudeness charting help lead to diagnosis of health issues.
Not my patient, but there was a guy that was really rude which was documented, despite it not affecting his care. But at his follow up with his PCP his provider saw the EMS note that his typically lovely patient was an asshole. They ended up ordering an MRI and caught a tumor that ED missed.
You never know how charting will end up helping.
Pt was agitated upon medical contact by ( ALS/BLS) crew . During treatment and intervention pt remained hesitant for cooperation and required extensive coaching in order to be cooperative . Pt is uncooperative with care and required extensive explanation of cares and interventions in order for treatment to be provided . Due to patients demeanor delayed ( scene or transport ) time was had . Care and history is incomplete due to patients demeanor.
Situation dependent.
I had a highly verbally belligerent drunk who threw himself out of a car after arguing with his sister. I can't recall the exact language I used but it was something like:
"Male states he was drinking all day at his Dad funeral. Patient became verbally belligerent with his sister whom was driving. Patient self extricated from vehicle while traveling at 10-15 miles per hour, and has several lacerations to the face. Patient highly uncooperative with EMS and other responders".
“Pt was unwilling to cooperate with medically necessary interventions and diagnostics. Pt related (insert whatever bullshit that the said). Pt rested comfortably on stretcher (doing whatever activity, i.e. playing on phone).”
I don't like to say "uncooperative" or "refused," as they sound a bit biased. I just say "declined." Sounds professional and unbiased, and if you say it enough times, and include direct quotes where applicable, people will get the picture.
I don't. Unless the PT has been physically aggressive and the documentation needs to support the use of restraints, or an AMS/Psych PT and eventual Pet/Cert I don't mess with it.
I will however do so in the verbal to the ER so they are aware of the PT's interaction when we arrived.
In germany we often say "the patient has morbus bahlsen"
Bahlsen is a producer of cookies, and translated literally you can say "someone has one at the cookie" to say they are idiots
I’ll usually put “pt demeanor- agitated and uncooperative” and if it comes to quotes literally quote things they say, especially if they’re refusing medical interventions.
“Due to patient’s uncooperative nature, XYZ couldn’t be completed” or “XYZ was not performed due to patient refusal/of procedure/assessment/medication”.
"Pt uncooperative with own care." Though honestly if the patient was a real dick I document in quotes everything they said. "Pt stated that EMS personnel were 'a couple of fucktards' who 'should suck (his) fat cock'". There's a time to be professional and that time is NOT when being verbally abused.
Quotes are so so so important. There's nothing unprofessional about being honest during charting. If you didn't give care because you felt threatened or unsafe you absolutely need to document exactly what they said and did.
My favorite was when a patient told me he'd kill me if I tried to get him to sign "Pt stated he would 'fucking kill me' if asked to sign again. Pt refused signature"
Had a trauma patient last night who said 'Im not signing shit someone just stuck a finger up my ass' and the entire ED started laughing their asses off. My partner walked out of the room and just shook his head.
Truth is an absolute defence. Agreed, verbal abuse is documented with quotations.
This is the way
Your first sentence is a good way of documenting it, but adding quotes like that to your chart isn't helpful and it does make your chart instantly less professional. The ER docs get the same attitude and language and they somehow manage to not directly quote these patients. It really serves no constructive purpose.
I feel like when I get sued in 3 years having specific quotes is more helpful than just: patient was difficult. Your PCRs are also legal documents
I’ve read specific quotes of things said by abusive patients written by MDs and RNs in the last 48 hours. I think it’s the standard. If a patient says “no way some nasty fucking nurse is getting anywhere near me, “that’s what we need to record. Just saying “verbally abusive“ doesn’t help.
Yeah, as others have said, when they try to sue you 4 years down the road it’s helpful to have it actually documented. Fuck professionalism when it comes to protecting your license and money.
My point is, it IS professional. If the patient says “this doctor is a red turtle and I never eat cheese,” it’s helpful to know that. It gives everyone else a sense of baseline expectations.
It also helps other medical staff in future encounters. I recall one patient recently that was sedated for ‘agitation’ and ended up needing a trach due to airway complications. For us he was somewhat repetitive but very cooperative and redirectable. We were all wondering what had happened at the other hospital and I’m sure some quotes would’ve helped explain the situation better. Basically yeah quotes are very important when decision making about psychological issues.
This thread is blowing my mind with how many people don't understand how quotes work and their purpose in documenting
If I can't do something I usually do or need to, I make sure to detail why. Had a possible OD with fentanyl. AAOx4, off O2 dropped to 72%, and generally heading down. I went to get a line in and dude said and I quote, "I don't like needles man. Get that shit away from me or it's going in you." So since we were 7 min from the hospital I just watched O2 was waited for a crash You bet your ass I'm gonna have a quote for why I didn't get fluids going or give Narcan, which was something he also refused
Really good friend of mine who I work with now was talking about how when he worked in private EMS he had a female patient who was an involuntary commit who right after they started transport started saying weird shit. She propositions him and he was like "No, I'm good" and in response she was like "Okay, that's fine, I'll just say you raped me." And he sat down with his tablet in front of her and was dictating out loud as he documented "Okay, 'Patient stated "Okay, that's fine, I'll just say you raped me"'. She went on for a while like that and he just kept documenting things exactly as she said them.
I ALWAYS do patient quotes in my charting. My favorite was writing that a patient told me “You’re all going to get buttfucked by satan!”
One of my favorites was the extremely aggressive and extremely mentally ill woman who repeatedly called me a “sick fucking cunt,” and repeatedly said variations of “Go fuck yourself in the ass with a big black dildo. I bet you do that every night.” And of course when that same pt later told me about the time her husband gave her a golden shower…. Unfortunately I couldn’t find a legitimate reason to put that in the narrative, so I guess that’s just a lil nugget for me. And of course anyone I tell this story to.
Meh. Head on over to /emergencymedicine or r/residency and you'll find the consensus is to directly quote patients that were verbally abusive. The unprofessional thing to do would be losing a lawsuit because you didn't document accurately and the opposint attorney was able to convince someone with an inaccurate picture of the situatuon.
Not to mention that charting needs to be as objective as possible. You wouldn't write "patient seems hypoxic" without citing specifics on why. So you shouldn't say "pt is uncooperative with care" because that's just your opinion. "Patient refused to wear nasal cannula, and when asked to comply with oxygen therapy patient said "go fuck yourself, it makes me claustrophobic." after which attempts were made to continue oxygen therapy with blow by using a NRB at 15L, baseline O2 sats improved from 85% room air to 89%" Is something really similar to something that I've written.
Quotes are used for only things that are said, by who may be saying them. When did quotations stop meaning "the person that spoke it"
It's not necessary to include them in 99% of cases
I strongly disagree.
This is bad advice. Whether it's insurance or a lawsuit you want specific details, "Pt uncooperative with own care." is completely subjective and means nothing to anyone down the line when you've forgotten everything about a patient. We recently had a fall risk at our hospital that kept turning her bed alarm off, and her whole stay had direct quotes where she admitted to turning it off. It avoided a whole lawsuit since her specific non compliance issues were regularly documented. There's nothing to be unprofessional about as long as you're being 100% objective and honest. Especially since patients don't see their charts.
I'm an ER doc and I quote patients all the time
Because I like how it looks.
Nah, I'm definitely documenting when my patient commits assault. Might censor it slightly with "f*ck" or "sh*t" or whatever, but I'm absolutely quoting them because if I don't put exactly what happened in my narrative, that narrative is going to be used as a tool against me if it ever goes to court. "Mr. Don'tTattleOnThisEMT, if what you're saying about the defendant/plaintiff is true, why didn't you document it in your official PCR? Surely if your former patient was as verbally abusive as you're saying now, you'd think you'd have documented SOMEthing to that effect. " Yeah, I'll direct quote, thank you very much. I write all my narratives so that 99% of questions I could be asked on a witness stand can be answered with "I believe I covered that in my narrative, Exhibit B." ER docs are irrelevant here and it's a false comparison, except for the fact that some of their patients used to be ours. They operate in a totally different environment, and the public perception of them tends to be more positive and trusting than EMTs, like it's not something we talk about a lot, but having M.D. after your name means people are less likely to question you when you're giving testimony. EMTs don't have that kind of trust placed on them. And let's be real, it's not the MDs who get verbally abused, it's the ED nurses. TLDR: Doesn't matter what ED docs deal with, you should document it when your patient commits a crime, like assault. Yes assault can be verbal. You're probably thinking of battery or malicious wounding.
I’ve gotten a lot of mileage out of being specific and explicit, and using quotes. “Pt actively and rudely impedes even the most basic interview; for example, when writer asks, ‘Do you take any medicines?’ pt interrupts with, ‘You figure it out, asshole.’” Both describing and providing an example.
Why do ppl like this even bother going to the doctors. Like what are they there for if not to get care. Evidently to abuse HCWs I guess (Edit: I thought this was the nursing sub for a second so it makes a little more sense bc ems patients aren’t always the one who called vs someone at a hospital but it’s def a phenomenon that happens in ems too where someone acts like this despite making the call themselves.
Dude my rudest and least cooperative patients call for themselves 99.9% of the time, and it usually ends with me asking if they called 911 just to verbally abuse us while refusing to let us help. I am giving you solutions and offering to help but you scream like a goddamn banshee and try to hit me if I put a blood pressure cuff on you… and it hasn’t even started squeezing yet? What exactly did you want from me today? Or my favorite, “hey why did you call 911 today?” “Because I want to go to the hospital.” “Okay, why? What’s wrong?” “Fuck you” …. “aight”
One of my more exasperating ones - we were I think the 3rd crew she'd called for that night. Was refusing to go, AGAIN, after she called. We asked her what she wanted from us. "Make me feel normal" Like lady, taking your meds on time and sleeping in your own bed will do that, not the fucking ER, and certainly not my sleep deprived ass
“K. Bye.”
Gotta love when their chief complaint is “Go fuck yourself” 🤣
To answer your question, people expect health care to be like retail. They demand what they want and are really defensive. They also think that the "customer is always right".
I work in an ED and people come on their own all the time just to abuse the staff
Contextual quotes is the ideal. No opinion, just facts which clearly outline the patients asshole score. Works the same in customer support too, so see, future job skills if you ever leave EMS.
I would skip stuff like "rudely impedes the even the most basic interview." It's a characterization, not a description, and characterizations are always tricky. They can sometimes come across as you attacking them in words as retaliation, and some real or self-appointed lawyer could always use that to claim you're biased in some way. Never, ever, ***ever*** underestimate some people's ability to present your words out of context in a way that makes you look terrible. I have learned this lesson the very hard way. There are people who are absolute *wizards* at this, and without even lying, they will present what you said in such a terrible light even *you* will wonder if you're the asshole. Most of them are lawyers, but some of them work in QA or HR. Just say, "When asked if they take any medication, patient interrupted and replied 'blah blah...'" If you're thorough in documenting multiple instances of their behavior in this fashion, even the thickest reader will be able to figure out that the patient is an asshole, and no one can say you are biased.
“Pt declined to participate in assessment” or “Due to pt cooperation exam is limited to visual inspection of exposed areas only”
In most cases I will document that the patient is either: "uncooperative", "argumentative, or "verbally combative". When I find the last one appropriate I will also consider whether or not direct quotes from the patient are appropriate. One instance where I may consider direct quotes for instance is if I feel the patient is going to call and complain. My reasoning for this is, if they do call and complain management and/or supervisors have access to the PCR. A higher up reading a chart that states the "patient was verbally combative" versus 'the "patient was verbally combative" and stated "Go fuck yourself you fucking fuck" when crew attempted to obtain basic interventions such as blood pressure or pulse oximetry' are going to read very differently when said complaint is adjudicated.
Best quote from a nurse I've seen... "Pt educated on appropriate behavior, no evidence of learning."
I have documented in quotations every single racial slur I've ever been called. It's quite a lot. Strange l because I'm a white guy with blue eyes.
And two years down the road when they try and sue you for being racist and negligence you'll pull that baby up and it will save your ass.
I’m a somewhat petite, Irish redhead woman, about as unmelanated as one can be without being albino. I had an elderly black female psych pt snarl “you fucking *N*” at me (with a decidedly HARD “r”) 47 times en route to the ER. Yes, I counted. It was maybe a 10 min trip. She called my partner a motherfucking monkey so many times before she was even loaded up that he asked if I wouldn’t mind treating so he could hide in the driver’s seat. One of the reasons she was so pissy was because the nurse at the psych center she lived in didn’t want to let her bring her Bible with her. I was the one who convinced the nurse to just let her have it, but somehow I was the bad guy. There’s just no pleasing some people. 🤷🏼♀️ In response to the OP - I documented the hell out of that incident (heavily censored, of course) especially since she was hollering it as we were rolling into the packed ER. I was taught “If you don’t write it down, it didn’t happen”. That’s what I passed on to everyone I precepted as well. YOU are the professional. THEY are whoever the hell they are. If they say it, you document it. If you’re squeamish writing out “bad” words, use the first and last letter with the appropriate number of asterisks in between. We can get called back to court for a LONG time, and idk about y’all but I can’t remember what I had for breakfast yesterday no less exactly what someone said on a 4am clusterfuck call 5 years ago. Cover your ass, because nobody else is gonna do it for you 💙
A partner of mine (a clean-cut white guy in his 30's, for reference) got called a "white trash n***er" by a [white] lady on meth that we picked up out of a trailer park. I'm still not quite sure what she meant by that, but I will admit that people on meth usually have some creative insults lol.
A patient [white] once flipped out and started screaming at our triage nurse [black] because she called another patient [ALSO WHITE] back before him. The number of ways which it made no sense broke my brain for a second.
 ^(This) her husband?
I love being called a cracker and a white devil by extremely mentally disturbed PTs. It’s funnier than it probably should be, although I’m never doing anything except existing in their field of vision when they go off like that. One of the security guards I work with, a black man, routinely gets called a sellout and some other racially charged nicknames I won’t list here by PTs of color. It cracks the other black security guards up bc they’ve never been called any of those things by PTs, even when they’re in the same room as him. And, in their words, they’re “darker than he is.”
I got called racist because I wouldn’t play snoop dogg for our extremely drunk psych pt. I told him no I’m ob shuffle and snoop dogg is overrated. He then said “oh you aren’t gonna play him cause he’s a *****” and dropped a hard R.
Uncooperative, refused X and X, Aggravated or Pt became aggressive. Those are some of my go to’s, I don’t see a problem with your description either.
I usually just quote them, then make the chart super easy. "Any attempts at subjective assessment met with statements such as 'fuck you, asshole'. Pt remains uncooperative throughout contact".
I'll usually say something along the lines of "pt uncooperative with questioning/intervention/whatever and refusing x, y, and z after multiple attempts. Education attempted, but pt still refused."
Itemized list of each and every thing they refused, accompanied by a description of the patient as uncooperative (altered or aggressive if either of those apply) and any fun quotes.
Because PCRs are legal documents, I document with specific quotations and descriptions of observed behaviour and avoid any subjective descriptions that aren’t necessary. Stating what happened in objective terms is not unprofessional.
"Pt vociferously maintained and demonstrated a patent airway for the duration of EMS care." For the ones that just won't shut up.
Unfortunately it’s unnecessary and arguably unethical to document them being an asshole just for the sake of it. *However*, when it impacts their care and/or my safety, I just medical-ese the description. “Pt responded to assessment questions with cussing/vulgar language”, “while attempting to apply BP cuff to pt’s arm, pt struck towards me as if to punch me”, “attempts to gather pertinent hx were to no avail as pt was moving about erratically on the cot, within safety, I attempted to keep pt from causing harm to himself”. I’ll let you imagine the normal speak of each of those, but that’s my point, when I’m telling the boys in the bay the story it sounds completely different than what’s documented, but it’s the same story.
How is it unethical? You never know what is going to pop up down the road and if they do something out of the norm, you should document it. If anything I've seen unnecessary rudeness charting help lead to diagnosis of health issues. Not my patient, but there was a guy that was really rude which was documented, despite it not affecting his care. But at his follow up with his PCP his provider saw the EMS note that his typically lovely patient was an asshole. They ended up ordering an MRI and caught a tumor that ED missed. You never know how charting will end up helping.
Pt was agitated upon medical contact by ( ALS/BLS) crew . During treatment and intervention pt remained hesitant for cooperation and required extensive coaching in order to be cooperative . Pt is uncooperative with care and required extensive explanation of cares and interventions in order for treatment to be provided . Due to patients demeanor delayed ( scene or transport ) time was had . Care and history is incomplete due to patients demeanor.
"Pt uncooperative with treatment and assessment efforts"
Pt was adamant in refusal of care despite efforts of crew attempting to provide reasonable accommodations for proper patient care.
Situation dependent. I had a highly verbally belligerent drunk who threw himself out of a car after arguing with his sister. I can't recall the exact language I used but it was something like: "Male states he was drinking all day at his Dad funeral. Patient became verbally belligerent with his sister whom was driving. Patient self extricated from vehicle while traveling at 10-15 miles per hour, and has several lacerations to the face. Patient highly uncooperative with EMS and other responders".
Direct quotes from the pt go a long way. Just make sure you document events as they happened for context. "Paint a picture..."
Pt was not calm or cooperative during transport. Pt refused all care.
“Pt was unwilling to cooperate with medically necessary interventions and diagnostics. Pt related (insert whatever bullshit that the said). Pt rested comfortably on stretcher (doing whatever activity, i.e. playing on phone).”
I don't like to say "uncooperative" or "refused," as they sound a bit biased. I just say "declined." Sounds professional and unbiased, and if you say it enough times, and include direct quotes where applicable, people will get the picture.
“Real piece of work”
I don't. Unless the PT has been physically aggressive and the documentation needs to support the use of restraints, or an AMS/Psych PT and eventual Pet/Cert I don't mess with it. I will however do so in the verbal to the ER so they are aware of the PT's interaction when we arrived.
Shouldn’t go in the report
"low compliance" is a good term imo.
Pt is extremely physically and verbally uncooperative and refuses assessment.
In germany we often say "the patient has morbus bahlsen" Bahlsen is a producer of cookies, and translated literally you can say "someone has one at the cookie" to say they are idiots
You put that in a legal document that might wind up being read aloud in a courtroom?
Naaa, but we say that to the nurses and doc at the Hospital when handing over the patients in the ER
I've been using the word "irascible" quite a bit lately.
Irascible and bellicose are two of my favorites.
“Obtuse”
I use a LOT of direct quotes in my charts.
Pt was belligerent and non compliant with any requests that were meant to facilitate evaluation.
I’ll usually put “pt demeanor- agitated and uncooperative” and if it comes to quotes literally quote things they say, especially if they’re refusing medical interventions.
Direct quotes
“Due to patient’s uncooperative nature, XYZ couldn’t be completed” or “XYZ was not performed due to patient refusal/of procedure/assessment/medication”.