Lying To Patients

Here is the thing – I’m a pretty poor liar.  I don’t get much practice, I don’t like doing it and as part of my personality flaws I love sharing things that I know with anyone that’ll listen.  Unfortunately in this business you need to try and keep some things to yourself.

I was called to a place of work where a fifty-five year old woman was complaining of constant headaches.  When I arrived on the scene she was being comforted by a work colleague as she had obviously just been crying.  Now – some people would be wondering why an ambulance would be called for a headache, and why I’m not moaning about the waste of resources.

The reasoning behind my not moaning are simple…

  • The woman was terribly upset.  This indicated fear, and I’m very forgiving if people call an ambulance because they are scared.
  • You are fifty-five years old.  you know all about headaches.  This is different, very different, to the headaches you’ve had in the past.
  • I’m getting soft in my old age.

I got a verbal history from the patient – the headache had been coming and going for two weeks and normal painkillers weren’t touching the pain.  there was no other history of ill health, she hadn’t been to the doctor for years and she had no allergies.  She told me that on that morning she had woken up with the headache and also a feeling of “not being connected to the world”.  Once more, her painkillers hadn’t even touched the pain.

A quick ‘n’ dirty neurological examination didn’t reveal anything particularly scary and her observations were all normal apart from a moderately raised blood pressure.  I discounted the blood pressure as her being scared and sitting in the back of an ambulance looking at my ugly mug.

So we had a drive over to the hospital.

All through the trip I could see that her main fear was that she had grown a brain tumour.  The words were never mentioned – but her fear was of such intensity and direction that I knew that this is what she was thinking.  I would have loved to have lied to her.  I would have given a lot to be able to put my arm around her and tell her that there was no chance of the headaches being caused by a brain tumour. 

But I couldn’t.

I had to sit there and explain about all my ‘negative findings’, I could tell her that her pulse was fine, that she hadn’t had a stroke, that her blood sugar was better than mine and that her short neurological exam didn’t show anything unusual.

But I couldn’t tell her what she wanted to hear.

We reached the hospital, and while I handed over to the nurse one side of her face started to become numb…


A little later, while returning to the hospital with another patient, I saw our woman in the resuscitation room.  She was sitting up and talking to her work colleague who had accompanied her in the ambulance.  I wondered why she was in there – but was too busy to ask the resus nurse.


Towards the end of my shift I saw our patient walking back from the toilet (with colleague still in tow).  I asked her what the doctors had found.

“They are keeping me in”, she told me, my heart sank.  “Apparently I have a really high blood pressure, and that’s what’s been causing it”.

“Oh superb!”, I said, “they can cure that!”.

You could see that she was a lot more relaxed, and that her main concern was that she was now going to be in hospital while the doctors treated her blood pressure. 

Hardly a concern at all.

 

Her blood pressure had been so high, our machine for recording it hadn’t been able to measure it correctly.  Which is a little troubling. 

 

11 thoughts on “Lying To Patients”

  1. at high speed and with blue lights, no less!No, seriously, it's good that you show concern even when you really might not like the outcome.

  2. Well…they tend not to tell otherwise healthy patients about the incurable stuff until after the docs have run every test under the sun.But yeah – offer my sympathies I'd guess, it's all you can do in the corridor of a hospital. It's why I *couldn't*/*didn't* rule out brain tumour.

  3. We've just been issued an O&%on auto BP machine on our volunteer ambulance. I think 300 is the top reading but you can set the default lower e.g. if its for own use and you don't want your arm cut off each time. My manual one is in the car and its raining so I can't be bothered checking what it goes to.cheers

  4. Yes our manual and auto NIBP (non, invasive, blood, pressure) monitors are all 300mmhg (Millimetres of Mercury) max. My BP (blood sugar) is often over the limit of the machines, and as for blood sugar I am normally too low to register. But thats working in an over-run, and under staffed A&E (accident and emergency department) department I guess. (OK so a little white lie about my readings but you get the drift)

  5. you're bloody brave following up stuff like that. I remember how badly I reacted just to being told by my friendly family GP I've known for years “you don't need to worry at this point, but there's a result on your EEG (type of brain-pattern scanning) that means we need to book you in for more tests…” I think I burst into tears at everyone who came near me that day until the evening when a friend told me his mum had died (always someone worse off).So I tend to take the Path Of The Big Chicken and although I ask people how it went at the hospital or whatever, I always dread the answer and I'll have probably put off asking several times already.

  6. Great story; very suspensefully told.A nurse taught me a trick for doing this by hand (the old-fashioned way), which is to feel the pulse as you inflate the cuff, and go up 20 or 30 mmHg beyond where the pulse stops. One night when I was being conscientious and doing it her way I diagnosed a heart attack with bp of 220/140. When I did it by just listening, I thought the bp was 140/80.

  7. Great post, Reynolds. I had a similar case once – middle-aged woman with sudden brown and smelly discharge from her nipple. I knew she was thinking cancer, just as you knew with your patient. At hospital I was saying this to the nurse who got on her high horse, asking, “did she actually say that was what she was worried about?” Jeez, sometimes it's not about the words. Anyway the nurse said it was probably an infection and stuck the sobbing woman in the waiting room.

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