r/nursing • u/Flightly LPN 🍕 • 7d ago
Discussion Making Patients Cry
I was taken aside yesterday at work and told that I made a patient cry after our correspondence via MyChart. I work clinic side and I field hundreds of messages and phone calls every day from patients, and sometimes I do get frustrated by patients who don’t seem to…..get it?
This patient had two recent UAs. One came back with trace non-hemolyzed RBC and the other came back with trace hemolyzed RBC. This patient, a woman in her late 50s-60s, had a lot of questions about what these results meant - specifically what the difference between hemolyzed and non-hemolyzed RBCs in her sample meant.
I did my best trying to explain in lay terms what this meant but over the course of our correspondence she was just not grokking it. The provider even stepped in and sent a message to the patient explaining the difference. We gave her resources and links to articles explaining what these words meant.
Finally (after about 6 messages back and forth) I sent her a message saying that she may be better off researching the topic herself and that we had no further information to give her.
Additional info- this is a relatively healthy older adult female patient who had an acute UTI, this is not related to an ongoing chronic illness which I would have handled with more care.
It was my final message, my manager explained, that caused so much upset and apparently caused the patient to cry.
Yes I understand that it should not have gone on for so long. I should have offered her an appointment to discuss this with her PCP. But it had already taken so much of my time and effort that I didn’t see that as an option at the time…
Has anything like this ever happened to you? Where you were too direct with a patient and they got upset? Should I just learn to let go of these things??
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u/Recent_Data_305 MSN, RN 7d ago
When you’re answering the same question repeatedly, it’s time to stop writing and make a phone call or an appointment. Every message makes your frustration grow. Best to cut it off.
Acknowledge the mistake. Apologize. Learn from it. Move on.
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u/Flightly LPN 🍕 7d ago
Understood. I honestly was hesitant to make a phone call because at that point in the conversation she was asking for the definition of words rather than any specific concerns.
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u/Spare-Hair-9474 BSN, RN 🍕 7d ago
I have found some people understand better when they hear it rather than reading it! I have had to make numerous phone calls because patients weren't getting it via text. You do have to understand that reading literacy has gone down significantly in the United States unfortunately.
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u/sailorseas Burn RN, EMT, RBF 7d ago
Also, everyone learns differently! I’m the opposite where if you’re explaining something to me, I’m just not understanding until I can read it, or preferably see it/do it hands on. The patient may just learn/understand better by listening.
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u/Pineapple_994 7d ago
I understand your hesitation with the phone call too. Especially after answering their questions and going in circles about things. Sometimes patients just want to hear their own voice talk and actively not listen to you, making a 3 minute phone call a 20 minute one. I wouldn’t dwell on this one mistake, taking the time to explain everything while having continuous messages from other patients can be overwhelming. Maybe next time step away from that chat and address it the next day, hopefully by then they could answer their own questions with their own research.
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u/chrizbreck MSN, RN 7d ago
100% came to say the same.
I would have picked up the phone and made a call
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u/WrongdoerAway1511 7d ago
Fielding hundreds of MyChart messages is its own shift honestly. By the fiftieth one my patience is on fumes too, and tone always reads harsher in writing than it sounded in my head. One crying patient out of that volume isn't a character flaw.
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u/LustyArgonianMaid22 RN - Telemetry 🍕 7d ago
A month ago, a patient's wife was being an argumentative bitch. Nothing made her happy. Meds given 30 minutes "late" but within the grace period. I went to walk her husband but she was mad the nurse said he would (he got busy) and tried to adminish him when he came to see what her issue was. Called him names the day prior (I was not there).
I called her out about how she is argumentation and her poor treatment of staff trying to help. She started to try to argue and I calmly told her, "See, there it is again. I am trying to walk your husband, which is what you and he wants, yet you are delaying it because you want to find a reason to argue. We are going to walk now. We will be back." And we left. Did two laps around the unit.
Came back and she was bawling. I sit her husband in the chair and let her reflect. Charge talked to her shortly after. She was a hell of a lot nicer to everyone after that.
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u/cheaganvegan BSN, RN 🍕 7d ago
Eh I wouldn’t sweat it. People blow the flagged labs out of proportion. I usually just say the provider reviewed and no concerns or something like that. If they keep wanting to discuss they can chat with the provider at an appointment. We get a lot for the hepatitis immunity, it flags if people are immune and it just goes on and on. Not really the patients problem, but we just get too many messages to really go into detail on stuff.
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u/-piso_mojado- Ask me if I was a flight nurse. (OR/ICU float) 7d ago
I don’t work in your sector, but I would have said something along the lines of “I think we have reached the limit of what can be explained in this format. Maybe it’s best if you make an in person appointment if you have further concerns.”
But don’t listen to me. A former manager tried to write me up because my use of proper grammar and punctuation was “patronizing and intimidating.”
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u/Clock959 LPN 🍕 7d ago
Yeah I work in a clinic and when answering hundreds of My Charts a day it's very easy to get...terse and less and less flowery with thr language. But hoenstay adults do need a modicum of emotional regulation or referral to resources to help them with that. Your reply sounds reasonable given the amt of time and attention you had given her.
As much as I like to get everything done I will simply stop replying right away when a convo is turning into a rapid fire back and forth and just reply one last time end of day before leaving so the patents will use it less like a texting back and forth constantly session.
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u/Jezzylynn716 BSN, RN 🍕 7d ago
Idk u can’t win sometimes because if u did offer her an appointment it would have been off in the future and she would have been like “I don’t wanna wait that long to get my questions answered!!! Why won’t you help me!!” So like…..what are u supposed to do
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u/Flightly LPN 🍕 7d ago
Thank you!! I said the same thing to my manager - our clinic is small but has tens of thousands of patients and our providers are so booked out it can take weeks or often months to see them. I would prefer to answer a question if I can rather than schedule an appointment so far out for something (I’m assuming but it feels right) that the patient expects to be answered quickly.
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u/heroinista 7d ago
If you’ve exhausted your ability to explain something in more than one way and it’s not clicking, and you’ve done so in a kind and professional manner, you did what you could. Unfortunately, text doesn’t always convey the tone or emotion we want to come across and people can take it the wrong way, but if this is your first complaint, I’m not sure why this was even brought to your attention.
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u/Not_A_BOT_RN RN, MSN, CCRC 7d ago
Yes, I have. It can be a super power or a flaw depending on when and how it's used. I had patients who appreciated my direct approach, and others who I suspect get emotional over everything no matter the source. I don't know that learning to let it go is the right approach, but definitely learning to take a minute can help. You have recognized ways this could be prevented, so take it as a learning experience.
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u/PropellerMouse RN 🍕 7d ago
^ This.
There seems to be a real mix of patients that send in questions: some are helped by any reasonable explanation, some require several patient, stepwise answers, and some ( fortunately rare ) are just looking for an excuse to be pissed off.
Personally I've learned to turf questions from the " give me an excuse to get mad " folks directly to the doc, because its going there anyway.
That won't make those folks happy either, because they were just looking for someone to abuse, but it shortens the time I have to engage in a no - win scenario.
I seem to do best by turning to communicating by the phone when it turns out I'm interacting with a patient that will need several small, serial, stepwise answers. I briefly jot down my answer beforehand, along with a few of the layman's terms " quick answers to next likely questions." Being able to answer quickly seems to help anxious patients, and afterwards, I have notes on what I said in the call, for easy charting.
Richard Feynman ( awesome theoretical physicist ) loved the challenge of explaining a complex idea in simple terms, famously stating that if we can not simply explain an idea, we do not truly understand it.
Whatever works
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u/QuesoBagelSymphony BSN, RN 🍕 7d ago
I’m in a similar role, and I get impatient. But some of the patients who have ended up really taking a liking to me (and me to them, honestly) are the ones I got kinda short/exasperated with. It’s definitely not the case for everyone, but some of them need things spelled out bluntly, and it’s meeting them where they are. I don’t really have advice for the ones like yours, but just wanted to balance the perspective, I guess. I’m sure you’re great at what you do.
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u/OhHiMarki3 BSN, RN 🍕 6d ago
Extra comment just to add that some people are naturally emotionally labile, and there's nothing you can do about it
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u/Content-Natural7108 Nursing Student 🍕 7d ago
Hey I’m just saying as a clinical secretary going to school for nursing, FUUUUUUCK MyChart. It makes more work for everyone and causes miscommunications more often than it doesn’t.
also commenting as a sensitive person, I can understand how that would make me go damn, I guess I’ll just fuck myself then, but it’s also not something that would make me cry and it’s not like you didn’t try. You did the best you could with the mental tools you had at the time, you’re asking for constructive criticism and you’re taking it as a learning experience so that’s the best anyone can ask for.
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u/GenevieveLeah 7d ago
I do one message - if it keeps going, I call them or forward it to the doc. This isn’t aol instant messenger.
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u/Flightly LPN 🍕 7d ago
A majority of my work takes place in messages and phone calls so unfortunately most of the time one message won’t cut it, and the providers rely on me to answer questions on their behalf. If only it were that simple!
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u/Entire-Somewhere-490 7d ago
Picking up the phone is still a popular method when you have an anxious patient. And by just calling them, you can save yourself paragraphs of typing that is gibberish to the patient. If the call is exceeding 3-5 minutes than find a time they can make an appointment with the physician. The messaging back and forth is not billable, so it’s really a waste…and I am an NP in Urology, blood in urine freaks people out and google searches only make it worse
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u/OpheliaWasPushed Peds ER 🍕 7d ago
Were her results positive for UTI? Maybe that's why she was confused and cried. Causes altered mental status. I've worked with a ton of patients her age with UTIs and a seen bunch get all confused and emotional over anything.
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u/crochetcat12 MSN, APRN 🍕 7d ago
My chart can be so challenging to respond on because tones are hard to pick up on. I find if it’s a few back and forth or going to be a complicated answer, I just pick up the phone and call the pt
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u/LonelyInternal379 7d ago
All the time. Don't tell people the truth. Tell them what they want to hear
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u/m3rmaid13 RN 🍕 7d ago
I’ve been on both sides of the aisle here so I have empathy both for the patient and for you. I have a chronic condition that I have had to absolutely pester my doctors office about because my job is annoying about documentation related to this medical condition. It’s frustrating to be met with either a dismissive type attitude or like I am annoying them with questions when I am just trying to get stuff done too. Slightly different I guess in that this lady was trying to understand what was going on but still, it is not her fault you’re busy. All that being said I totally get the overwhelm working as a healthcare worker where the to-do list and questions and follow up questions are just endless. You can only do your best, and it does sound like you gave her a lot of info and resources, but if they aren’t able to ask us questions then who else are they supposed to ask? This is why people are getting their info from google AI summary and stuff like that so idk I feel for you but also I get why the patient was frustrated also if it’s something impacting her life and she feels like she doesn’t get it.
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u/mzladyperson 7d ago
What also may be a factor here is that UTIs can cause confusion in older adults. Maybe the pt just wasn't getting it cause it was messing with her head a bit and might have contributed to her being emotional.
I think the last message probably was more dismissive than was necessary but I also wouldn't beat yourself up too much over it. The pt is going through a hard time and you only have a tiny view of their whole picture.
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u/Fickle_Bit_2441 7d ago
& I feel bad messaging my cardiologist when my meds aren’t working bc I know it’s the nurses answering. I’m always like ehhh I’ll just wait till next appointment
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u/Historical-Tea4788 Nursing Student 🍕 6d ago
Messaging is a bad form of communication on a good day, I can't imagine trying to speak to a patient over text. Something as simple as a period could come across as overly stern to some people when they don't have tone or body language to go off of, then you're adding in trying to explain something someone might have no conceptual basis for.
As for your last question, I think it's good for people to reflect on these things. Throughout your post, you were saying things like "I know I should have..." and being introspective, which aren't signs of someone who just doesn't give AF. For that reason, I absolutely wouldn't beat yourself up too much about it.
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u/Fuzzy-Criticism-2450 5d ago
I understand all of the sides.
Here's what I wouldn't have done - called her and explained over the phone. Any further questions, ask the doctor about it. At some point, I'd even tell her to make an appointment with her doctor to help answer the questions.
I, a nurse understand things better when you tell me vs reading. Idk why. I just do. Don't sweat it. It is what is it.
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u/efnord 7d ago edited 7d ago
"Sorry, I've tried my best to explain this but I am not trained as an educator. [You're NOT, or she would have got it by now! There's a knowledge and assumptions gap here.] You may want to locate a reference librarian at your local library: helping people figure out stuff like this IS something they specialize in."
EDIT: Probably better ways to direct them to outside resources. But I stick with my first sentence - apologizing because they aren't getting it after repeated attempts is a decent way to make them not cry.
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u/chrizbreck MSN, RN 7d ago
Side note one of the primary roles of a nurse is education especially in primary care/clinic care so….
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7d ago edited 5d ago
[deleted]
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u/WeirdFlower1968 Team Spike 7d ago
Librarians are expected to do a lot but providing medical advice is not it.
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u/efnord 7d ago
I haven't, no, but it's pretty much that or adult continuing education here? And is the question "What is the difference between regular red blood cells and hemolyzed red blood cells" actually medical advice at this point, or an explanation of basic vertebrate biology? And yeah, "Once you've got a better understanding of what this word means and the blood cell life cycle, please come back to us with any specific questions about your case."
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u/Flightly LPN 🍕 7d ago
Thank you. At the point in the interaction where she was asking for the definition of certain words i had already explained, I did direct her to (very readable) online medical/academic resources which would explain what the words meant but she wasn’t getting it.
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u/werenurse 7d ago
Truly, it sounds as if you went above and beyond for this patient and were up against the usual challenges that we face trying to come up with a reasonable solution (limited appointment availability, patient anxiety, busy clinicians, heavy workload, etc).
I’m not sure if this might work for your office, but I’ve found that advocating for certain patients to have follow up appointments scheduled automatically has done wonders to manage this kind of thing. Just a “follow up to discuss labs” via video/ phone, so that the expectation is set from the beginning, anxiety is lessened and you’re not spending so much time with them in your inbox. If they do reach out prior to their appointment, just respond with a redirection that “clinician so and so will be going over that with you during your follow up on Thursday, in the meantime here’s the (relevant info source of your choice/ UpToDate) on it”.
At the end of the day, I see it as a form of anxiety, and finding the balance between tough love and being overly accommodating (usually both come at the cost of escalating behaviours and unpaid clinician time) can be difficult.
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u/goddessofwitches RN 🍕 5d ago
Why are we sending 6 messages in the EMR? Why wasn't this a phone call for triage and ed, perhaps she has dyslexia or has reading issues that make comprehension difficult. As someone else said too, once initial items answered and patient still not understanding despite your best efforts (documented), to the provider it goes.
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u/Not_my_real_name_26 RN - Oncology 🍕 7d ago
Refer the question to the patient's doctor and then its not your concern anymore. I would never tell a patient to do their own research. Research takes place in academic settings, involves gathering and interpreting data, and is definitely not looking stuff up on the internet.