During the last week of a cardio placement on a medical ward one of my new patients was a man admitted with a non-infective exacerbation of COPD. He had been admitted to hospital repeatedly for this in the past 6 months with 4 admissions within the past 2 months. Schizophrenia bipolar disorder and a tendency to be aggressive and argumentative were included in his past medical history. He lived in a hostel, smoked 50 cigarettes a day and was non-compliant with his medication. During the subjective examination, the patient told me to F*%! Off as soon as I introduced myself. I did manage to get him to explain the correct use of medications to check his understanding of this (but was not game to do anything else with him) before he told me to F#@* off again.
I found the situation with this patient is very difficult because he had health issues which were significant enough to have him admitted to hospital repeatedly. The experience confirmed for me how important it is for health professionals from all disciplines to work as a team to care for patients because although this patient had problems relevant to physiotherapy, psychiatric and social problems needed to be addressed before any other issues could be dealt with effectively.
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I have also found that even though something is noted in PMH dont always assume how much of an impact it will have on the patient. I had a patient who had repeatedly documented aggressive behaviour but once i met him he was extremely frustrated with having had a stroke and was lovely. I realise this wasnt the case for your patient but just be aware not to prejudge what you think your patient will present like
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