scolded a patient

for the first time in my working life
while talking to a patient
i raised my voice so high that i stunned the whole ward
everyone turned around and looked at me
...i felt so guilty for doing so...

yesterday was the first day
a friend of mine who is going to be a clinical pharmacist at female ward
following me for ward round
she was trained at different hospital than mine

since there were 6 patients who need MDI counselling on that day
we decided to counsel 3 patients each
so that we can learn from each other regarding the counselling points

it counselling session started with me
i counselled an elderly, patient A
he seemed to understand yet he performed poorly
hence, we decided to counsel the patient next to him, patient B
with the intention to ask patient B to demonstrate the correct technique.

so, my friend counselled patient B
doctor ordered MDI Salbutamol 2p PRN
and MDI Berodual 2p TDS for him, a newly diagnosed COPD patient
who is a chronic smoker (daun)

here starts the story...

at first patient B was very cooperative
then after my friend done with the counselling
and asked him to demonstrate by taking 1p of MDI Salbutamol
as this is the SOP

patient B kept repeating the steps as told verbally
and refuse to take actual dose as directed
my friend tried to persuade him to do so, yet she failed
hence, i tried to persuade him as well
after trying a few times, i failed too

i asked him for the reason
and he said he only want to use the meds when required.
now he felt that he is well, so he don't want to use the MDI
he is worried that he addicted or need to rely on the MDI
i further explained to him that the MDI Berodual for maintenance therapy
is to keep the airway open.. yet, he refused..

after explaining to him and trying to persuade him for so many times,
i decided to try the hard way.. haha
i raised my voice so loud that everyone in the ward was stunned and stared at me
"PAK CIK UBAT INI (MDI Berodual) PERLU GUNA SETIAP HARI.. TAK KIRA PENAT ATAU TAK PENAT.. PAK CIK KENA GUNA JUGAK.. UNTUK ELAKKAN PAK CIK PENAT KERAP..YANG BIRU NI.. PAK CIK GUNA BILA PERLU JE.. PAK CIK PAHAM TAK? "
"faham.. tapi pak cik nak guna bila perlu sahaja.. bukan tak mau guna.."
"PAK CIK.. PAK CIK KENA PAHAM.. UBAT PUTIH NI UNTUK ELAKKAN PAK CIK JADI PENAT KERAP SANGGAT."
"faham.. bila pak cik penat sangat.. barulah pak cik guna pam ni.."
hmm.. hard way was not going to work anyway.. hence, i decreased my voice..
"ok.. kalau macam tu.. saya simpan balik yang putih ni.. pak cik guna yang biru ni je.."
"pak cik nak guna dua2 jugak bila pak cik rasa penat sangat.. sekarang tak penat.. pak cik tak mau guna dulu"
"tak boleh.. kalau macam tu saya habak kat doktor pak cik tak mau guna yg putih.. buat masa ni.. pak cik guna yang biru je noh.. lain kali kalau pak cik kerap masuk wad.. barulah kami bagi yg putih tu.. ok tak?"
"pak cik nak guna dua2 jugak.. bukan tak mau guna.."
"pak cik.. yang putih tu kena guna tiap2 hari.. kami bagi hak biru tu je buat masa ni.."
and this continued for a few more times..

i turned around and walked to my doctor
when i was about to explain to him what happened
he said "tak perlu cakap.. saya faham dah.. kalau pt tak mau.. tak payah bagi dah.."
and he off the MDI Berodual

after that i insisted that patient B need to demonstrate it
and he did so...
apparently lots of mist came out from his mouth and the inhaler
my friend and i further counselled him, yet he failed
hence, we decided to counsel him the next day..

the patient grandson witnessed the whole incidence..
i explained to him what happened and he just nodded

my friend said that she will be more fierce than me if she need to 'scold' a patient
she didn't think that i actually scolded him
just talked louder only..

anyway
moral of the story..
if soft way doesn't work
the hard way might not work too
figure out why before using the hard way...

there's no point crying over the split milk
i cut my hair that night
hoping that it will be a new beginning tomorrow

now, it's the high time to polish my counselling skill and of course EQ
might need a meditation class??

may all be well and happy always