As a physician you have to be sympathetic and understanding. You also have to be respectful to the patient. A lot has been written about doctors’ responsibilities as healthcare providers and about patient’s rights as healthcare consumers.

What about patient’s responsibilities? Do they have any?

What do you do when the patient is being openly disrespectful and unreasonable?
You are supposed to take the “high road”, yet how much abuse should you take?

My patient was admitted with severe respiratory failure and ended up on mechanical ventilation. Subsequently, the patient developed pneumothorax (air in the chest) and extensive SQ emphysema (air under the skin). Later, the respiratory status improved and mechanical ventilation was discontinued. The chest tube remained in place due to a persistent air-leak (air escaping through the chest tube).

The patient was upset about the fact that the chest tube was still in and there was a facial "change".

SQ emphysema may temporarily change facial features due to swelling and air under the skin. Once the air is resorbed (days to a couple of weeks) the facial features return to normal.

Now, what do you do if you are being yelled at for providing treatment that is appropriate in the situation, even though, it does not fit with the patient’s plans (going home in this case)?

I explained, once again, why the chest tube cannot come out now and, when the patient went on a yelling rampage again, so I left the room. Right or not, sometimes, you have to have some respect for yourself.