Among the many ways that patients irritate me are two things that especially bother me. They are things that moderately functioning adults should not have a problem with. They tend to occur in late middle-aged male patients, especially at the VA, but I have noted this problem across the age and gender distribution. (Note that if these people had a psychotic or dementing illness I would understand their challenges, but these are people that at most have a substance issue; usually, no Axis I diagnosis at all.)
1) Patients who seem to have only one social contact in the whole world, a "buddy" (if female, usually phrased as her "sister, but not really my sister") - and they know that friend only by a nickname. Maddeningly, this friend is usually someone they've known for 10 or 20 years, seeing them almost every day, yet somehow in that time they haven't managed to learn their real name, phone number, or address. All social challenges would be solved by the impossible task of contacting this patient (getting the patient's prescriptions from home, getting a ride home from the hospital, etc.)
2) When during history-taking, the patient gives you a timeline of their life that is internally inconsistent, and they insist it's correct as presented and get upset when you question it. Example:
Me: Are you married?
Patient: Not anymore, but I was married twice.
Me: Okay, when was the first time you were married?
Patient: '87. For 8 years, then we separated and got divorced.
Me: Alright, when did you get married the second time.
Me: Well...if you were married for 8 years, that means you only got divorced in '95.
Patient: No, I got remarried in '93.
Me: That's fine, but then you couldn't have been married for 8 years. That's only 6 years in there.
Patient: No. I got married in '87, was married for 8 years, and then got remarried in 93.
Me: That's not possible. Either you were only married the first time for 6 years, or you were
married 8 years but didn't get remarried until at least '95, or you were married to two women at the same time.
Patient: No! Don't you put down that I was only married for 6 years. 8 years, married in 87, remarried in 93. And I ain't no two-timer. (At this point the patient nods and purses his lips as if he's satisfied for telling The Man what's what. I imagine him later bragging to his friend Jobbo about his proud exploits.)
That is all.
Anaphoric that considered harmful
59 minutes ago