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The first step is to take a deep breath and calm yourself - you are the professional here and need to act and respond like one regardless of how much you want to simply call the patient a doofus.

Second, ask the patient for his understanding of what post-operative care he needed to perform. In many cases, patients simply don't understand what they were supposed to do after being released from surgery and make mistakes because of this lack of knowledge. What is very obvious to a nurse or doctor may not be obvious to the patient, who has much less medical knowledge. If the patient is being very abrasive, you may have to work at choking back the retorts and biting comments about "not doing what you were supposed to do" - playing the blame game at this point will fix nothing.

Third, in simple, a-fifth-grader-would-understand terms, go over what has happened between the end of surgery and the development of problems. You should use statements like, the skin was cut during surgery and when water got onto the cut skin the water went into the skin and allowed an infection to start. Brace yourself, since you're probably about to hear a whole new tirade about "why didn't you people tell me this earlier". Choke back the response that you did, several times, and wrote it all down for him on that piece of paper he threw in the trash. Blame is not going to help anyone at this point.

Fourth, explain in the same simple terms what needs to happen now. Does the patient need surgery again to remove the surgical site infection? Does the patient need a new antibiotic prescription? Will the patient be off work longer than expected? Brace yourself, because this will be a brand new tirade of "you people just want to see me hurting". Make sure the patient really understands - get him to explain back to you what he needs to do this time to help prevent a third round of problems.

Lastly, if at all possible, after the patient is on his way, take a five minute break and tell yourself that you have been through the trial by fire and have the patience of a saint. Get a cup of coffee, tea, water, whatever beverage soothes you (non-alcoholic, unless you are done with your shift and don't have to drive). Let the bitterness and frustration flow out of you, and see if your next patient will be more pleasant to work with.

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Q: What is the best way for a health care worker to deal with a patient who has not following the instructions given about postoperative care and who then complains about the negative consequences?
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