How to I advocate for myself when getting blood draws?

June 21, 2017 4:56 AM

I'm what they call a "hard stick," and I've read the previous questions with tips for blood draws. I always drink tons of water, for instance. But there's a problem in getting the blood-drawing folks to take me seriously when I tell them I'm a hard stick. How can I be a kind, polite person, but still advocate for myself?

After 45 minutes and multiple pokes yesterday, I left without getting my blood drawn and my arm still hurts this morning from all the digging around, so I'm in a bad mood about this whole thing. I've had a phlebotomist tell me that lots of people claim to be hard sticks, but they aren't, so that may be part of the problem. I've twice had phlebotomists get sarcastic with me (though they both easily and quickly got blood from me, so I'll take the sarcasm). In the ER, I've asked them to use the ultrasound. Sometimes they do. Sometimes they insist on trying first without it (and failing, then getting the ultrasound equipment). I ask them to please start with their vein ninja, but they want to try anyway - then bring in the vein ninja. All of this was a pain before I had cancer (now in remission), but now I need a lot more blood draws, and that makes it all worse (after this next draw, I'm be at one every three months, so no, I'm not getting a port).
I recognize that it's super hard to get blood from me, and I know that nobody wants to cause me pain, but I feel that I'm frequently not taken seriously until they actually try and find out how hard it is (though again, there are phlebotomists who really do seem to have no trouble at all - one told me she had worked in a nursing home, and another had worked in a neonatal unit). I don't want to be obnoxious or make anyone mad at me. Is there a better way to handle this? When my arm stops hurting from yesterday, I'll need to go in again. What can I do differently? What can I say? I always try to be very friendly and polite throughout the whole process.

(In case you're thinking I might be at fault because of the sarcasm, in one case, years ago, I asked the guy if he was really good at getting blood, and he said they were all incompetent. In the other, I just told the woman I was very difficult, and she said "Oh no - it's my first day" - she then told me she had twenty years of experience. She wasn't trying to be obnoxious, but that did ratchet up my anxiety.)

posted by FencingGal to Health & Fitness (30 answers total)

Response by poster: One more thing: in one case, I asked a phlebotomist at the cancer center if it would help if I wrote I was a hard stick on the little slip of paper I fill out when I come in, and she said no.
posted by FencingGal at 5:03 AM on June 21, 2017

I am sorry that they suck at not taking you seriously and "joking" with you and making this whole experience worse.

Is there any way to ask for a specific person by name to do your blood draws? My dad had to do this when he had every other weekly blood draws. Dad would rather wait for his favored guy to do it than just randomly get whomever was available. Can they make a notation in your chart? I would make a complaint and go to the charge nurse or whomever is next up the chain of command and explain that "Look, I am a hard stick, you can see that after the last time and the evidence of bruises and pain and no sample that I really need to see the one/two people who can successfully do this". Good luck!
posted by tipsyBumblebee at 5:25 AM on June 21, 2017 [7 favorites]

The trouble is, EVERYONE says they are hard to take blood from, even people with veins like drainpipes. So we end up just taking it as an expression of their anxiety around needles, at least until we've looked for ourselves (having said that, if they've looked and can't find anything they should get the US out rather than stabbing around blindly).

Since you have had cancer, tell people that you are difficult to bleed because of the chemo (it does wreck your veins). People are more likely to take you seriously from the start if you give a reason for your crap veins.

We also do remember who is hard to bleed, so if you can go to the same clinic for all of your blood tests you may find that helps. Make a note of the people who can bleed you, and ask for them. And point them towards your "best" veins.
posted by tinkletown at 5:32 AM on June 21, 2017 [14 favorites]

We had a similar communication situation around our cat. Everyone talks about how cantankerous their cat is, and most are exaggerating, but we're not — when friends who are good with animals have tried to gently pick him up or pet him like they would a normal "shy" "cantankerous" cat, he's bitten them immediately, without warning or hesitation, hard enough to draw blood.

So we've taken to acknowledging the usual exaggeration. "Most people talk about how cranky their cat is and it's fine, but with ours we really mean it. It doesn't matter if you're good with animals and normally don't have a problem — you still really, really don't want to touch this guy. Even we don't touch him unless he's in a great mood or we really have to."

I wonder if you could do something similar here. "Look, I know lots of people say they're a hard stick and it turns out they just want special treatment. But I've had really good competent phlebotomists try for an hour and give up. This happens to me regularly. I'm not anxious, I'm not looking for reassurance, I'm not new to this, I'm just trying to make the whole thing quicker for both of us — if you've got an ultrasound, you might want to get it now."
posted by nebulawindphone at 5:33 AM on June 21, 2017 [17 favorites]

Are you going to the same place? Do they have a client advocate or someone on their management staff that you could talk to about this? I feel like you need to go up the chain to have a talk about this and see if there is anything to be done. Talking about your past chemo experience is a good idea, too. And I'm so sorry. Not being taken seriously when we aren't feeling well is one of the worst things.
posted by amanda at 5:37 AM on June 21, 2017

Are you using the terminology "hard stick?" I wonder if that might be making them reflexively assume you're someone who has been googling too much and is coming up with professional/medical terminology that you don't understand. If that's the case, it might help to concretely describe what happened in your previous blood draws "they had to get out the vein ninja, they had to try five times and I was bruised for X days."

Maybe also try something to create at documentation of the difficult blood draws, such as calling in to the clinic with questions about how to care for the pain now (not sure if that would result in a note being written for your chart), or mentioning the bruising if possible when a doctor gives you a physical exam. Then it might become "real" in your medical record and be taken more seriously.
posted by sometamegazelle at 5:37 AM on June 21, 2017 [7 favorites]

Ugh, my sympathies. I'm a difficult blood draw too, and although I'm reasonably cheerful about letting people just take a whack at my arms and hands until they find something, if I had to do it on a regular basis I'd be significantly less sanguine about feeling like a badly bruised pincushion.

I wonder if next time, you might start with specifically saying "I was here last week and they tried for 45 minutes but couldn't get a vein, so please pull out any tricks you have this time." I also wonder if you might ask after the blood draw, "now that you've seen for yourself what my veins are like, is there something I could have said at the beginning that would have helped to make that clear, so I can make things easier on both of us next time?" Maybe there's some specific terminology or phrasing you can use that the phlebotomist can clue you in to for future draws.

I'm sorry, this sucks and it sucks that you're not taken seriously. You're not being obnoxious at all, your wishes seem very reasonable here.
posted by Stacey at 5:53 AM on June 21, 2017 [17 favorites]

Explain once, then stop explaining.

"I'm a hard stick. The last time I [was here | got blood drawn], it took 45 minutes and I was badly bruised and they didn't even get the blood. Get the ultrasound."
"Oh, you'll be fine, here, let me--"
"Get the ultrasound."
"I'm sure that I can--"
"Get the ultrasound."

Use the same (lack of) inflection each time. Don't get angrier, don't get louder, don't get quieter. Be a robot. Look at them flatly and keep looking at them.

"Get the ultrasound."
posted by Etrigan at 6:06 AM on June 21, 2017 [21 favorites]

Wherever you went yesterday and got too many attempts, no success, and were left in pain - that's not acceptable, and certainly not when you warned them. Call the clinic, speak to the clinic manager and ask how you can make a complaint. And ask them what you can do to get your medical needs taken care of the next time.

Apparently, in many states, there is little to no licensing. So when you make an appointment or go to a clinic, tell them you will need a very experienced phlebotomist. Explain that you've been told repeatedly that you have difficult veins and now they are worse due to chemotherapy. Ask if they have a patient's bill of rights. Then at the appointment verify that the person who's going to draw your blood is a trained phlebotomist and how many years they have been in practice. If the answer is not satisfactory, ask for a supervisor and refer to their patient bill of rights. Not all health care providers have a bill of rights; you might want to choose accordingly.

If you have success with a phlebotomist, ask for their name, write an email saying they did a good job and ask for them next time. Obviously, you'll be extremely courteous to the staff you meet. You are asking for good medical care; that makes you smart, not a problem.
posted by theora55 at 6:11 AM on June 21, 2017 [23 favorites]

I am a hard stick as well.

The only thing that works for me is doing what Etrigan suggests and not caring about being nice. I usually let them try once and if they can't find it with one try I make them stop.

Don't worry about being nice. The last time I was nice about it was the time I ended up black and blue for weeks from my wrist to my elbow because they had three different people rooting around in my arm. Being nice is for people with good veins. Don't be rude, of course, but being firm about advocating for yourself is not being rude.
posted by winna at 6:19 AM on June 21, 2017 [11 favorites]

Do you know where you can get a good stick? If you tell them where to go other than your arm, it might make the process easier.

I figured out very early that my veins in my arms where people typically do blood draws are too deep and too small to be usable. My mom has the same deal. So I just started telling the phlebotomis to go in my hand or wrist, where I know there are veins. Occasionally they warm me it's going to hurt more, but I tell them it's fine and I'm used to it. I sometimes make a hole about the one wrist vein that's great for IVs, or the vein on the back of my hand that has taken me through all the pokes for the last decade (which has been a lot).
posted by kendrak at 6:27 AM on June 21, 2017 [4 favorites]

I have tiny veins and I've had some success with being specific -so I say something along the lines of 'Sorry it might be tricky, I have small veins. Some nurses have used butterfly needles in the past and it's been the most pleasant for me.'

So if you know what makes you a hard stick - rolling veins, delicate veins, etc - you could try mentioning that first thing so they see you really do know what you're talking about. It might also be a good idea to emphasize just how often you've had to have blood drawn lately.

Finally, I'm sorry you're having to deal with this. It is awful being poked and jabbed, especially when you're also not being listened to.
posted by brambory at 6:34 AM on June 21, 2017 [2 favorites]

Since you have had cancer, tell people that you are difficult to bleed because of the chemo (it does wreck your veins). People are more likely to take you seriously from the start if you give a reason for your crap veins.

As a fellow cancer survivor, I came into recommend something similar. In my experience mentioning cancer freaks people out - even non-oncology medical professionals - enough that they'll pay attention to you. Saying you've been through cancer treatment also makes it more obvious that you've had quite a lot of procedures and blood draws in the past and do indeed know what you're talking about. Play the cancer card! Sometimes (a very few, rare times) it comes in handy.
posted by something something at 6:36 AM on June 21, 2017 [4 favorites]

Would taking pictures of the bruises and taking them in with you be any benefit at all?
posted by bowmaniac at 6:41 AM on June 21, 2017

Nthing telling them specifically what makes you a hard stick. For example, I've had good luck telling phlebotomists that I have "deep/hard to find veins" and suggesting which arm is better.
posted by jazzbaby at 6:45 AM on June 21, 2017

Describe what has happened to you on previous draws. Let them draw conclusions about what that means.
posted by empath at 7:10 AM on June 21, 2017 [1 favorite]

Great advice here. As a fellow hard stick, I agree with all of these suggestions, but particularly going to the same place every time. They're more likely to (a) take your concerns seriously; and (b) remember where your best spots are.
posted by DrAstroZoom at 7:20 AM on June 21, 2017

One of the problems with robotically demanding the ultrasound is that some clinics literally don't have one. The prices have come down a lot over the years but they are still quite expensive and I've worked in plenty of places that had phlebotomy but not ultrasound.

I agree that you should play the cancer card. I would also seriously recommend complaining at the clinic where you were sent home -- simply sending someone away with no plan other than "make them someone else's problem when they come back" is really not OK (on top of 45 minutes of digging, which is terrible although sometimes necessary or at least well intentioned).
posted by telegraph at 7:41 AM on June 21, 2017 [1 favorite]

I have a hard time getting blood drawn as well. I usually point them to the location of the vein that is most likely to work, because it's not where they expect it to be. It sounds more like a heads up than a warning, if that makes sense. That way they are less likely to get anxious about not getting it. I joke that I'm screwed if that vein blows, because it's the only one that is reliable. If at first they don't succeed, THEN I say that I'm not surprised, that this is typical, and that I usually need acute measures to get a stick and not to take it personally. I say that sometimes it works to warm up the vein, and that I promise I hydrated as much as possible.
posted by Stewriffic at 8:34 AM on June 21, 2017

Another tack: can you have your blood drawn at the local children's hospital or at a cancer center/infusion center where they are used to difficult sticks?
posted by pecanpies at 9:19 AM on June 21, 2017

Response by poster: Thanks for all the great advice. A few things.

Yes, they've tried my hands. It's painful and doesn't work. I don't let them do it anymore.

I've had a lot of blood draws at the cancer center, and I find that they're no better than anywhere else. And someone there will do a great job and then not ever be there when I go because they have so many phlebotomists. Plus you can't play the cancer card there because everyone has cancer. :)

The place I went to yesterday only had two people there - there is someone who works there who is really excellent, so I might call to see if she'll be there next time I go in. I am also thinking of going to the main hospital, where there will be more people on staff.
posted by FencingGal at 9:42 AM on June 21, 2017 [2 favorites]

My advice (after undergoing a lot of medical stuff in a single-payer environment and watching a friend go through cancer in same):

- Prepare the staff. Call in advance of your visit (20 minutes) and ask to speak to the floor/area/dept supervisor. Explain to them calmly that you are anxious as you have had problems with veins and do not want to go through so much pain this time around. Ask if they can accommodate you with their top vein person.

- Don't be afraid to be the squeaky wheel - you want to get a reputation of having hard veins and needing extra support. Calmly and patiently advocate for yourself at every opportunity. If you get emotional, step back, give yourself a minute and if possible have a friend or loved one continue the conversation calmly on your behalf.

- Come early and announce that you spoke to "___" (floor supervisor) about your vein issues. Ask to speak to them in person. If they aren't available, patiently explain to anyone who works on you exactly the call you had. They will have noted it.

- Once you find a staff member who can do it easily/properly, ask for them by name every time. Make it clear to the person attempting that the only person who has had success is "____".

- Tell the first person who sees you clearly that you will only tolerate a certain amount of attempts or length of time before you will ask for them to use special equipment or get someone who can handle your tricky veins.

For whatever reason, it really gets medical staff's hackles up when you use in-hospital lingo ("hard stick" "vein ninja" etc). I assume it's a sort of hard wired red flag for the many people who are attention-seeking/drug seeking/"problem" patients. This sucks as you genuinely have an illness, but so do lots of people.

Medical staff don't want to be told they can't do something, or that they are not competent or the patient knows better. They also don't see anything as "emergency" up to and sometimes including the point that you're not breathing or are actively spurting blood. They often see some discomfort as inevitable. Patients are always telling them with full confidence the exact wrong thing, down to what medications they need. Patients' word are not taken as gospel but once supervisor or chart tells them so, it becomes rock solid fact.

In your case this is a recurring problem, hence the "barking it up the chain" you're going to do to make it clear that you've been used as a human pin cushion many times and you are not able to tolerate it any longer.
posted by SassHat at 10:02 AM on June 21, 2017

Don't sit still for 45 minutes of digging! You are the boss of your body! You can get up and walk out and tell them you'll be back another day *before* they have mangled you!

They often want to go in my elbow and don't believe that a particular vein in hand works really well for me. I tell them, you can have one stick in my elbow—and no digging—but if that doesn't work then you have to go to my hand. That's worked. Sometimes they get it in my elbow, sometimes they take their one stick and go to my hand, sometimes that look at the veins there and go straight to the hand. All three of these outcomes are okay for me. I also have a (so far, mental) three-sticks rule, that after 3 I'm going to get up and walk out and try again another day. It helps my anxiety to know that I have a plan.
posted by BrashTech at 10:45 AM on June 21, 2017

I empathize with your problem. I have been through this many times. I can only use one arm for blood draws, so the trying to get a draw is more limited. I typically say, "my veins are difficult to get, they roll easily. Please use a butterfly on my hand or wrist". If they hesitate, I will reply that they can try once and then use the my suggestions. So far, it has worked.
I think/hope/imagine that if you told them that the joking makes it worse for you, they'd be more aware of how they talk with patients.
posted by jennstra at 10:46 AM on June 21, 2017 [1 favorite]

I know you've tried your hands, but when you find a place that does work, remember that and offer it first. My arm veins are tiny and deep, but the backs of my hands always work. So now, I just stick my hand out and tell them to start there, to kinda head them off at the pass. I've had some try to object and say it'll hurt, but I always insist. It saves so much time and digging and stress.
posted by jhope71 at 12:04 PM on June 21, 2017

Butterfly needles save my arms in every possible way.
posted by Hermione Granger at 2:21 PM on June 21, 2017 [1 favorite]

People have been giving you a lot of good advice (butterfly needles, yes!). I was sometimes a hard stick as a kid and maaaaaaaaaaaaaaaaaaaaaan, I do not envy the the phlebotomists who had to had to dig around in my little arms. I remember the tech, my mom and I were all fighting tears on one occasion.

The broken record/squeaky wheel advice is really solid. You'll feel like you're being rude, but explain yourself and don't back down. Also, it can be helpful to be more confident before you're in the chair. If you can, have the conversation where you are both standing, rather than with you somewhat hampered by sitting, disarrayed clothing, etc.
posted by annaramma at 3:49 PM on June 21, 2017

I have Type 1 diabetes and with both of my pregnancies had blood draws twice a month for that. Plus 24 years of blood draws every three months for just regular maintenance of it. I always explain that I have been told I have small wiggly veins and the best success is with this ONE spot and a butterfly needle. I kind of act clueless, if you know what I mean. Sometimes I tell them about the time someone jammed a needle in my arm and hit a nerve. I couldn't straighten my right arm for months. So I go in with good natured anecdotes trying to help THEM have an easier time. If I were you I would tell this 45 minute failure horror story every time for years to come. And let them see how scared/anxious you are. I wouldn't go for the tough patient routine, just not my personality right now. And yes a max of two tries and then I am out of there or they bring someone else in IF I agree to it. Go where there are the most people available to help you and complain if it is bad. I wish you the best of luck.
posted by ChristineSings at 7:08 PM on June 21, 2017

I have always been squeamish when it comes to having my blood drawn, so I have a protocol that I sort of force onto anyone who draws my blood lol. I also have 'tiny veins' according to people who have drawn my blood in the past

#1 I emphasize immediately that it is a must that I am laying down when they take my blood, otherwise they'll have to deal with me passing out on them. This gets their attention and they listen carefully to me from that moment on (who wants to deal with a grown woman falling down and going boom in their care)

#2 I tell them they must use a pediatric needle

#3 They must use my left arm, this is where the 'good veins' are

#4 I always go in well hydrated and bring some orange juice or some other juice to drink immediately afterward so I don't pass out

#5 I always sit for a little while afterward until I know I'm good

This usually prevents any digging or endless jabs. Also I've had terrible and wonderful phlebotomists, it really depends on their skill level
posted by Avosunspin at 9:59 AM on June 22, 2017

In addition to commenting that they always end up using the back of my hand, so I'd like to start there, when I was having a lot of blood drawn on a regular basis I would go in and say, "Whoever the person is that you go get when you've been trying for awhile and not getting the vein, please go get that person now."

I also pay attention to their behavior when they're looking for a vein. You can tell if they feel confident (quick feel, "There it is!") and when they're not so sure (fiddling around for a long time, poking a lot of different places with their finger). I say, "Unless you are 100% sure you've found a vein, I want you to use the back of my hand." Sometimes they argue that the back of the hand is more painful. I say, "It's much less painful then having someone miss the vein and go on a digging expedition."

If they're super-pushy, or declare that they are the BEST PHLEBOTOMIST EVER, I say "You may try once. If you don't hit the vein, no digging, just pull it right out and use my hand." If they start digging, I tell them to stop. If I'm not in the mood for that even, I say, "Let's just use the back of my hand."

Once I find a good phlebotomist, I learn their name. It is possible to call the lab and ask if so-and-so is working today. And then when they call your number, to say, "I'll wait until so-and-so can help me."

It really takes a little bit of deciding that your comfort and pain level are more important than being polite. Which is hard for a lot of us, including me. But at one point in my life I was getting weekly blood draws and it helped me really firm up my resolve for it not to be a torture session.

I rarely bother to say, "I'm a tough stick." Because that's subjective, they can argue, they can dismiss it, they can declare that I will not be a tough stick for them. Saying, "We usually end up in my hand, so let's just start there to save time and needle sticks," seems to work a lot better. It's a factual description, and not a challenge to their prowess or something. Since I dropped, "I'm a tough stick," I don't think I've had a single phlebotomist demur.

I did not even know about the use of ultrasound. That could be helpful someday so I'll keep it in mind.
posted by Orlop at 7:59 PM on June 22, 2017