Thursday, February 9, 2012

Against Medical Advise and common courtesy

As a health care provider I am very careful to be as kind and compassionate to patient's as I can. I feel a strong part of my responsibility is to deliver good care with compassion. I find I often, very often, do not receive the same treatment back from patients.

I've joked before about the all-too-common comments I get on a daily basis from patients about how much they "hate THE dentist." They are sometimes rude, short, or annoyed with my questioning. I understand that most of my patients are nervous or afraid when they come see me. I understand that most people don't think of their friendly neighborhood oral surgeon as friendly. I know I am the one who is there to "come at them" with sharp tools, "stab their gums to deaden their teeth," or "rip out their teeth from their faces." I'm not talking about this brand of impoliteness.

I am talking inappropriate, rude behavior that I would hope you wouldn't use with anyone, let alone the person who rolled out of their warm, comfy bed after a long day at 3 am to help fix your face (and your pain).  A sadly high proportion of patients are belligerent, yell, cuss, or refuse to cooperate (--not to mention sexual harassment or innuendo, which luckily is usually reserved to the geriatric male population). Sometimes they even threaten physical harm. I usually laugh or ignore the inappropriate behavior. I want to be understanding. I would be angry too if I was "sucker punched." I may even swear if I was told my jaw would be wired shut for 8 weeks. Maybe I've been afraid of being seen as rude, uncaring, or even of being sued. But I am getting tired of being treated horribly for trying to deliver medical care.

Today I was asked to speak to a patient who wanted to leave the hospital "AMA" (against medical advice). When I arrived he was yelling and cussing at everyone in the room and a family member on the phone. I tried to listen to his problem, give him some time to process, and figure out what the plan was. We were trying to get him to his surgery which was scheduled to happen at that time. He continued to yell and cuss until I finally, sternly, told him his behavior was inappropriate. Not only was it unfair to his nurses and to me, but to all of the children on the pediatric floor he was staying on. He continued to yell and tell me I was the one who was disrespectful, some "nurse who just comes in here" and disrespects him. At some point he even did some threatening body posturing in my direction--behind my back which I didn't see.

He calmed down, stopped yelling, and agreed to have the surgery after a male resident talked to him (of course, he had no qualms about yelling at the 7 women there before, but a man shows up and he is perfectly reasonable). Things ended up okay but it made me think about how to act in these situations. I have started telling patient's when their behaviors are inappropriate. I have asked them to stop swearing. To treat my staff with more respect. But it is still hard. I wonder what I would do if I were physically threatened by a patient. Would I be allowed to protect myself without worrying about some kind of negative consequences? Would I be brave enough to fight back? I have heard stories of nurses being attacked (or groped), why not me? Today was the first time the thought has even crossed my mind.

Ultimately, I am trying to help. I am trying to do my job. And a lot of the time anger, fear, annoyance, prejudice, etc gets in the way. In a big way. I don't see this happening in many other industries. Can you imagine cussing out your baker because they gave you a free sample but didn't pay for your parking? Or berating your barber for asking you to hold still after you came in (with your own free will) to get a haircut? Or tell your waiter you don't know if you can control yourself and not hit him if the coffee isn't hot enough? I didn't think so. But I didn't make up these scenarios (just changed the context).

(This isn't even mentioning the guy who called and hung up on me Saturday night for asking him questions about his problem. He called me! And he hung up on me! But according to him, I was the rude one.)


Rachel Culmer said...

WOW!! If I were a nurse on your staff I would appreciate you standing up for me. I hope the nurses appreciate you. Keep standing up for yourself Erin! No one should be treated like that--male or female.

Camber said...

Something about being in the hospital seems to bring out the worst in people. And sometimes it brings out the best in them. I've had to tell people they're being inappropriate, too, and sometimes just walk out of a room if someone is out of control. I think when people feel awful or vulnerable they take it out on people around them--even people trying to help them. I wouldn't be surprised if this man also treats other women in his life just as disrespectfully as he treated you and the nurses. Way to stick up for yourself, though!