Would it kill you to treat your patients with respect?

16 Mar

by Carolyn Thomas  @HeartSisters

Not since I was a teenager having my wisdom teeth surgically removed with the aid of that luscious nitrous oxide laughing gas have I floated home from a dental appointment feeling so exhilarated. Because yesterday, I took a personal stand against rudeness and disrespect in the delivery of my own health care.

Regular readers here will already know how surviving a heart attack (plus, I suspect, my advancing progress towards Cranky Old Lady Land) have made me increasingly ticked off by health care providers who:

  • treat us as if we are simply a piece of meat on a slab – and worse, an invisible piece of meat on a slab
  • forget that we are far more than just the 10 o’clock procedure in their daytimers
  • disregard the fact that there is an actual real live human being attached to the body part they happen to be working on

My recent mission in life seems to be to put the brakes on this kind of pervasively rude behaviour, one health care provider at a time.  

Back to my dental appointment:  the pleasant dental hygienist was well into our annual teeth cleaning appointment, using a fancy little instrument of torture called a Cavitron® scaler and air polisher.  With this, the patient endures the high-pitched scream of this cleaning tool while having icy cold water sprayed not only inside the mouth but also, sporadically, all over the face, while a vacuum suction wand attempts in vain to collect the icy cold water before it chokes said patient.

While dutifully scraping, spraying and suctioning, my hygienist was also engaged in a conversation with her co-worker in the next-door cubicle. She hollered a comment over the half-wall separating our cubbies, and her co-worker responded by yelling back.  Apparently, they wanted to chat about a recent dental meeting – while I was lying there being scraped, sprayed and suctioned.

“Was Joyce there?” one yelled. “No, but you know who WAS there?” called out the other. This was the level of their earth-shatteringly urgent collegial conversation going on over my head.

Now, I know I should be used to being ignored like this, and I honestly don’t know why this particular behaviour bothered me so much on this particular day.

But after a few minutes of listening to them while feeling increasingly annoyed, I raised my right hand in the air, forcing the hygienist to remove her fingers and the Cavitron® from my mouth.  I then looked up directly into her face, and I calmly asked her:

“Would you like to go finish your conversation with your friend in the other room? Because while you’re working on my procedure, I would prefer that you focused on me instead of on her.”

Her immediate reaction was defensive, explaining weusuallydon’tdothis butwehaven’tseeneachothersincethismeeting. While she rattled on like this with her rapid-fire defense, I was sorely tempted to again thrust my hand skyward (but this time, right upside her head). I honestly felt like interrupting her with:

“I DON’T WANT TO HEAR IT! I SIMPLY DON’T CARE! I HAVE HAD ENOUGH, AND I’M SICK AND TIRED OF PUTTING UP WITH RUDENESS!”

But before I had a chance to even go there, she suddenly stopped cold in mid-defense, took a deep breath, and quietly said these magical words to me:

“You’re absolutely right. I’m sorry about that.”

I felt like high-fiving her!

Being ignored, of course, doesn’t happen only in dental offices (although I have frequently observed that some dentists tend to carry on inane over-our-heads conversations with their dental assistants about what they watched on TV last night). Note to all dentists and their staff: if you’re going to act as if your patient is not even alive, at least offer us a set of headphones and our choice of interesting music so we won’t notice you ignoring us.

The same dismissive behaviour happens in retail checkout lines when the attention of the clerks on duty is intensely focused on their he-said-she-said gossip without pausing to acknowledge the existence of the living, breathing customers in front of them whose sole purpose seems to be to interrupt their important conversation.

And how many of us heart patients have been laid out flat, frightened and vulnerable on a hospital gurney while the staff who are purportedly taking care of us are talking over our bodies to each other?  They chat about the weather, about their kids, about their upcoming weekend plans AS IF WE DON’T EVEN EXIST.

How many of us have encountered health care providers who enter the room and do not bother to introduce themselves to us?

How many of us have had to undergo complex diagnostic procedures that the technologists did not bother to clearly explain to us in advance?

If we are very, very lucky, we might get a care provider who actually makes eye contact or even touches our shoulder reassuringly. Health care professionals like this can make a frightening or uncomfortable patient experience a little less so. If we are lucky.

And even though today’s procedure might be absolutely routine to those who are providing it, there is nothing routine about any clinical procedure when you are the one on the receiving end.

In Dr. Don Berwick‘s wonderful 2009 essay* called “What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist” in Health Affairs, he describes the lively debate that occurred on the Institutes of Medicine panel, defining what’s known as Patient-Centered Care.  He  adds these three parameters for patient centeredness:

  • The needs of the patient come first (a pervasive slogan at Mayo Clinic, where I saw this posted on virtually every wall).
  • Nothing about me without me (from Diane Plamping, a U.K. health care organizational sociologist)
  • Every patient is the only patient (sign at the entryway to the Harvard Community Health Plan Hospital in Boston)

Dr. Berwick warns his fellow doctors:

“Ask patients today what they dislike about health care, and they will mention distance, helplessness, discontinuity, a feeling of anonymity – too frequently properties of the fragmented institutions in which modern professionals work and train. (We need) a reconnection of the feelings of health care professionals with their work. Violence is done when that connection is sundered by institutional norms and training.

“Threats to the health of the professions come far more from denying our basic instincts to help than from embracing them. What undergirds authentic patient-centeredness are the very same words we use when we first came to the patient’s side: “How can I help you?”

When the medical journal Archives of Internal Medicine recently published a study** called “The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality”, many a physician cheered – particularly docs who are feeling alarmed by the growing popularity of the empowered patient movement, or by their own poor Rate Your Doctor scores online.

This study suggests that the higher patients rated their medical care, the worse their actual health outcomes. Patients who report being highly satisfied with their doctors, for example, may not always be getting the best care and, surprisingly, are about 26% more likely to die than people who feel less satisfied with their physicians.

I’m not aiming to address here the inherent problems of doctors feeling pressured to cave in to patients’ unreasonable demands for unnecessary tests or treatments (an action that many patients will rate as more satisfactory than if the doc had justifiably refused the test/treatment they want). I’ve previously written at length about this serious issue here, here and here.

As award-winning health journalist Naomi Freundlich wrote on Reforming Health:

“Patients have been pretty clear about what they consider a satisfying experience. They didn’t want to wait too long in the waiting room; they wanted doctors and nurses to treat them kindly and with respect; they wanted prompt symptom relief; and they didn’t want to be discharged too soon or before they felt their medical problems were fully addressed.

“Often, patients indicated on surveys that they were dissatisfied with care when they felt slighted or ignored.”

My hope is that every patient could feel comfortable simply raising one hand in the air - or, as patient advocate Trisha Torrey puts it - “channelling our inner Aretha Franklin” – in the face of being ignored by those who are supposed to be treating us with respect.

If we aren’t able or willing to do this, we are saying that the pervasive lack of common courtesy in health care is acceptable to us.

And we all know that it is not.

© 2012 Carolyn Thomas Heart Sisters

See also:

* Don Berwick, MD “What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist”, Health Affairs.  July/August 2009 vol. 28 no. 4 w555-w565

** Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D Bertakis, MD, MPH; Peter Franks, MD Arch Intern Med. Published online February 13, 2012. doi:10.1001/archinternmed.2011.1662

8 Responses to “Would it kill you to treat your patients with respect?”

  1. Elle M., RN January 27, 2013 at 8:37 pm #

    I have been in the health care field for 30 years; 23 of them as an Intensive Care Registered Nurse with lots of initials after my name that really impress no one ;)

    I may have that “old school” etiquette, as the newbies run around with training that seems to have focused more on data than humanity, but I am a firm believer in giving every patient, family member and medical team member my eye contact and attention early in the interaction.

    This is critically valuable in establishing the relationship.

    There are no words that can replace “I will be your nurse tonight. My name is Elle” (saying my name secondly rarely requires a repeat).

    You can literally see and feel some tension relax when the patient/client is assured of who you are and what your role is in the plan of care without them having to ask.

    And a gentle touch goes far beyond words.

    Like this

    • Carolyn Thomas January 28, 2013 at 6:42 am #

      Elle, thanks so much for your unique perspective. Wish more health care professionals took a page from your book.

      Like this

  2. Campykid March 19, 2012 at 7:31 pm #

    Right-on Heart Sister! I’m fortunate that my dentist and his assistants know me well and focus on my care while I’m in the chair (hey-that rhymes!). However, I’ve had some absolutely awful experiences with cardiologists.

    -While taking my history (the first one I’d ever had with a cardiologist), the Dr. interrupted, telling to be quiet and let him talk.
    -In preparation for a trans-esophageal echocardiogram, the same doc smirked and giggled when I gagged.
    -An electrophysiologist allowed a doc into the exam room to chat about another patient and then took a phone call from someone else.
    -The same electrophysiologist called to scream at me after I ended-up in the ER upon being overdosed on warfarin post-ablation.
    -After I told my primary care physician about the smirking, giggling cardiologist, the cardiologist cancelled a pre-procedure appointment at the last minute and then fired me at the rescheduled appointment. Hilariously, one of the things he said during his 20 minute rant was that I shouldn’t tell my friends how he’d disrespected me.

    Like this

    • Carolyn Thomas March 19, 2012 at 7:39 pm #

      Campy, the part that disturbs me about this list (more than the screaming, the smirking, the giggling) is: “…allowed a doc into the exam room to chat about another patient and then took a phone call from someone else.” A perfect example of the patient as merely an invisible piece of meat on a slab…

      Like this

  3. Mirjami March 18, 2012 at 3:37 am #

    Oh Carolyn! It is terrible to have such experiences.

    My dentist is an angel. He always asks me at first: How is your heart? Have you got new stents? He makes the hygienic procedure himself once a year in my case.

    But not all doctors and nurses are so nice.

    We have a cardiac center about 20 km of here, but I refuse to be brought there once again having had 9 days of rude and unfriendly nurses. As I had my heart attack because of a stent thrombosis 4 years ago, the ambulance came, wired me with EKG and wanted to bring me to this nearest cardiac care, because it is the usual practice. I cried: “I do not go to this hospital. They are so unfriendly and terrible. I prefer to die than go there.”

    The doctor in charge looked at me as if I were a fool. My hubby said them: If you do not bring my wife to the cardiac care she wants to go, you can took all the wires away and I bring her myself to the other hospital. The problem is that the the doctor has to order a helicopter to bring me to my favourite hospital, because it is over 100 km away from our village. This has been the case 3 times.. Till now we have always won. But it has always been a matter of dispute.

    Usually my hubby brings me to my cardiac hospital 100 km away from here, when my family doctor orders it. I have only to go to my family doctor and say that I have unstable angina. The cardiac hospital is one of the best in Germany and I am happy to be a patient there.

    In the case of a heart attack ( when I think it is one) we have to call the ER and this has always been a great dispute. I hope I will never bee alone at home and have to call ER.

    AT the moment I have no problems with my heart and I am very happy about it.

    Greetings.
    Mirjami

    Like this

    • Carolyn Thomas March 18, 2012 at 6:31 am #

      Hello Mirjami – I’m so glad your heart is doing well these days. Having to debate where the ambulance should take you must be horribly stressful in the middle of already stressful cardiac symptoms. Most patients just go where the nearest hospital is, despite the quality of care.
      Thanks for sharing your perspective here.
      C.

      Like this

  4. airedalelover March 17, 2012 at 7:02 am #

    Good for you.

    I had the opposite experience with my dentist and his hygienist. They are honestly interested in me, how I am coping with a bad cancer diagnosis and treatment. They are so careful not to cause any pain or discomfort unless necessary (even numb my gums before a novicaine shot or rub something on gums before cleaning). They see ME when I am there. I am more than grateful to them, they soothe my soul.

    Like this

    • Carolyn Thomas March 17, 2012 at 7:14 am #

      Your experience is just as it SHOULD be for all of us, isn’t it? Your dental staff are role models for other health care providers.

      Like this

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