Would it kill you to treat your patients with respect?

~ Carolyn Thomas

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’tseeneachotherinalongtime…. 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 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 have to lie there focused on how you are 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 WERE ALREADY DEAD.

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

How many of us have encountered health care providers who enter the room and do not bother to introduce themselves to us?  (For more on the importance of health care professionals introducing themselves to patients, visit #HelloMyNameIs, a U.K. campaign launched by physician-turned-terminal cancer patient Kate Granger).*  See also my “Top 10 Tips on How To Treat Your Patient” in An Open Letter to All Hospital Staff

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 essay(1) 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(2) 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

*  Dr. Kate Granger died on July 23, 2016. The physician who told her that her cancer had spread did not introduce himself, and did not make eye contact with her. She was so disturbed by his behaviour that she launched her #HelloMyNameIs campaign to encourage all health care staff to introduce themselves to their patients. RIP, Dr. Kate.

See also:

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

2. Joshua J. Fenton, MD, MPH; Anthony F. Jerant, MD; Klea D Bertakis, MD, MPH; Peter Franks, MD. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality” Arch Intern Med. Published online February 13, 2012. doi:10.1001/archinternmed.2011.1662

Published by Carolyn Thomas

21 thoughts on “Would it kill you to treat your patients with respect?”

  1. Brilliant. I had just the most awful dental treatment today (I was so baffled that I did not know what to say) and your article offered me solace. I will speak up next time.

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    1. YES! Never be afraid to speak up, Diana. Be polite but assertive. Women are socialized to be nice and pleasant and not rock the boat but YOU are the customer here. You have a right to expect and get quality care. I hope there won’t have to be a “next time”, but if there is, you’ll be better prepared…

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  2. A lot of simple courtesy would go a long way: I went to a new hygienist since my dentist retired after our 20+ year relationship. This new hygienist starts work, and during the first visit says to me “why are you even here”? I was stunned by such rudeness, and didn’t know what to say.

    For an older guy with a complete set of teeth, with 1 filling and 4 minor plastic hooks filled in– yes, I’m a rarity. Fast forward to another visit, and she was extremely rude to me again and complained the whole time with comments like my mouth is too small, I can’t see, I hope you never need a filling because “we” can’t do it.

    Well, for starters you’re treating me like crap, and my mouth was tightening up in anger, plus my other dentist, although my mouth was smaller due to some dental surgery years ago, fillings and other procedures were easily completed.

    Needless to say, this hygienist has been “fired”, and I’m going somewhere else now. Somewhere they appreciate my business– man oh man, what is happening to all these new narcissistic generations?

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    1. Hi Kevin – your experience just proves my point: you can train that hygienist for skills, but you can’t train for personality. There are dental professionals out there who are pleasant and nice – I hope you’ve found a replacement that’s one of those!

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  3. This post really hit home for me! The part where you asked how many of us have been laying flat on a gurney while hospital staff have had conversations over us made me want to raise my hand high and say “you have to hear this!”

    Once, I lay in a recovery room, alone and unable to move, listening to my nurses discussing the bargaining situation for the union and the possibility of an upcoming strike–maybe they thought it was okay to do so since they weren’t actually with me at the time, but at the nurse’s station about 5 feet away.

    The one that made me want to laugh and cry at the same time was the Sunday morning when I was being wheeled down for (another) CT scan —yes, I was so sick at the time that I was getting scans, X-rays, etc. on a SUNDAY–and the orderlies were having a nice flirtation over me. Looking back, I’m not really sure why it took two orderlies to wheel me down to radiology, but apparently it did… and the conversation took some interesting turns. But, the real corker was when they started to discuss the maple-bacon donuts you can get at the specialty donut shop in Portland. Really?? Remember me, the patient? You have no idea what’s wrong with me!!! Personally, the idea of a maple-bacon donut in the best of circumstances sounds unpleasant–but on that day, it made me want to hurl over one of them. Fortunately, I contained myself, as that might have ended any possibility of their happily ever after. 🙂

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    1. Such good examples of really clueless behaviour, Charlotte. It also reminded me that I react with the same annoyance to being utterly ignored if it’s two clerks at the grocery checkout chatting about their weekend plans right in front of me – but the difference of course is that I’m not lying, frightened and helpless, on a gurney when I line up to pay for groceries. (By the way, I’m guessing you have never visited the fabulous Voodoo Donuts in Portland….) But your point is well taken: it doesn’t matter WHAT the overhead chatting’s all about in hospital – the only chat going on should be focused on the PATIENT. Anything not patient-related belongs in breaktimes…

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  4. I have been seeing the same dental hygienist for a few years as she is in my dentist’s office. I have put up with her condescension because she does remember me and ask about family. Last time she asked if I would like the dentist to pop in and check my teeth for a minute, so I said yes. A minute it was. She said to him “She’s a mouth breather” – in the same tone that one might say she is a paedophile. And it was not true.

    And this brief minute cost $45, which she did not mention. Other niggles – too many to mention. I have not been back and wrote her a letter at the time (but I lost it). I must rewrite that letter as I really felt disrespected and invalidated.

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    1. This is in response to your article about etiquette in the dentist’s office. I went to a new one last week and the whole time the dental assistant talked to the dentist about what sandwiches she had for each night the previous week etc. Totally unable to make a rational comment. When she left to get something, I asked the dentist “can you shut her up?” We laughed. Quietly the dentist said when the assistant returned asking why we were laughing: “no”.

      In this case, I’m sure the dentist was as bored as I — and having to put up with it for day after day after day must be worse than looking into people’s rotten teeth. Nevertheless, it seems she didn’t dare deal with the assistant because of the bad feeling it would create, but also because the assistant was so brainless that she wouldn’t understand what the dentist is going on about.

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      1. Hi Barry – I’m not sure if “brainless” is the right word. More like socially inept or immature. I’m guessing that this dentist is her boss, and so the buck stops directly in the boss’s corner. She needs to be trained (by her boss) about what’s appropriate/inappropriate in polite professional conversations with clients (i.e. stop being so self-absorbed!) When a dentist (or any health care provider) starts getting requests from patients to “shut her up”, it’s time to grow a backbone and set some basic workplace ground rules. At least you spoke directly to the boss!

        I once went to a hairdresser like this (just once, and never again) who spent my entire haircut appointment talking over my head to her colleague nearby about her upcoming vacation plans. Unacceptable! My only regret was that I wish I’d spoken directly to the salon manager before I left that day… If we say nothing, we are essentially accepting unacceptable behaviour.

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    2. I just want you let you know that mouth breathing is actually is something that the dentist should know about! It actually can cause cavities and relates to the well being of your oral health, so when she told the dentist that you are a mouth breather it wasn’t to be rude, it was to inform him. (Just like someone who grinds their teeth, there are certain indicators that show that)
      I don’t know how she said it, tone wise but just thought I’d let you know it probably wasn’t meant in the way you thought it meant

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  5. 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.

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    2. Elle,

      You have the key to it all! As someone who has been in the hospital so many times, laying there in fear–it is the nurses and orderlies who act as compassionately as you that make all of the difference!

      I even remember asking a nurse to hold my hand as I was going through a procedure that was particularly scary to me… she was so surprised when I asked that she had to repeat the question to me before she realized what I wanted. It was interesting to see HER face change and soften as her focus shifted from the mechanics of taking care of me (monitoring the machines, the IV, etc.) to being a source of human kindness. I have several stories tucked in my memory of nurses who have reached out to me in frightening times, and may God bless all of them. Those of you in the profession who continue to find the humanity and connection with people in the worst times of their lives deserves all of life’s joy and blessings!

      But, sadly, for every one of those stories, I have about 3 or 4 nightmare stories of feeling “less than”–less than human, less than worthy, less than worth the time this is taking, less than the effort, less intelligent…

      And it is because that the ratio is so skewed towards unhappy and negative interactions or non-interactions, that so many of us chronic “frequent flyer” patients feel so left out.

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      1. Charlotte, that story of asking your nurse to hold your hand is such a compelling reminder that hospital staff themselves are often so busy and distracted with the important task at hand that they can act as if they have forgotten about the real live patient attached to all those monitors. You managed to offer that nurse a very important reminder, and luckily you got one that was open and willing to remember that for the rest of your scary procedure.

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  6. 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.

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    1. 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…

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  7. 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

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    1. 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.

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  8. 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.

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    1. 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.

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    2. You are so lucky, I have a lovely Dentist too. His Dental Assistant is a man; I was sitting in the chair as a first time appointment, haven’t been there before & I heard this tapping noise. I turned around at this guy, my Dentist said oh that’s my Dental Assistant Chris. Chris never smiled & never made eye contact. I said something to my friend & she said the same, except for he stares at her all the time or plays on the computer, & we are both ladies, lying in the chair OK, but what if the Dentist is out of the room. Oh well I guess I can still kick! Please reply, should I say something to my new Dentist or not!

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