I watched a man recently telling the story of how he’d been “fired” by his cardiologist. All he had done to deserve this, he explained, was to use the f-word during a confrontation with the office receptionist. He complained that he’d been subsequently fired after this receptionist reported his outburst to her boss. He specifically blamed the terms of a recently implemented anti-bullying policy at the medical facility. Because of this stupid receptionist and this anti-bullying policy, he was now stuck in the unenviable state of being without a cardiologist.
No. No. And NO! It was his own decision to behave badly that accomplished that result for him. Not surprisingly, physicians, nurses, and other healthcare staff are fed up with bullies like That Guy, who act as if being a patient means you get a free pass to be a jerk.
It does not mean that at all – and I don’t care how sick you are.
But don’t sick people often say or do unpleasant things that we wouldn’t normally say or do if we were healthy?
Aren’t we more cranky simply because we’re ill, exhausted, in pain, frustrated, afraid or overwhelmed?
Sometimes, we may also feel dismissed or ignored by healthcare providers, and that can make us sound desperate, even hostile. Physician Dr. Lori Hein of North Carolina, interviewed for a Wall Street Journal article on patients who get fired (February 8, 2010), acknowledged that sometimes, patients may believe they “have to throw a fit to have somebody pay attention to them.”
So being ill can bring out the worst, not the best, in us. And sometimes, we feel so bad that we lash out at those around us – yes, even those we need most.
I’ve written about how awful it can feel for people who worry about being unfairly perceived as a “difficult patient“ – not because they are being rude, but often simply because they ask questions or request a second opinion or remind a health care provider to “please wash your hands.” But the reality is also this:
There are indeed some truly difficult patients out there who apparently don’t give a flying fig if the way they behave hurts other people.
My own hunch is that if you’re self-aware enough to worry that your actions might be construed as “difficult”, you’re probably not being difficult. But if you haven’t ever even asked yourself if dropping the f-bomb at your doctor’s reception desk is enough to justify that “difficult” label – well, have a wee talk with yourself.
Perhaps some patients were already ornery long before they became patients. Perhaps they’re being even more ornery now that they’re suffering, a fate which they may believe somehow entitles them to make others suffer, too.
That Guy who was fired by his cardiologist? I believe that he likely IS suffering. He may also be depressed because of the reality of his own prognosis – and that may be why he thinks it’s acceptable to “mouth off” (his words, not mine) to members of his medical team.
But here’s the plain truth, in case it’s not clearly obvious yet:
Just because you feel sick does not mean you get to act like a jerk.
Don’t get me wrong. In a free society, you can choose to behave in an anti-social fashion if you absolutely insist on doing so. Just don’t whine afterwards about the unpleasant consequences of making that choice.
Disrespectful behaviour goes both ways, unfortunately.
Regular readers will know that I’ve written a lot about patients being treated disrespectfully by health care professionals (here, here and here, for example). I am no friend of doctors, nurses or any others who mistreat patients. But losing your temper rarely if ever helps to improve your physician’s communication skills, to restore courtesy, or to motivate others to be kinder to future patients.
“Mouthing off” to your healthcare providers simply chips away at the peeling veneer of civility throughout our society, while making both you and your targets miserable.
Compassion for others goes both ways, too. Why would we expect the entire healthcare profession to be eternally respectful to all patients if we believe that patients should be able to get away with blowing up whenever a clinic receptionist tells us something we don’t want to hear?
We can take a page here from the late U.K. physician Dr. Kate Granger, who was appalled by the disrespectful way she was being treated as a hospital patient. The doctor who broke bad news to her about her rare cancer, for example, did not introduce himself to her and did not even make eye contact when he announced “Your cancer has spread” – before abruptly turning his back on her and walking quickly away.
Now, Dr. Kate might have felt justifiably furious at such truly awful treatment, but she didn’t choose to lash out at that witless doc. Instead, she launched what would soon become a global movement called Hello My Name Is to remind all healthcare providers to be more polite by introducing themselves to every new patient. And as she wrote to me in response to the Heart Sisters post I called “The Lost Art of Common Courtesy in Medicine”:
” I believe it is more than a simple common courtesy; I think it is the beginning of a therapeutic relationship, building trust and a human connection in which you as the patient feel comfortable to share your fears and anxieties or to let intimidating examinations happen.”
There’s a far smarter reason to follow the example set by Dr. Kate instead of That Guy, which is this: acting like a jerk makes it harder to get your needs met.
It may feel perversely satisfying in the moment to be “mouthing off” to other people. But as a strategy for enlisting support, it’s a misguided plan that’s doomed to fail. And anybody who deliberately chooses to target the person least likely to be the actual decision-maker in any healthcare dispute is indeed a bully, and deserves to be called out.
I’m also guessing that, human nature being what it is, rudeness likely guarantees that it will take a whole lot longer to get whatever it is you want. As TV’s Dr. Phil McGraw likes to ask his guests about their own poor behaviour decisions:
“How’s that working for you so far?”
In the local hospital where I worked for many years, there are now posters displayed in every public waiting room with this warning for patients, family members and visitors who interact with hospital staff:
“Violence, foul language and abusive behaviours are not acceptable. Verbal threats or acts of violence will not be tolerated and may result in removal from this facility and/or prosecution.”
How would you like to go to work every day in an environment where warning signs like these to protect front-line employees are even necessary? The very fact that such signs are now posted tells us that verbal threats, acts of violence, foul language and abusive behaviours must already be happening at rates that hospital employees are simply no longer willing to tolerate.
Is it open season on health care staff? What the hell is going on here?
In online patient support groups, we see jerk-like behaviour in the form of patient trolls. After certain site visitors become novices, they may not necessarily become active members. They can also become trolls, described as group members with a high level of activity for a short period of time who are mainly interested in disturbing the community.
An example of this happened recently when a male heart patient decided to join the WomenHeart online community, as I wrote about in this 3-part series of articles about online patient support groups. After posting a number of offensive and provocative comments in response to a lively WomenHeart discussion about Mayo Clinic’s Dr. Mary O’Connor and her recent essay on gender imbalance in women’s health care called “The Woman Patient: Is Her Voice Heard?“, the male heart patient in question posted this gem:
“I am sick of hearing the down trodden women were (sic) heart problems are concerned.”
Clearly, this man (who, let’s remember, had intruded into a women’s online group discussing women’s heart health) was not remotely interested in Dr. O’Connor, in participating in the already-active group discussion of her article’s specific points, or in learning how to spell.
He was, in fact, your textbook flaming troll.
I jumped in to reply to his rude comments (including his accusation that our opinions on gender imbalance in women’s health care were simply “propaganda”). I suggested that he was clearly out of line, and that if he truly believed what he’s posting online (sick of all those downtrodden women with heart problems), he should leave our group, because each one of us, over 22,000 female members with heart problems, was very likely to make him sick.
On the following morning, the Inspire administrator behind the WomenHeart support group sent me an email advising me that, because I’d asked the troll to leave our group, my response to him had been deleted from the site; my reply was deemed “inappropriate and detrimental to the group.”
My first reaction:
“Wow . . . The trolls are winning.”
This online community is moderated, meaning that an administrator or team of people is working behind the scenes to ensure a consistent environment, ostensibly checking that destructive behaviours such as those of our troll are filtered out.
In this case, however, the admin team had deemed that I was the one who had violated the site guideline: “Don’t tell other members to leave!” which begs the question: But don’t trolls deserve to be kicked out? (There was, however, a happy ending to the troll’s jerk behaviour).*
Patient advocate Trisha Torrey, author of the terrific book You Bet Your Life: Helping Patients Get The Most From The Healthcare System, explains why providing feedback by speaking up (NOT blowing up) should be your first step:
” The point to providing feedback should be to help improve the overall experience for all. That means that when we patients make an observation we want to share with our providers, it is important to be as objective as we can.
“Just complaining isn’t enough, and probably won’t work anyway. Of course, when we are upset, or feel as if we have not been treated well or fairly, it’s tough to be objective about the experience. Complaints come very easily.
“Therefore, objectivity is important, because presenting both positives and negatives to the right person will mean you have a better chance of bng heard. Patients who do nothing but complain will be labeled as chronic complainers, and office personnel who can actually make positive changes will stop listening. But patients who provide feedback in a more objective, constructive way will find they are taken far more seriously.”
In case you’re wondering if physicians are even allowed to fire their patients (anti-bullying policies or not), here’s the scoop: in Canada, the Canadian Medical Association has determined that patients can be dismissed by a physician for many reasons, including inappropriate or abusive behaviour (e.g. foul language, rudeness, argumentativeness). Doctors here can dismiss patients at their discretion by following explicit guidelines, explains Dr. Jeff Blackmer, the executive director of the CMA’s Office of Ethics – although Dr. Blackmer prefers to politely call it a ‘discontinuation of a doctor-patient relationship’ rather than firing.
These guidelines are especially applicable when abuse is aimed at front desk staff or other patients in the practice.
The same can be true for those who exhibit drug-seeking behaviours, or habitually miss their appointments. In my (now former) GP’s office, a sign on every exam room wall warned that missing a scheduled appointment more than once would “result in being advised to seek your medical care elsewhere”.
In the U.S., patients can also be advised to seek care elsewhere for not paying their bills.
In most developed countries, doctors are prohibited from firing patients for discriminatory reasons based on a patient’s gender, race, religion, disability, national origin, or sexual preference. Nor can they fire a patient during a critical stage in ongoing treatment (e.g. third trimester of pregnancy, mid-course of cancer therapy, etc.) unless appropriate alternative care is arranged.
Conversely, patients can fire their doctors for any old reason.
Patients are free to terminate their physician relationships at any time, with or without notice, and they can then go on to broadcast the details of such termination to the world by trashing the physician or staff person involved on online Rate Your MD sites. We embrace an exquisite double standard when it comes to firing, it seems.
If your physician ever feels the need to drop the f-word into an angry public attack upon you, I’m betting that you would stand up, walk out of the room, and fire that doc’s sorry ass.
And that is why That Guy’s cardiologist fired him, too.
Please. Don’t be That Guy…
Q: If you were That Guy’s physician, would you have fired him, or given him a second chance?
NOTE FROM CAROLYN: I wrote more about being (and avoiding becoming) a difficult patient in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use the JHUPress code HTWN to save 30% off the list price).