Being sick doesn’t excuse being a jerk

7 Aug

by Carolyn Thomas    @HeartSisters

angry-mobI 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 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.

But don’t sick people often say or do unpleasant things that we wouldn’t normally say or do if only 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 hostile, even desperate. 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 they believe somehow allows 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 their providers (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 we patients can get away with blowing up when a clinic receptionist ticks us off?

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 turning his back on her and walking away.

Screen Shot 2016-07-26 at 9.06.26 PMNow, 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 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.

EARTH TO MEN: unless you are the spouse/caregiver of a woman with heart disease, please do not under any circumstances join any online group that’s clearly devoted to WOMEN heart patients sharing their cardiac experiences with other WOMEN.  (And no, it’s not because we don’t love men – we do!) This would be as inappropriate as if I decided to participate in a men’s online support group. Trust me, nobody there wants to hear from me. Nobody!

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 person (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 being 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, as in That Guy’s case, abuse is aimed at front desk staff. Even other patients in the practice are sometimes inappropriately targeted.

The same can be true for those who exhibit drug-seeking behaviours, or habitually miss their appointments. (In my 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.

But 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. We embrace a fine 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?

See also:

* Some of the troll’s offending posts were finally removed by Inspire moderators from the WomenHeart forum post called The Woman Patient: Is Her Voice Heard? after other members also asked him to leave, posting statements to him like: “Please find another place to vent your anger.”  

14 Responses to “Being sick doesn’t excuse being a jerk”

  1. Caroline Ronten August 14, 2016 at 4:28 am #

    I got fired by my eye doctor last fall. Why? Because I dared to question the front desk staff about the long wait and then complained about their answer. I asked the front desk after waiting 30 minutes past my appointment time if there was a delay. All I was told was that I was the next person to be called. I restated my question again and asked if there was some kind of delay. I got no answer to my question other than the line that I was next. I asked the doctor about this (when I finally saw him) and he said it was not right and agreed I deserved some kind of explanation. I Yelped the experience and then got a follow up call from the office manager who basically told me I needed to remove my review. I didn’t. And got a letter informing me I needed to find a new eye doctor.

    I didn’t swear. I didn’t push. I asked a respectful question and got a flip answer. I dared express my opinion and got canned. I honestly review almost every restaurant, hotel, store, or place I go so didn’t think it would be a big deal. Doctors are not gods and should not expect to be treated as such. Both patients and staff need to treat each other with respect. I didn’t feel I got respect so I stated that.

    Like

  2. bveltrop72 August 8, 2016 at 5:11 pm #

    My mom is in the ICU again with chest pain and an infection in her fractured ankle. I have tried since Friday to speak with a physician or his nurse. I’m a cath lab RN. Do you think they would call me back? NO! I actually speak the lingo and can translate to my family and mother but no! Not even a courtesy call!

    Like

  3. Kathleen August 7, 2016 at 11:09 pm #

    Sure. Abusive behavior is never the right thing to do. I am glad that you acknowledge that patients are often treated disrespectfully, even abusively. Especially in the US, medical offices are businesses, with all the related issues. I do realize the hyperbole, but found myself wondering whether patients should take as their model the Minnesota woman who videoed her own impeccable behavior as the police shot and killed her partner.

    This story is the closest I came to getting “fired” by a doctor: The office person at my five star orthopedist was very cute and blonde, but she simply never replied to my mailed request or to any of my repeated voice messages in which I said that my employer required me to show up with a status report by this given date or I would be terminated/fired, and that I would arrive that given morning to pick up that report. My injury was on the job (an entirely different insurance system in the US ) so, not unreasonably, the orthopedist told his office person that the injury system would not pay him for such a report. Only nobody bothered to tell me any part of that, so I showed up at the office 3 hours before my appointment with the company docs and learned that there was no report. Shocked and facing a very real prospect of losing my job for failure to comply with a direct order, I lost my temper. Why had they not even bothered to tell me? Fired is a very poor negotiating position. I said that I would pay for the report, since that appeared to be the issue. The doc was summoned and (after warning me about proper treatment of his staff) he handwrote a quick status report, but he had no defense when I asked him, “What was I supposed to do? How can I respond to no information? Zero replies?” Quite a while later his financial person confided to me that the front office people really were not hired for their competence.

    Perhaps I would have fared better with the front office staff had I been a major league football or basketball player, but alas I am not.

    Like

  4. helenakinc August 7, 2016 at 9:04 am #

    This is an important topic and yes, I agree with the importance of patients being appropriately and politely assertive, as well as the importance of physicians and staff likewise being understanding, polite, and appropriate.

    There are a couple of other factors that are important to underscore with regard to this topic. I believe there have been studies which demonstrate that patients who believe in and trust their physicians fare better than those who do not. When I ask questions, I always try to ask in a way that isn’t confrontational, but is an attempt to gain understanding and/or information about what is going on with me. That builds trust and also compliance. If I understand why something is being recommended, then it helps me to adhere to the directions. My doctors also realize that that is how I am and if they do not like that, then something has to change.

    Secondly, I think it is very critical for the physician to actually care about the patient. That doesn’t happen automatically. There are all sorts of recommendations about protocols and treatments that ensure the bare minimum treatments are performed in a given situation. But, personally, I don’t want the bare minimum. I want a motivated doctor who actually cares about me and wants me to be healthy, because he/she cares about me.

    I think that may have actually saved my life when my heart was accidentally punctured during a procedure and I had two cardiac arrests, minutes upon minutes of CPR and emergency open heart surgery. My electrophysiologist himself jumped on the gurney and did CPR. I heard later from a friend, who just happened to know someone who was on the team doing the procedure. The team member started describing the incident and said, “we thought she was gone” over and over. My friend knew what had happened to me and they talked.

    Well, my doc and I had a great doctor-patient relationship. When he came to see me in the ICU after I came to, he was on his knees, next to me, weeping with both joy and sadness that I had had to go thru that. I believe that because we had a very good doctor/patient relationship, he kept up that CPR probably longer than what was required. And no one would have blamed him if he had stopped CPR a few minutes earlier. But he kept it up and lo and behold, I am here to talk about it. Doctors are human beings and I think it is important for patients to remember that while at the same time remembering that patients are their own best advocates.

    Liked by 2 people

    • Carolyn Thomas August 7, 2016 at 10:01 am #

      What a moving story about an amazing survival experience! Good point about the need for patients to be “appropriately and politely” assertive. Some of us readily get the “assertive” part right, but forget entirely about those adverbs… Thanks for your comment.

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  5. Mary Mack August 7, 2016 at 6:53 am #

    Great post. Dropping F-bombs and losing control is never ok. My hunch is that there was a slow build up and a final snap. The culture is still one of general disrespect toward patients–often office staff behave abruptly and speak in a rude and disrespectful tone. It’s accepted within the culture and therefore very common. Until that culture completely changes, separate behavioral rules governing grounds for patient dismissal is disrespectful in and of itself. It comes down to having extremely good self control in the face of a very difficult to navigate–dismissive–environment, while simultaneously feeling vulnerable and fearful depending on your circumstance. I’m reminded of the movie Terms of Endearment when the mother–after very nicely requesting the pain medication many, many times– finally snaps and screams “Give my daughter the effffing shot!!!” Everyone can relate to that.

    Argumentativeness as reason for dismissal is baffling to me, unless a patient is simply picking a fight out of nowhere and in relation to nothing relevant. Disagreeing with a diagnosis with good reason could be construed as “argumentative” by any medical professional who does not like being challenged or doesn’t feel like investigating further. This happens so very, very often.

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    • Carolyn Thomas August 7, 2016 at 8:51 am #

      Thanks for bringing up that famous Terms of Endearment example, Mary. I love that unforgettable scene – and don’t know a single mother who wouldn’t do just what Shirley MacLaine’s character did! But that’s mama bear terror, not being a jerk. Just this morning, I read a report that said nursing is now considered the most dangerous occupation in Canada because of the level of workplace violence directed at them by patients or their family members. Every angry person who lashes out at a nurse or other health care provider will likely justify this abuse by simply insisting that “she started it”. It’s not about blame, it’s about stopping the behaviour.

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      • Mary Mack August 7, 2016 at 11:44 am #

        Yes, thank you–I am aware of what the Terms of Endearment scene is about. I get it. If it were–however–to play out for real somewhere in a hospital today: the mother of an adult daughter loudly demanding the pain medication at the nurse’s station be delivered immediately to her daughter, she may well be perceived as a jerk—and escorted out or worse.

        The dismissive behaviors and the angry outbursts ALL need to stop. The culture of disrespect is a clear reality–It’s not an excuse for patients to lash out (and it should not be) , i.e., the “she started it” gobbledygook –however-the culture of disrespect is very much present and it creates problems for everyone. There is ridiculous disrespect among medical professionals alone just between themselves, never mind getting patients in the mix. Yes, its not about blame– I’m surely not condoning (did it sound like I was?)the bad behavior of every angry patient who lashes out or who has lashed out at hospital personnel, doctors and/or nurses. It’s extremely wrong. The culture of disrespect in the medical arena, however, does need to change. It’s a big part of the problem and of what’s wrong in healthcare.

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        • Carolyn Thomas August 7, 2016 at 12:18 pm #

          I hear you, Mary. You’re preaching to the choir! I’m pretty sure you’re not condoning bad behaviour from patients. What you DID say – “the culture of disrespect is not an excuse for patients to lash out” – is so true, and that’s simply what I’m saying, too. If you’ve read any of my previous posts on communication and respect in health care (a few links are at the end of this post), you know that I’m an equal-opportunity jerk-basher, no matter where such disrespect originates.

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  6. Holly Shaltz August 7, 2016 at 4:47 am #

    It’s not possible for a patient to fire a doctor when that doctor is the only one in the specialty needed, no matter how incompetent, biased, or otherwise inappropriate the doctor may be. And if that specialist is a gatekeeper to treatment needed to save one’s life, it’s not even possible to make a complaint. If patients must be held to a behavioral standard, so must doctors, even in a gatekeeper situation.

    Like

    • Carolyn Thomas August 7, 2016 at 5:23 am #

      I agree, Holly. In a perfect world, behavioural standards would apply to EVERYBODY.

      Like

      • Barbara Keddy August 7, 2016 at 9:02 am #

        I was thinking about the same things recently. Having had a hip replacement almost 7 weeks ago, it has been a revelation that many of the complaints are aimed at the gatekeepers …those generally not high paid (usually women) who are the ones who book appointments etc. They have to take the abuse of patients who are frustrated, frightened and needing attention sooner than can be arranged.

        So many people, even a physician friend, told me to be nice to the ‘secretary’ as she determines your fate. I relate to both the frightened patient on long wait lists and the administrative assistant who constantly hears these tales of woe. It would be interesting for a physician to answer the phone for just one day to see and hear what she experiences.

        When I knew I was having the hip replacement, friends said they would find out who the secretary/ assistant of my surgeon was and tell me if she was a friendly type or not and how to behave towards her, not to aggravate, but be conciliatory. Another physician friend even laughed and said: “Send his secretary flowers”. I can’t begin to count how many people told me various ways to approach her. It turned out she was a polite person, although I never met her face to face. Their jobs must be awful, dealing with irate, anxious patients on a daily basis.

        What a conundrum. Sickness, disability, pain can bring out the worst in us! I am no stranger to what pain can do to my personality, but taking it out on others in regards to cursing is not helpful to anyone!

        Liked by 1 person

        • Carolyn Thomas August 7, 2016 at 9:57 am #

          Thanks so much for sharing your unique perspective as both a health care professional and a patient, Barbara! I love your observation: “It would be interesting for a physician to answer the phone for just one day to see and hear what she experiences.” (That eye-opening experience might result in a big fat raise and flowers on her desk from now on!) Some patients just don’t seem to get this: yelling at or insulting the front desk staff (or anybody who simply does not wield the power to change things) will NOT get you moved up a waiting list one bit faster. A little less hostility and a lot more niceness towards people who have to deal with “frustrated, frightened, irate, anxious patients” every day is never a bad idea. Hope you are recovering nicely…

          Like

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