Why you should not yell at cancer patients

by Carolyn Thomas     ♥    Heart Sisters (on Blue Sky)

I know this sounds horrible, but there are some people working in health care who need to be told this basic communication rule: “Don’t yell at cancer patients!”  I first learned the importance of that rule when my phone rang one sunny morning in May and the anonymous caller told me to show up tomorrow morning in the Chemo Room at our Cancer Clinic for my first chemotherapy appointment. I didn’t know much about chemo at that time, but what I did know were these three must-do steps I had not done yet:

1. I need to book a blood test appointment at the hospital lab 3-4 days before each chemo appointment. 

2. I need a lab requisition from my oncologist in order to book that blood test.

3. I need my oncologist to review my bloodwork results to make sure my white blood cell counts are stable enough to withstand each upcoming round of toxic chemo drugs.  

But on the particular morning when the anonymous caller started yelling, I had zero advance notice of this new chemotherapy date, nor any opportunity to get either the #1, #2 or #3 requirements completed in time. 

And for a freshly-diagnosed breast cancer patient, delaying treatment is a truly frightening option. 

When I try to explain to the anonymous caller on the phone why I’m unable to show up for chemotherapy tomorrow (see #1, #2 and #3), she loudly interrupts me to repeatedly scream: “DON’T SHOOT THE MESSENGER!  DON’T SHOOT THE MESSENGER!”  Then, she yells even louder:  “If you want your chemotherapy, you’ll show up at 9 o’clock tomorrow!”  before hanging up on me. 

So she’s both a yeller and a hanger-upper – just what an anxious new cancer patient needs.  

NOTE FROM CAROLYN:  #1   The yeller/hanger upper is clearly confused about what “Don’t shoot the messenger!” means.  (That’s what you’d say when somebody is yelling at YOU, not when you’re the one doing the yelling!)

I too felt confused by her phonecall  – especially because of all that yelling!  But I wasn’t confused enough to forget those three required steps I’d read about in my treatment plan notes.

This is healthcare communication that’s not actually designed to help overwhelmed patients feel less overwhelmed.

Being able to speak to a real person in a timely fashion about a question as important as: “When is my appointment?” can mean the difference between a calm, informed patient and a nervous wreck. Pick the one you’d prefer to be. . . 

Newly diagnosed patients (no matter the diagnosis) have so many questions, especially in those earliest of days. Often, we’re unsure what questions we should even be asking. We don’t yet know what’s urgent or what can wait. Nothing is routine. Nothing makes sense. Nothing feels “normal” to us. 

Patients may need to be creative to get some questions answered. One of my questions a few months after the yelling incident was in the hospital lab, where – as instructed –  I had booked my required appointment for bloodwork (see #2).  I’d been assured that my blood test requisition had already been faxed to the lab so it would be on file waiting for me when I arrived. But it wasn’t.

After waiting half an hour, I had a dilemma. I needed the blood test that day, but “no requisition = no test”.  So I decided to walk over to the Cancer Clinic to see if anybody there could help me. I knew that the Chemo Room always had lots of nurses wandering around, so I popped upstairs, uninvited, no appointment, of course. Two friendly nurses near the main door looked up when I walked in. “Can we help you?” 

“I’m  booked for my Chemo appointment on Monday but my lab requisition is missing and I can’t go to Chemo without my blood test results.”  Less than one minute later, the nurses found my requisition on their  computer,  pressed PRINT, and then handed me a copy of my missing paperwork.  You might think it’s inefficient to expect busy Chemo nurses to be the ones helping patients obtain important lab requisitions on time, but their assistance turned out to be a solid example of nurses being helpful and respectful. 

A column published in the journal Pharmacy & Therapeutics (P&T) explained (but did not excuse) the behaviour of health care staff like my anonymous caller, blaming such behaviour on “health care’s continued tolerance of and indifference to disrespectful behaviour”, adding: ¹

“Widespread disrespectful behaviour in health care persists unchecked and is found at all levels of organizations and among all disciplines of staff. Disrespectful behaviours can arise in any health care setting, and both the stressful nature of the environment and human nature itself can play roles in this destructive behaviour.

“We are driven to function in ‘survival’ mode when forced to cope with difficult frustrations and workplace system failures. Disrespectful behaviour is often ‘survival’ behaviour gone awry.² Although personal frustrations and system failures do not excuse disrespectful behaviour, they often create a tipping point by which an individual is pushed over the edge into full-blown disrespectful behaviour.”

Disrespectful behaviour in health care (e.g. yelling at cancer patients) extends well beyond the overwhelmed patient.  Consider workplace research on the topic of bullying of hospital nurses, for example,³  which found that bullying occurred most frequently in Medical-Surgical areas of care (23%), Critical Care (18%), Emergency (12%), Operating Room/Post Anesthesia Care (9%), and Obstetrics (7%).

Meanwhile, the bullying perpetrators are senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%), while bullying behaviours range from being publicly humiliated, isolated or excluded to being excessively criticized. The P&T authors also described health care bullying as a “hidden problem with significant patient-directed quality performance.  

Subsequent stress levels of the bullied nurses studied were reported as moderate or severe, with personal support found primarily with family, colleagues or friends – but not with an available workplace infrastructure solution. Researchers reported that many nurses under those circumstances left the workplace completely, with or without jobs awaiting them.

A Canadian study on how family physicians are treated at work reported results that many of us might find surprising – namely, that physicians are subjected to “significant amounts of abuse in their day-to-day practices”. About 1/3 of the physicians surveyed reported having experienced an abusive event in the last month (classified as minor, major or severe) inflicted by a patient or a patient’s family member. Of the physicians who experienced an abusive event, over half were not aware of any workplace policies to protect them, 76% did not seek help, and 64% did not report the abusive encounter.⁴   I’d probably be yelling non-stop if I worked in conditions like those.  

I’m not unsympathetic to any health care staffer who faces abuse, or bullying, or burnout, or any disrespectful workplace encounters. I can even imagine that the anonymous caller who yelled into the phone at me might very well have faced a stressful event that day which could have been the tipping point which “pushed her over the edge into full-blown disrespectful behaviour.”  

But disrespectful behaviour (like yelling at cancer patients) is a problem when that stress morphs into “full-blown disrespectful behaviour” that’s aimed directly at patients – and very likely at those who had little or nothing to do with the cause of that original stress. As the P&T authors suggest: 

“Patient confidence is undermined by disrespectful behaviours.”

It requires the same effort from healthcare staff to be rude to patients as it is to be kind.  So why not be kind? 

♥

NOTE FROM CAROLYN #2:   In my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press), I wrote much more about the importance of effective healthcare communication. You can ask for this book at your local library or bookshop (please support your favourite independent booksellers!)  or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press. Use their code HTWN to save 30% off the list price when you order.

1. Grissinger M. “Unresolved disrespectful behavior in health care: practitioners speak up (again)” PT. 2017;42(1):4–5. 23.

2. .Zimmerman T, Amori G. “The silent organizational pathology of insidious intimidation.” J Healthcare Risk Management . 2011;30(3):5–6. 8–15. doi: 10.1002/jhrm.20055.

3. Vessey JA et al.  “Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments.” J Prof Nurs. 2009 Sep-Oct; 25(5):

4. Miedema BB et al. “Monthly incidence rates of abusive encounters for Canadian Family Physicians by Patients and their Families.” Int J Family Med. 2010;2010:387202.