NaBloPoMo 2016, Letters to Patients, Day 5

To Patients Who Abuse Medical Staff:

Let me be clear: That is not okay.

Let’s define some terms first:  By staff, I mean clinic receptionists, medical assistants, nurses, phlebotomists, schedulers, hospital nurses, housekeepers, pharmacists, food service workers, billing and medical record staff, social workers, case managers, and anyone else who contributes to your care.

By abuse I mean insulting, yelling, name calling, intimidating, swearing, threatening, and otherwise conveying hostility and aggression toward others.

I have very specific behaviors in mind here.  I’m not talking about the inevitable frustrations that we all face in over-scheduled clinics and understaffed hospitals.  Exasperation, disappointment, and even anger are appropriate emotions we all share.  We understand that you may make surly faces and splutter a little when your expectations are not met.  Most medical staff are trained and expected to handle such interactions with patience, compassion, and calm.  They are frequently also given only narrow parameters within which to convey information, and almost no decision-making authority or autonomy.  Believe me, they feel terrible when they cannot help you, and often there really is nothing they can do in the moment.  But they can always ask for help, so I respectfully request that you give them the time and space to do so.

The medical community has a lot of work ahead to integrate our care teams.  We serve you best when all team members are empowered to exercise their best judgment, within their scope of practice, to move care forward toward your best health.  We are all here doing our best.  Physicians play a crucial role in both local and global medical culture.  But we are only recently stepping up as actively collaborative leaders, rather than authoritarians and paternalists.  You may see us physicians abusing our own staff, so let me be clear again: That is also definitely not okay.  Never mind that it undermines morale.  It can also endanger patients.  I hope in my lifetime to see an end to this contemptible behavior.

If I witness you abusing my staff, be sure that I will call you out.  I will do it respectfully, even lovingly, especially when I know you’re going through a hard time.  I understand how hard it is to control our emotions when we’re unwell and frightened.  It’s good for all of us, however, to know exactly where the boundaries of acceptable behavior and language lie.  Expect that if you cannot abide them, I will ask you to leave.

If you witness me or my colleagues abusing our staff, we need you to call us out, too.  Relationships are never one direction.  In medicine and health, the webs of connection are inextricable—one person’s mood and attitude can rapidly infect a group—and the stakes can be high.  I expect myself and my staff to conduct ourselves professionally.  We expect you to behave humanely.

Thank you for your cooperation!