“How does he treat you?”
I don’t only ask this question of women whom I suspect of being abused at home. I also ask my medical assistants. Not about their domestic partners, but about our patients.
In my first practice, I sat/stood to the left of my medical assistant every day for six years. It was a cozy (cramped) little counter space stacked with charts from end to end, with a couple of high-wheeley chairs. Each chart stack had a laminated cover on top: “For Cheng to Review/Sign,” “For Rose,” “Labs,” and “Messages.” Charts journeyed from my left to my right/Rose’s left, to the bin under the counter to be filed. It was incredibly efficient, actually. I had a handwritten emoji system for indicating (dis)satisfaction with cholesterol and diabetes results. Rose knew all of my patients and how to communicate sentiments and instructions clearly and lovingly. She had been an MA since I was a kid; she knew what she was doing. If a patient had a question on the phone, she could put them on hold and clarify with me, or I could just get on the phone and speak to the patient myself. We were busy and happy, a well-oiled team-machine.
One day as I came up to my spot at the counter, I noticed an unusual sound next to me, like a distant, scratchy loudspeaker. I turned and saw Rose holding the phone receiver about an inch from her ear. The sound was my patient, yelling profanities at her so loudly I could hear his words from two feet away. I can’t remember what the issue was, but he was obviously upset, and taking it out on her. It surprised me because I had only known him to be sweet, respectful, and grateful. Maybe he was just having a bad day? I looked at Rose, who rolled her eyes and exhaled heavily. I asked her to put him on hold so she could catch me up. Apparently this had been going on longer than I knew, and she had not told me. Had I not come upon it in real time, she may never have told me. She would have simply tolerated it.
I picked up the call and declared myself. He was the usual, respectful and calm patient I had always known. I answered his medical questions. Then I told him firmly that he did not have the right to treat anyone in my office the way he had just treated Rose. I think there may have been some excuses and then an apology. I made it clear that if he abused my team again, he would be discharged from the practice. He agreed and apologized again.
That was my first opportunity to stand up for my team as an attending. I will forever remember it. I was a petite, young, Chinese woman doctor, speaking to a white man decades older than myself. I stood up for my medical assistant, a woman of color and a couple decades older than me. She had felt powerless to stand up for herself to his verbally vomitous abuse. All I had to do was pick up the phone and say, “Mr. Soandso, this is Dr. Cheng.” He never yelled at Rose or anyone in the office again, to my knowledge. How could I have this much power, and why had nobody asked me to wield it in their defense before? It was just accepted that patients could yell and scream at our staff, with no consequences?
We recently discussed abusive patients during our regular doctors’ meeting at my current practice. Immediately I thought, HELL NO. The good news was that our team members feel safe reporting incidents to our managers and physicians. My partners and I have all had to call patients to clarify our expectations of respect. We understand that illness is stressful. We understand that our healthcare system, especially at a large, bureaucratic institution, causes frustration, even rage. However, none of that ever justifies or entitles a patient, or anyone, to belittle, dehumanize, or otherwise degrade another person, and especially not a team member who is doing their best to help–ever. At this meeting, gratifyingly, we all voiced definitive confirmation that we fully support our team, and we will, without hesitation, educate and/or discharge any patient who violates our team’s right to a collegial and non-threatening work environment.
Even as I write this, I shake a little with rage and outrage at these patients’ behavior. I can feel tightness and tension in my chest and abdomen, my breath quicker and shallower than its usual resting state. I wonder if this triggers me because my mom is a nurse and I have seen how patients in the hospital abuse nurses. I also know how women physicians are mistaken for nurses and thus ignored or dismissed, even by female patients. I have known racism and sexism first hand. But as a physician, I’m in a position to not have to tolerate it. By virtue of two letters after my name, I have the power to protect my team, with authority. And I work with other physicians who also recognize both this power and its attendant responsibility.
I hope our team feels protected, defended, and loved by us docs. We may be the default work unit leaders, but they do the lion’s share of work that allows our practice to run as smoothly and successfully as it does. They are who let me do my work as well as I do. I depend on them every day. So caring for them absolutely makes me better, makes us all better.