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IT isn’t always easy to be nice in medicine, but couldn’t we always try not to be rude?
A few weeks ago, Tom*, a doctor and close friend, was diagnosed with a serious illness. After months of ignoring a niggling cough, his chest x-ray showed a string of enlarged lymph nodes and he was sent for a computed tomography (CT) scan.
Not prone to worry, he didn’t really. But, like the lymph nodes, he couldn’t shrink the anxiety that nestled in his chest as he presented for the scan.
At the radiology clinic he glimpsed the world of being a patient.
“The interactions were either cold or rude – really transactional,” he told me.
At the desk, the receptionist snapped at him to fill out a form somewhere else, then he was ushered to the scanning bed, where the rushed technician told him to hold still and listen for the machine. So Tom lay still and listened for the machine.
“Breathe!” it growled. And so he did. “Hold your breath!” it growled again.
“Hold my breath in, or out?” thought Tom, not wanting to make a mistake.
At that point the technician came back in, clearly annoyed. He told Tom they were already running late and to take a deep breath in and hold it. Chastised, Tom did as he was told.
Afterwards, back in the waiting room, Tom asked if he could see the radiologist to discuss his scan. After 20 minutes, she came out to the waiting room.
“And, then she told me, without introducing herself, ‘I can’t be sure what it is but either way, you’re going to need chemotherapy’. It really floored me,” he said.
“Mostly, though, I was just embarrassed that everyone in the waiting room had seen and heard it.”
But it might be more than just hurt feelings at stake.
- Related: MJA InSight — Kindness in medicine more than skin-deep
- Related: MJA InSight — Kim Oates: Case for kindness
- Related: MJA — Workplace aggression in clinical medical practice: associations with job satisfaction, life satisfaction and self-rated health
- Related: MJA InSight — Co-worker aggression concerns
A recent study in Pediatrics showed that clinical performance decreased significantly for neonatal intensive care teams as they tried to complete their tasks in the face of rudeness. There is now a randomised controlled trial proving that we don’t perform as well if we’re rude to each other.
How surprising.
Having said that, in preparing for this article, I couldn’t find any trials that proved there was a worse outcome for our patients if we were rude to them.
Do we really need one?
In a paper published in the Journal of Advanced Nursing in 2010, it was reported that up to two-thirds of operating theatre staff have seen rude behaviours and half of them have been in the firing line.
It seems too that rudeness might be contagious – or at least can be described like a contagion. Perhaps that explains why some workplaces just seem ruder than others.
There are, of course, lots of reasons why health care workers might be rude. From burnout to simply running out of time – ours is a world of rapid consultations and workforce pressures to do more with less.
There’s no doubt that we have to develop a thick skin early on, weathering the job of treating sickness in uncertainty and inadequacy. Perhaps impatience or rudeness can be explained, but not excused, by the stress we often endure. It’s easy to see how, in the milieu of patient problems, we can lose sight of our patients.
Maybe it makes it easier because most of what we have to offer to patients actually works – and is often free. And so our patients forgive us for being a bit prickly from time to time.
Whatever the reasons for rudeness, it wasn’t much fun for Tom. After his experience, feeling drained, he left the radiology suite and decided to have a massage to try to relax.
The masseur welcomed him warmly, put her hand on his chest and said she could see his stress and wanted to heal him – generic but sincere words of human connection.
“I nearly burst into tears,” he said.
Ironically, Tom might end up owing his life to the information in the CT scan that day and to the expertise within the radiology clinic. But they’re not the ones who actually cared for him.
*Not his real name. Story used with Tom’s permission.
Dr Simon Hendel is a Melbourne-based anaesthetist and is completing his postgraduate studies in journalism.
Sir Douglas Gow this is by far the best analysis i have read so far. I have acquired a dread of dealing with patients!!! Why are the doctors considered robots who dont possess emotions and have only “right and nice” applications built in them, guaranteed to behave and act in a precise way without getting affected by emotions. And for me i get swamped by a lot of negativity?
I’m a retired anaesthetist who (partly) chose that speciality to avoid having to speak to patients more than necessary. Perhaps the doctors known to be rude to patients (and they know who they are!) should choose other “non-contact” specialities. Indeed that may be why the radiologist in question is a radiologist and not a psychiatrist. I expect this to bring a tsunami of protest from my colleagues, which I will ignore. I wish it would bring a similar wave of insight from rude doctors, who will also ignore it.
I am a GP and I have also been a patient. I usually try not to disclose the fact that I am a doctor when I consult my colleagues. I have unfailingly met with politeness, grace and courtesy from reception staff to radiologists. When, as the conversation often comes round to the fact that I am a doctor, the attitudes do not change for the better. I am usually offered the chance of speaking to the radiologist at that point if I am having my annual ultrasound. This is in a busy public hospital in Adelaide. I think the work culture of a system is central to the idea of compassionate service and this is where we should start making changes.
Hang on… But Tom* is not an ordinary patient… He’s a doctor and he’s taken the big liberty of asking to speak with the radiologist – something not usually afforded to the general public. He should have waited until he saw his GP. Does the medical world really expect radiologists to review a scan in 10 secs (so they dont keep the precious Doctor Tom waiting “20 mins”)? Quality reporting, like quality clinical assessment (also poorly under done now days) takes time. I’d say the radiologist wanted to make absolutely sure of the result before having to come out and explain something they probably didn’t want to do. Is it their job to break the bad news? Put yourself in the radiologists shoes…. It’s pretty confronting to have to do something you’re unfamiliar with – try taking out a kidney when you’re not a urologist… Whilst I don’t condone the radiologist’s lack of introduction and graces, and the receptionist had no reason to be rude, the radiologist was probably pretty nervous and sometimes these graces can fail you in uncomfortable circumstances. Sorry Tom*, I understand that you’re the patient and you should always come first, but it doesn’t hurt to think about other’s perspective too when you’re demanding special flavours. You can’t be both Doctor and patient. The worst outcomes often arise when doctors meddle in their own care.
So many health professionals are finding it difficult to be courteous in the workplace! We should be asking what is it that’s preventing our core business of showing kindness (a.k.a. compassion) and what can we do about it. There is a substantial body of published literature on compassion, and it testifies to entrenched system factors that strip compassion from our “care”. This suggests that it isn’t enough to remind individual health professionals of any discipline to just pull up our socks, because it just isn’t enough to solve the problem. The problem is systemic, and we need to create the work settings where staff are enabled to demonstrate compassion in their care. We (myself, Sarah Winch, Margaret Kay & Amanda Henderson) felt concerned enough about this scenario to write about compassion literacy (http://www.collegianjournal.com/article/S1322-7696(15)00081-5/abstract), and would welcome readers’ comments on what this article brings to light.
Cure sometimes, treat often, comfort always – Hippocrates
Simon, you have hit the nail on the head when it comes to alternative medicine. I will bet that the massage therapist charged Tom more than the GP, and probably a greater ‘gap’ than the radiologist. I have never heard anyone say that their chiropractor was rude to them. With all the burden of statutory requirements such as informed consent, following clinical guidelines, using evidence based practice, and as you say, often doing it for free, the human aspect gets squeezed out of the six minutes available. There is no time for the quiet chat, and putting the hand on the chest of someone of the opposite gender risks a medical board complaint. As does the medicolegal implied warranty of ‘wanting to heal him’. And I’ll bet that the massage therapist didn’t ostentatiously wash her hands both before and after touching his chest, or wear disposable gloves. We can’t do anything meaningful about the regulatory burden, but we can be human.
Perhaps the simplest thing we can give our patients is a long enough appointment to sit there and listen to their concerns, and then deal with them appropriately and humanely. The massage therapist can do it because she takes that time, and I suspect that the Toms of this world would not be averse to paying an extra 50 bucks to see an unrushed and compassionate GP. Rather than criticising CAM quackery, perhaps us scientific types could learn from their compassionate and empathetic behaviour, including their allocation of ‘quality time’.
And sadly, this is why people are flocking to Alternative practitioners. They rarely do anything more then offer a kindly consultation and are just reassuring and decent to the person. I’m sure lots of people who go to them, know their advice is bullocks, but because they are kind and caring and relax the person. They are sought out. I once had a Doctor be incredibly rude to me. It was just awful really. He was just a pig really and whilst I completely understood that he was busy and stressed probably, it was just not a nice feeling and made me never want to go back to him.
A smile, a welcome and some reassurance and decency goes a LONG way with human beings.
Therese
I think the 1991 movie ‘The Doctor’ with William Hurt should be mandatory viewing for ALL those working in the health system.