WhiteCoat

Provider Attitude and Patient Violence

Kevin MD published an op-ed in USA Today titled “Violence is a symptom of health care dysfunction” which discusses patient frustrations as one source of violence against health care workers. I’ve been busy this week and the comments section is apparently closed on Kevin’s post, so I didn’t get the chance to put my 2 cents in … yet.

The premise of Kevin’s post is that our system is broken and we need to better protect our health care workers.  Agreed.

A second premise is that there is a deterioration of the doctor patient relationship. Also agreed.

But Kevin then says that “Patients are rightly frustrated, and some are lashing out.” The way this sentence is phrased almost makes it seem as if it is OK for patients to lash out when they are frustrated.

Kevin ends his op-ed piece by stating that health care providers could use more empathy and that patients need to realize that health care professionals are doing the best they can and should avoid violence.

Again, the impression that I was left with after reading the last couple of paragraphs in the article was that health care providers need to empathize with patients in order to stop the violence.

So I have a couple of thing that I need to set straight.

First of all, it isn’t just patients that are frustrated about the health care system. Providers are just as frustrated about the state of affairs. Patients think they’re frustrated? Take that level of frustration and multiply it times 24 hours a day, 7 days a week. Now put yourself in a position where federal agencies are micromanaging you, where the people you are trying to help have the potential to wig out and injure you, where your payments are being decreased, where your liability is being increased, and where you often work way more than 40 hours per week. Welcome to medicine. Not only do we have your frustrations, but we also have a plethora of other frustrations on top of that.

Second, some of the patients commented in Kevin’s op-ed about wishing they had an old-school doctor patient relationship. If you’re expecting a Marcus Welby experience in the emergency department, it isn’t going to happen. Most of the time is you show the staff a little respect, chances are good that you’ll get respect in return. Not all the time, mind you. Everyone has a bad day, so you might not have the warm fuzzies after every emergency department visit. However, if you come across as a foul-mouthed, demanding, bad attitude wretch, I can almost guarantee you that you will be treated as a foul-mouthed, demanding bad attitude wretch.

But I also have some good news. If you want a Marcus Welby relationship with your physician, you can have one. Find a doctor you like and actually stick with the doctor. Stop playing hopscotch with your doctors every year when your health plan changes and then complaining when the new doctor you see once or twice (before you change doctors the following year) hasn’t committed your complete medical history to memory. Yes, I know that doctors move and that residents graduate, so patients aren’t always at fault. But I see a whole lot more of the former scenario than I do of the latter scenario.

I don’t care if patients are “rightly frustrated” about the health care system. Never should society accept violence against another person as an outlet for those frustrations. It isn’t OK to punch a police officer because you’re “rightly frustrated” about your speeding ticket. It isn’t OK to threaten a judge because you’re “rightly frustrated” with his ruling. I’ll bet that even hospital administrators would agree that it isn’t OK to stab them with a knife if you’re “rightly frustrated” about the way that they are running a hospital. Violence can never be an acceptable outlet for frustrations.

Kevin has become a prolific medical blogger because his opinions are consistently well-grounded and well thought out. I agree with his position 99+% of the time which makes me think that the way he phrased some of the statements in his op-ed piece did not express his true intent and created an unintended picture in the minds of many readers, including me.

The fact that so many health care organizations and so many health care providers tacitly accept violence against health care workers as an outlet for patient frustrations just shows how low our health care system has sunk.

Even Marcus Welby couldn’t fix that.

12 Responses to “Provider Attitude and Patient Violence”

  1. Pudortu says:

    Thanks for the response to his post. That Cheryl lady posting in the comments section made me want to dropkick a clown in the face (but clown violence is acceptable because I’m sad at current clown affairs). Anyways, deep breaths.

  2. Anon Doc says:

    Sounds similar to how DV situations used to be viewed, ie that women had to understand when their husbands were rightly frustrated and just couldn’t help lashing out. And that women should’ve had more empathy for what their husbands were going through – especially while they were being beaten.

    I thought the whole blame the victim mentality went out in the 80s.

  3. Your points are excellent and delivered exceptionally. Working in an ER setting for four years of residency and 15 years of attending-status, I can verify that almost all of my partners and staff are frustrated by the current system. A system that doesn’t seem to be changing anytime soon…all we want to do is deliver excellent emergency (key word) health-care in a timely manner.

    That’s all.

  4. Nurse K says:

    It’s pretty bold for an office doc in lovely, quaint New Hampshire, who can turn away anyone for any reason and collect co-pays at the front desk, to say that ERs in hospitals like Henry Ford in Detroit should forgo metal detectors for empathy. He just didn’t say that people should be more empathetic, he said that people shouldn’t have guards or metal detectors and, instead, choose empathy.

    It was Onionesque in its ridiculousness. Dry humor, maybe?

    PS: http://crasspollination.blogspot.com/2011/03/kevin-mds-really-interesting-solution.html

  5. Kevin, MD is an left New England propaganda outlet. It will not allow any diversity of views. The scum of the earth are their constituents. So violence is always the fault of others. This is the constituency of the lawyer as well, so no one may even verbally criticize them. Try saying, Stop acting the fool. You will be fired for verbal abuse.

    Most violent patients are drunk, are bastards from single female homes, and are violent in other areas than the ER.

  6. KT says:

    I often say this, but I can’t understand why healthcare professionals accept this behaviour. It’s no different to walking into McDonald’s and assaulting the 15 year old at the counter because you had to wait too long for your McDiabetes burger.

  7. I read the comments. Kevin is just too good to reply to the criticism from people in the real world. A phool, and arrogant.

  8. DefendUSA says:

    WC…
    One bone of contention. A lot of people *are* being forced to change physicians!! I have been lucky to keep my docs, but I have several friends who could not as a result of what plans are being accepted where.
    We were willing to pay when we did not have insurance to keep the same docs, but a lot of people are just not that pro-active and do not have a choice.

  9. tracy says:

    i always liked Dr. Kiley better.

  10. SkullCandy says:

    I wish there was an emoticon here for the finger, cause I would use it for Dr Kevin.

    Sorry, screw him. I lived in the Detroit Medical Center area during the 90s and it was bad then with the substance abusers, homeless vets and other assorted mayhem. My friends work down there now, and it is even worse because of the psychiatric patients who can not find services.

    So pound on the hoodville hospitals, Ford, Children’s, Detroit Receiving, and Harper for metal detectors and armed guards. I’d love Dr Kevin to work ONE Saturday night at Receiving during July, and see if he isn’t happy to have the detectors and guards. You just can’t reason with a drug or crazy.

    If anything, the ER staff bends over backward trying to be “nice” to idiots that ramp it up to intolerable asshole mode, because “they have stress issues from the wait”.

    The jackasses are never parents of a coding child etc. It’s always “I’ve got the flu-cure me.” types. Or my ferret polished off my new xanax and Vicodan scripts, and can you write me out some more?

    When did it start it was okay to abuse ER staff.? No other doctor specialty would put up with that crap.

    • Nurse K says:

      Kevin didn’t say it was OKAY to abuse us, just that we shouldn’t do anything to prevent abuse except express understanding of their issues, whatever they may be.

      Sort of like leaving all your doors and windows open and then reasoning gently with the burglar when they try to take our flat screen.

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