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Foreward “Would
you just back off!?!”, I snapped at Marie, a well-meaning nurse. I am no saint.
Although the red hair is augmented, I come by the temper genetically.
Having read on anger, rudeness, and incivility a lot recently, I
recognize it as a learned behavior…and one I should be able
to curb. It had been
a rough day in Endoscopy…patients having been mis-scheduled
due to new office staff were coming in hours early or not at all,
the ER was calling with critical bleeders, the floors with inane
questions and long hold times. In the midst of my latest colonoscopy,
my home fire alarm went off. The monitoring service, as they should,
called me (I had been having 4AM false alarms all week). However,
this false alarm was at a different time than usual, so I needed
the fire department to go out to my home. It was into
the midst of an urgent call from the fire chief requesting my presence
at my home that Marie, all unawares, stepped. After I completed
the call (no, I would/could not go home in the middle of the tightly
packed day), I took several deep breaths, and then went to find
Marie. I owed her my apology. I found Marie
in the recovery area of endoscopy, releasing a different patient
to home. In front of the patient and family (she deserved that at
least—I had “flamed” her in the hearing of her colleagues),
I apologized for my behavior. I was astonished
when Marie lit into me. A soft- spoken, helpful, heretofore meek
individual, I had not heard her raise her voice or speak in her
own defense. But I heard her now. In front of
the patient, she told me that she was looking out for my patient
and his family, and that she felt that I should be able to control
my behavior more professionally. She said a great deal more, but
I’m afraid the burning of my ears blocked out all but the sting
of reprimand. I had spoken
to the nursing staff on the incivility epidemic in medicine, of
the poor patient outcomes and the nursing burnout that are a consequence.
I had discussed several techniques to use on physicians or rude
associates to curb behavior, to nip it in the bud. I had encouraged
the nurses to take action immediately to alter such behavior patterns,
much as one would use a newspaper to smack a puppy that piddles
on the living room rug. I was chastened….I was trained… And I was proud, so very proud, of Marie. Chapter XX David, my senior
partner strutted down the hall in our office,bearing a close resemblence
to Balloo from Jungle Book. As he drew near, under his breath I
could hear the strains of the immortal tune….”Zippidy
Doo Dah, Zippity Yay….My oh my, what a wonderful day….” Yes!!!! We’d
done it! We had proven that doctors CAN be trained! Hiding my smile,
I stepped back into my office, closed the door, and called Linda,
a nurse at the hospital. Whether doctors
can be trained or manipulated is not really open to question…you
really don’t think that the pharmaceutical industry spends
so much money on pens and pads emblazoned with drug names because
they want to make sure that our children have enough writing implements?
No, I’m sure that a bunch of money has been spent proving that
we docs are quite suggestible and subliminally directed. But now
we’d proved that we could do it in a clinical setting. The scam—we
wanted to see if we could plant a song in the brain of a physician. It had worked,
and David had no idea where the cheery tune, not heard perhaps for
decades had sprung from. We had achieved mind control! Why do you care?
Well, much of the incivility that we experience comes from one on
one contact---not whole group gang ups. We need to show that we
can control the behavior of others, either overtly or subliminally,
for a brief period of time. Please note,
David had lost the song by morning. We do not preach that we can
change your overall behavior, influence the change of a life, or
cure cancer. However, when I read about control of obnoxious behavior
in others being impossible, that you can only change your reactions
to it, I say an unqualified “Bullshit”. Physicians are
smart, and are trainable. We are at least as smart as dogs, perhaps
not as smart as cats. You will not be able to affect a life charge,
a persona change. But you should be able to train us to act in an
appropriate manner when around you, the trainer. Lets carry this
dog training analogy along further. A viscious pit bull can get
trained, but is no less viscious. A retriever is trainable, but
started out lovable. We do not propose to change the basic nature
of the beast, just to school them in appropriate collegial behavior. Lets talk about
what usually happens when a doctor acts up. The current scenario
at most hospitals is that the doctor gets “cranky”, takes
it out on the nurses. The nurse speaks to the head nurse, who asks
her to report it in writing to administration. Several days later,
it is received in administration, reviewed by committee, and a form
letter is generated after the next scheduled committee meeting (in
about a month) telling the doc to be nicer to the nurses, but being
very vague on details. The doctor’s miffed. He/she can’t
recall the incident, aqnd had someone told them of the problem,
then they could have corrected their actions. Miffed, the doctor
goes on rounds, and the world continues on its unending axis. What is this
like to the offending doctor in dog terms? Think of the doctor as
a somewhat clueless puppy, newly aquired, who has just piddled in
the middle of your new white living room rug. You’re upset
immediately, but don’t say anything to the dog. Then one month
goes by, and WHAM, out comes the rolled up newspaper! And the puppy’s
going….HUH? What I do? Some way to teach a dog, isn’t
it? Here’s
the thing—you’ve got to hit us with the newspaper right
at the time of the event if you want to make a change in our behavior.
It will take a commitment on your part, but you will end up with
a well-trained dog over time, at least in your home and with regards
to piddling. Thus we need
to discuss techniques to train. The rolled up newspaper (figuratively
please!) is quite direct, and most are not brave enough to face
the offender down. However there are some oblique and even subliminal
behavior modifications that you can implement to control the behavior
of your docs and your more unruly colleagues. Here they are,
from easiest and least direct to fully confrontational: 1. Technique:
Possession is 9/10 Possession is
9/10 You are in possession
of your clinical space…we doctors are only visitors. Although
it sounds a lot like one of those 1950s wifey things, have you made
your unit a nice place to be? Do you greet him at the door with
problems and whiny snotty children, or with his slippers, nice music,
and the smells of supper? Sometimes wer’re
stressed (duh!) and arrive late at the unit to have no nice greeting,
but an entire litany of problems cast at our feet. This is not the
way to start our interaction. How about a
simple “hello” or similar greeting first, the gently launch
into the problem as well as some possible solutions for it? One
of the things we’d like to enhance in medicine is the collaboration
in patient care of medical caregivers, so don’t wait to be
asked, just tell us a solution…often we’ll be glad of
your solutions. Control the
environment. How about music, flowers, snacks? How about a joke
board, a quote of the day? How about having a clean space to work,
charts that are complete with paperwork. Not only will
your docs respond favorably to this very 50s environment, it can’t
but make you feel better organized as well. Virginia Beach
gastroenterologist, Patricia L. Raymond M.D. FACG is an author and
consultant, who speaks to nurses and physicians through hospital
systems and medical conventions. With her company Rx For Sanity™,
she humorously leads physicians and nurses to rediscover their joy
in medicine and to learn to first “Turn Care Inward”.
Her book, “Don’t Jettison Medicine: Resuscitate Your Passion
For The Career You Loved!” is available now. Visit www.RxForSanity.com
soon for complimentary information and links to better care for
yourself and for your staff, and to subscribe to our FREE monthly
newsletter, Rx For Sanity™ eNews, with medical humor and simple tips
to enhance your life in Medicine.
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About Dr. Raymond • Speaking Topics • Articles • The Sanity Store • Sensational Free Stuff Subscribe to Passionate Health Care Newsletter Subscribe to Your Health Choice Newsletter Patricia L. Raymond, MD FACP FACG 757-547-0368 • 757-547-7727(Fax) • PLRaymond at RxForSanity.com All Rights Reserved. © 2007 Patricia L. Raymond |
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