I have written in some detail about how medicine is one of the fields where asshole poisoning appears to run most rampant. I've written about Dr. Gooser and research showing that medical students and especially nurses face many demeaning doctors (See an artist's vision of Dr. Gooser in action to the left). I have also written about how one surgical resident and his colleagues took action to break the cycle of abuse that is so common in hospitals. And I recently saw some hints of how doctors -- especially a couple of surgeons -- can have attitudes toward nurses that fuel such nastiness. I gave a talk to Stanford alums a few weeks back (in fact, Kent Blumberg was in the audience), and two doctors pushed back on my claims that nurses face especially high levels of abuse, both claiming that nurses are often overly sensitive to their comments, and one saying -- at least as I interpreted it -- that there are times when nurses are messing up and deserve to be slammed, I am sure that nurses, like everyone, make mistakes, but as Amy Edmondson's research suggests, when nurses are afraid to speak up and are belittled when they make errors, it leads to less learning and more mistakes.
There is, however, another side of his story that I have not touched on: What about abusive patients? Certainly, doctors and nurses who face nastiness and insults from patients can suffer the same kinds of negative outcomes -- anxiety, physical illness, reduced motivation, and catching the nastiness -- as happens to anyone else who encounters assholes in the workplace. I have written about dealing with asshole clients, about how some organizations and people just refuse to serve them, and others levy "asshole taxes" to get some payback for their suffering at the hands of these creeps. Well, as you will see below, doctors do get rid of difficult patients, but even assholes deserve health care. And charging them more seems suspect to me.
Along these lines, I got a request from a doctor for ideas about how he should deal with asshole patients. Here is his email (with just a few things removed to protect his identity). It is a charming little note, with come interesting turns. I invite you to read it carefully, and in particular, to suggest some useful ideas for this and other doctors who face mean-spirited and demeaning patients. This is not an easy task:
When I was doing my internship after medical school, my best friend
there and I had our own version of your rule. This came up while we were
playing Monopoly on a day when we were snowed in. Over the course of a
long day of Monopoly, multiple small disputes would come up, and we kept
creating rules and sub-rules to address all the different permutations of our
disputes. Eventually, we just created a no a-hole rule, and all the
tension subsided. All parties involved knew what it meant to be a decent
person, and wouldn't cross the line. I've tried to integrate this rule
into every aspect of my life, and succeed most of the time (although, as you
noted, there are those times where I deviate- and your book brought about some
needed self reflection).
On a similar note, there is a version of your rule in Utlimate Frisbee. Even at the highest level, Ultimate is played without a referee. Instead, the players invoke "The Spirit of the Game"- and all parties agree to not be a-holes and allow disputes to resolve by their good will. It's a great rule, and it works pretty well.
As a physician, I find the hardest part of adhering to the no A-hole rule is my interactions with patients. The vast majority of my patients are a delight, and what fuel my desire to be a physician. However, as you noted, 1 negative interaction can have far more impact than many positive interactions.
In particular, I deal with patients who have some form of pain, and some of these patients can be nasty, impatient, entitled, and just in general be total certified a-holes. While many of your suggestions work well in other contexts, as a physician I have a professional and ethical obligation to continue to provide as high a quality of care as possible, even if the patient is being an a-hole.
Do you have any recommendations for how physicians should deal with a-hole patients? The most popular current method is the "dump," where colleagues will refer their problem patients to other physicians (the famous "referral preceded by an apology."). While this sometimes helps find a patient-physician interaction that works for everyone, more commonly it just spreads misery around, and doesn't help anybody. Any feedback you have would be appreciated.