Friday, February 04, 2005

A Soft Answer Turneth Away Wrath

"Speak when you are angry and you will make the best speech you will ever regret."

-Ambrose Bierce

Once upon a time a fire broke out in a house, and as the fire chief arrived he could see many people hanging out of the windows upstairs, hollering for help. He quickly drew up a plan and his team of firefighters went to work with ladders and hoses. There were more people to be rescued than rescuers, and some victims had to wait their turn. Some residents became irritated and insulted their saviors, calling them slow, or clumsy. As the blaze was extinguished, a crowd gathered around the chief and bitterly criticized his leadership. When he defended his plan they accused him of being rude and unsympathetic. The chief tossed his helmet to the ground and lashed back at the residents. He blistered their ears, calling them ungrateful.

Some patients, like the sooty patrons of the house in this fable, have limited insight into the work involved in trying to save a life. They may be rude, demanding or unappreciative of their doctor's efforts. They might even be so blind as to fail to see that they have just been pulled from the consuming flames. How the doctor reacts to the cavils of the very same people he is sworn to help can determine both the success and the length of his career. No doctor enjoys caring for an obnoxious patient, no matter how infrequently this creature is found. If, however, a physician gives in to the temptation to humble the insolent, he places his calling in peril, and not just because of the possibility of being denounced to the State Board (cf. Blair, Eric Arthur 1903-1950). More importantly, once a doctor blows his stack he now has two adversaries competing for his attention - disease and anger.

All doctors experience "one of those days" when they cannot seem to please a patient or family member, or when they run into someone whose cup runneth over with churlishness. Since doctors tend to be self-centered and overrate their social skills, they interpret a negative reaction as an affront. They become incensed that anyone would dare to question their judgment or compassion - why some kingpins would even go so far as to call it lese-majeste'. Although it is acceptable as it is unavoidable that some hackle-raising will occur at this time, the doctor must quash anger before it bursts through the cracks. Anger is not only unprofessional, it is like smashing The Portland Vase in a fit of rage - one feels a savage sense of satisfaction at first, but then try to leave the museum without the guards noticing. A doctor who erupts at a patient will have to face the consequences sooner or later. His most precious commodity - his reputation - will sink like a torpedoed freighter if he fails to control his temper.

What then, could our beleaguered fire chief have done to soothe the irate crowd short of submitting his resignation? Well, for starters he could have summoned up what seems to be a rapidly disappearing attribute in these days of reality television - self-discipline. It takes only a moment of deep-breathing to delay the wrathful response, and by then hopefully another helpful concept, like a record plopping on the old jukebox, will begin to play in his mind - perspective. Keeping everything in perspective should be a constant goal of the doctor as he counsels, so that those in need understand that treatments such as chemotherapy, with all their distressing side effects, are necessary to achieve the prime goal of remission.

If these techniques are still ineffective in getting the villagers to drop their scythes and torches, try my personal favorite defense - humor. The use of humor in oncology has been neglected and is just now being recognized as an effective way to help patients cope with their illness. When applied appropriately it is a great way to raise spirits and give hope - especially if the boss tries a little self-deprecating jesting.

Finally, the doctor's last defense in a midst of a potential confrontation is this, as best relayed by the character Sgt. Barnes in the movie Platoon:

"Take the pain! Take it!"

In other words: shut up, Doc, and let the rant burn out on its own. Remember, this too shall pass, and the head will rest easier on the pillow tonight knowing that once again anger tried to take command of an emotional situation, and once again it failed like the miserable chump it is.


At 12:24 AM, Anonymous Anonymous said...

...and then remembering not to resent them for it later. self-discipline, perspective and humor. what a wonderfully pithy way to sum up how to deal with almost any sort of person. i just like to remember deep down in my polyanna heart that people are inherently good and would treat you exactly the way you'd want to be treated all the time, if it weren't for that pesky filter of emotions, experiences, memories, hormonal imbalances, drugs or mental disorders.


At 1:17 AM, Blogger Joan said...

Your excellent advice can be condensed into the following handy rule: "No freaking out."

Here is the excellent illustration that accompanies it.

Obviously this lacks finesse but so far it's working pretty well for me, and my three kids.

At 7:54 AM, Blogger Orac said...

Good advice. Unfortunately, surgeons are among the least likely to take it, perhaps because so much of our identities are tied up in our surgical skills.

Another specialty where patient "ingratitude" can lead to problems is trauma. Back when I used to do trauma, many were the times when I felt zero appreciation after staying up all night operating on a car crash victim or gunshot victim, only to find the family berating me and the hospital. Many are the times when I had to exercise great self-restraint to hold my tongue.

At 2:11 AM, Blogger Chris Rangel said...

You forgot one important tactic. It's one my mother taught me. -->SMILE<-- act nice, nod, say I "understand" and "I agree" a lot.

Or in the very least look concerned and "pretend" that you entirely agree with their tirade while at the same time you defend yourself and try to explain why their complaints against you are entirely friggen wrong and baseless!

Patients blow up at their doctors for numerous reasons and few of these reasons are rational. They are scared, under stress, in denial, feeling powerless, and they usually don't understand the processes of medical diagnosis and treatment. They seek compassion or possibly someone to "unload" on.

Remaining calm and at least making the appearance of compassion is the best way to maintain a good relationship with your patients. It's even one of the best ways to avoid a lawsuit since the majority of lawsuits are not filed over malpractice but because of a bad outcome and a poor doctor-patient relationship.


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