Part One | Part Two|
Part Two – Psychological Price of Becoming a Patient
By: Jean Johnson for Medtech1
“It’s nothing new,” Northern California political science professor Ginger Baker, Ph.D. continued. “This idea of how dehumanizing the medical world can be. Remember that book by a doctor who got cancer? It came out a decade ago at least, I think. Anyway, it was precisely the shift in status that troubled him the most. He went from doctor whatever-his-name-was to plain old Bob. And believe me didn’t like it any better than the rest of us do. It wasn’t the first name thing per se, but the attitude behind it. And as he observed, when the doctor uses not only surname but title as well, having the patient go by just their first name sets up an equation that’s off kilter from the very start. And if you don’t believe words and forms of address are powerful, just consider the way we address the president of our country. Certainly, calling him George would be considered a sign of disrespect.”
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| Author Susan Frampton offers an example of why, as either a patient or a staff member, you should consider the feelings of the person on the other side of the counter |
Patient: I’d rather be called by my surname, but the times I’ve actually said that, I’ve encountered even more hostility than usual.
Staff: Only the doctor has a title. Everyone else has always gone by their first names, the staff included. If patients want their last names used, though, all they have to do is say so.
Patient: An attitude and tone of voice that makes me feel like a child is insulting.
Staff: We are only trying to be sympathetic. Many people are nervous or don’t feel well when they come in and we are trying to acknowledge that.
Both examples from “Putting Patients First: Designing and Practicing Patient-Centered Care” illustrate the importance of considering what the other party is thinking or feeling.
Baker’s point on titles and forms of address used in the medical world was touched on briefly by The New York Times in its focus on dehumanizing aspects of what many patients endure, but the paper gave more attention to physician attitudes. Once again, a female patient’s experiences were highlighted – in particular, those of 55-year-old Mary Duffy.
According to the Times:
“Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room. Without a word, one of them – a man – leaned over Ms. Duffy, pulled back her blanket, and stripped her nightgown from her shoulders. Weak from the surgery, Ms. Duffy still managed to exclaim, ‘Well, good morning,’ a quiver of sarcasm in her voice.
But the doctor ignored her. He talked about carcinomas and circled her bed like a presenter at a lawnmower trade show, while his audience, a half dozen medical students in their 20s stared at Ms. Duffy’s naked body with detached curiosity, she said. After what seemed at eternity, the doctor abruptly turned to face her. ‘Have you passed gas yet?’ he asked.
‘Those were his first words to me, in front of everyone,’ said Ms. Duffy, who runs a food service business near San Jose, California. ‘“I tell him ‘No, I don’t do that until the third date,’ she said. ‘And he looks at me like he’s offended, like I’m not holding up my end of the bargain.’”
Body1, of course, took the tale of this incident out and about in search of physicians willing to comment. Several we invited to comment declined, but eventually we found Miles Hassell, M.D., medical director of Providence Health System’s Integrative Medicine program in Portland, Oregon. From what we gathered, Hassell is apparently so much on target treating patients with dignity that he wasn’t threatened by the question: What’s at work behind this seemingly impermeable façade the medical profession has erected between its practitioners and those patients it serves?
“Discourtesy is just rude. And acting that way is a reflection of an individual’s attitude. You’re not going to be rude to some hero – most people aren’t anyway,” Hassell said. “Lack of respect, then, is what’s being communicated in the New York Times story. That surgeon wouldn’t walk into the room of his own aunt and treat her that way.”
Hassell also notes that his staff and most of his patients call him by his first name when he’s at work. “I don’t really care what a physician gets called, even though since I was trained in a more formal system in Australia, I usually ‘Mr.’ and ‘Ms.’ my patients. Formal address has its place in the world of medicine where normal barriers of physical space must be broken. So I think a little formality puts a nice coating on relationships.”
Baker, on the other hand, takes issue once again. “The problem as I see it is in the lack of parity. I’m glad to go by Ginger if the doctor uses her or his first name too. It’s just that throughout the healthcare system everyone except the doctors go by first names. In one breath is Jane this and Joe that. And those very same nurses or administrators or PR people turn right around and do the Dr. thing. ‘Right away, Doctor.’ That sort of thing. It just feeds the hierarchical establishment, and you know ultimately that it breeds resentment – resentment that I think is taken out on patients who, whether they like to admit or not, are at the bottom of the heap. If we all either did last names – that probably are more appropriate for the medical setting – or first names across the board, I think we’d be a whole lot better off. ”
A Seattle banker, Mark Sohenberger, thinks Baker is onto something with the medical hierarchy model. “For me it’s not so much the doctors as it is the staff. Frankly, it reminds me of being in the military. First there’s the receptionists who seem intent on doing their very best to patronize. It’s not so much the first name as it is the way they say it,” said Sohenberger.
“Tone-talking is what I call it – voice body language. What I’ve experienced consistently over the years are two versions. First there’s what I guess is their version of a professional demeanor, but it comes across as pure arrogance since it lacks sincerity. Instead there’s this unspoken message – something to the effect that ‘listen hear my friend, you need us way more than we need you at the moment, so get in line, take your lumps, and play-pay our game.’”
“Play-pay. Yes, that’ my private little coinage to depict what I see going on in the medical world.” Sohenberger stopped shortly to collect himself from memories so upsetting that his initially pleasant voice turned strident. “And if the first rung in the gauntlet isn’t repulsive enough, there’s act II to follow. I mean, these doctors don’t settle for merely one set of guard dogs. They charge you enough to set up a big Wizard of Oz façade,” said Sohenberger, recovering his humor and chuckling. “So you get the nurse person or whatever they are stepping through the door to inner sanctum door and making her pronouncement: ‘Mark, Doctor will see you now.’ By then, I’m seething and also wondering why ‘the doctor’ has turned into ‘Doctor.’ I’m also – as a banker would – trying to tally up just how much all this first and second rate act stuff ends up costing me. Being jerked around is one thing, but paying through the nose for the privilege is another.”
Curator of a London university museum collection, Laura Peers, Ph.D. who is Canadian has had similar experiences and agrees with Sohenberger that oftentimes, it’s the staff, not the physicians themselves, that is most egregious when it comes to minding their manners. “It was back when I lived in Canada and my sister had surgery,” Peers said in a quiet, studious voice, composing her thin hands in her lap. “I’d gone in early to wait and was minding my own business when the receptionist said some pretentious thing – I don’t remember now the exact wording but the effect was that she was quite the person of importance, and I was merely some peasant who needed to be grateful – not to mention dutiful – for a spot in her domain. Anyway, I lifted my eyes from my magazine and said, ‘It’s a little early in the morning for patronization isn’t it?’ That was the end of it. She was visibly angry, but took her ruffled feathers off to bully someone else and let me be.”
Not all agreed that becoming a patient – or a friend of a patient – means forfeiting one’s dignity, of course. Indeed, one of the letters to the editor that the Times piece on Meg Gaines spurred was written by Arthur Yeager of Edison, New Jersey. Yeager took the position that those who complain are just ‘whiny’ and that hospitals’ first responsibility is to ‘render competent effective treatment’ not cater to people like they are in a hotel on vacation.
Regardless of where in the debate one stands, however, simply knowing the discussion is out there can be helpful. Clearly, taking on the mantle of “patient” is loaded with all manner of quandaries and varying degrees of emotional upheaval. So realizing that others have walked similar paths, had parallel experiences and reactions, and finally, are engaged in serious debate about appropriate conduct on the part of healthcare professionals can be empowering.
Concluded in Part Three