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Sun, Feb. 23

THE GOOD PATIENT: Actions you can take when doctors act disrespectfully

Are you kept waiting for a long time to see the doctor? Do you get "patronizing and dismissive answers" to questions you ask? Have you gotten the sense that you didn't get the whole story - "full and honest disclosure" - when something went wrong in the course of treatment? Did you ever feel later that you weren't given the information that would have allowed you to make a better choice about getting certain tests or treatments?

According to six doctors and another expert writing in the journal Academic Medicine, these are all types of "systemic disrespectful treatment," that are "so common and so intimately woven into the healthcare environment and everyday work that they are accepted as normal and often are not recognized as disrespect."

What else do the authors mean by disrespect? They quote from an extensive list used in Ontario, Canada, in a procedure manual titled Guidebook for Managing Disruptive Physician Behavior. (The authors of the journal article strongly recommend that all hospitals create policies and procedures, as the Canadians quoted have done, to address such behavior).

Some of the examples they give of disruptive behavior are: "profane, disrespectful, insulting, demeaning, or abusive language; shaming others for negative outcomes; demeaning comments or intimidation; inappropriate arguments with patients, family members, staff, or other care providers; rudeness; outbursts of anger; behavior that others would describe as bullying; insensitive comments about the patient's medical condition, appearance, situation; jokes or non-clinical comments about race, ethnicity, religion, sexual orientation, age, physical appearance, or socioeconomic or educational status."

Is there ever a justification for such behavior? It is hard to find one.

But what about patients who may not be model citizens? Maybe they land in the emergency room several times a month without good reason. Maybe they have a history of drug abuse. Maybe they have a mental illness that leads to behavior outside acceptable bounds.

Imagine a doctor at the end of a long day or a double shift at the hospital, dealing with a large volume of life-or-death crises - and the next patient he sees is what hospitals term a "frequent flyer," for whom the hospital exit seems to be simply a revolving door. Maybe this patient is known to shop around to see how he can get the highest volume of prescription narcotics.

Then is it justified to deal with the patient using "profane, disrespectful, insulting, demeaning, or abusive language" and so forth? Again, it's hard to understand how doing so might be expected to improve this challenged - and challenging - patient's health and wellbeing.

What can you do if you are on the receiving end of disrespectful treatment?

It's a very difficult situation for patients. If the doctor is one of a small number who can provide a service you need, or you don't feel that you can wait for an appointment with someone else, you may feel that you have little choice but to tolerate the behavior.

If you want to try to improve the situation, you have several options.

First, focus on key points that you need the doctor's expertise for. Lay out clearly your main issue; how exactly it interferes with your life; and what you want from the doctor: a quick fix for pain so that you can leave on vacation tomorrow? Information about long-term treatment options?

Second, ask the office manager or one of the nurses for help. For example, "Can you suggest how I might approach my next visit with Dr. X so that I get my questions answered?"

Third, if you are up for it, you can try using a technique called "'I' Messages" to explain how the doctor's behavior affects you. "I" messages have four parts: the action the other person takes (described without inflammatory language), how you then feel, why you feel that way, and the consequences for you. For example: "When you turn your back to me and change the subject when I ask a question, I feel diminished and upset, because I conclude that my priorities aren't important to you, and then it is hard for me to want to follow your advice."

Just be prepared for option number 4: find another doctor.

To tell your story, propose a topic, or ask a question, write to

Bewley's latest book, a collection of 40 articles from this column, is available locally at Hastings and at Peregrine Books and online at Amazon. It is entitled "Not Your Grandmother's Nursing Home: Demystifying Today's Retirement Living Options."

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