Thursday, October 23, 2014

It's easy to be a jerk

I was recently reading an article on why doctors can be such jerks.

I wouldn't describe any physicians that I currently work with that way but I've certainly worked with plenty of jerks in the past. There are jerks everywhere, but it does seem like the percentage of doctors that are jerks is maybe somewhat higher than average.

This article talks about why doctors are jerks. The two reasons are first that doctors become arrogant and look down on their patients, and second that doctors become jerks when they're frightened or stressed out, which is obviously common in medicine.

I think part of the problem is that it's often easier to be a jerk then not to be a jerk.

For example, I was recently trying to reach a doctor at another hospital with a question on a patient. I had been waiting an hour for them to call back, and when they did, a random nurse picked up the phone, and told them that nobody was trying to reach them and then hung up, without even asking around.

I was so angry, rightfully so, I believe. It would've been so easy to snip at that nurse for what she had done wrong, and I'm sure I would've gotten away with it, considering what she had done had compromised patient care. It was much harder to take a few deep breaths and calmly explain the situation to the nurse, and then go through the process of reaching that doctor again.

Or to give a less obvious example, often when I walk onto the ward, immediately everyone descends on me with questions, before I've had a chance to catch my breath or get my bearings. It can be very tempting to snap at everyone that they need to step back and give me a minute.

Taking care of patients can be really frustrating, and it is actually really hard to calm yourself down and continue to be kind to the people around you. The staff on my unit call me the "nice doctor" because I try so hard to be nice and approachable, no matter how frustrated I am, no matter how much I feel like if somebody asks me one more thing, I'm going to punch a wall. I monitor every word that comes out of my mouth, to make sure that is not something that would hurt another person's feelings.

You'd think that would be easy. And some days it is. But many days, it is a real challenge.


  1. The nice doctor, eh? They've clearly never gone shopping with you. ;P

    I would rather your stress come out at Kmart than in the clinical setting, though. It's so hard to manage. Stay strong!

    1. I feel like I have incorrectly given people the impression that I am ranting and screaming like a crazy person at the stores. I don't have the personality to do that. My daughter was more upset that I was persistent and taking a long time to resolve the situation, and ranting and fuming about it after we left the store.

    2. I don't think you're ranting and raving, Dr. Fizzy. I believe you're having a hard time dealing with frustration. In your own words though, "my daughter was more upset than I was....ranting and fuming about it after we left the
      store." Why do you think that's so Dr. Fizzy? No sarcasm intended.

    3. It's so easy to criticize others. Sounds like your behavior on the wards is quite appropriate. We all get frustrated for similar reasons and I don't think it's anyone's place to criticize the feelings or thoughts that go through your mind while doing your job perfectly well.

      When I call doctors at outside hospitals I usually give my cell phone number to make it as easy as possible for them to reach me.

    4. Hmm. I don't think it's inappropriate to be upset when you spend 30 minutes trying to buy a pair of sunglasses while dragging two cranky children around the store, just because the store failed to label the item appropriately. I would be impressed with somebody who remain completely calm and polite through that entire ordeal.

    5. In response to PGYx, I agree it's easy to criticize others. I personally could not handle the academic rigors of medical school nor the abuse that is attached to it. I feel a deep sense of sadness as I read stories about the difficulties physicians face in this new era of medicine. However, while I sympathize with Dr. Fizzy's plight, I understand the difficulty in dealing with unreasonable people. Perhaps it's an expectation of reasonableness that is at the crux of it. Yes, the store
      should care about retaining you as a customer. Yes, they should have
      handled the K-Mart and the Pottery purchase differently. Yes, if I was
      manager, you would have had a different outcome. However, since that
      is not the case, how much energy do you want to give it? Visualize the
      problem, process it and be done with it. I offer this as a person who suffers from low frustration tolerance, especially when confronted with
      these types of situations. I wish you Dr. Fizzy and PGYx only the best.

    6. I read this article the other day. It put things into context.
      Please accept my apology Dr. Fizzy.

  2. I am not in the hospitlal, but primary outpatient clinic.We have the same situation where we are bombarded constantly with questions, requests. We can be reached via instant messaging, electronic record, email, paging operator, phone and personally by staff knocking on your door. And often you are contacted by several people at the same time. Nurse or two stand next to you, reporting, then phone rings, then someone requests order via instant message that pops up on your screen. And that's all day. I too am more responsive than my colleagues, some of who are known to say "I will get there when I get there". For 2 reasons, the faster I resolve the situation, the faster I can go back to current business, and the faster another staff person can go back to their job. But it can be stressful. And sometimes I remind my kids when they are giving me a hrad time in the evening, that I already have a hard day behind my belt. I am saddened that since its unacceptable to show your stress at work some of us do it at home with people we most love. My way of handling it is dedicating more time to my own rest. I take 1-2 hours each evening for reading, walking, TV. I schedule events with my own friends, try to go to the spa. And I walk every day at work during lunch break. we are all human. Don't bottle your stress, find the way to diffuse it.

  3. What is a jerk? According to various sources, it's a person who treats others badly. In effect, someone who is acutely aware of their own pain but not others. So, if a person is literally on fire, does that make them a jerk? Of course not. However,people are "on fire" all the time and we accuse them of being jerks. I prefer to think of them as people who are in a great deal of pain, and for the moment, can't see outside themselves. So, the next time you see a "jerk", understand the pain. Yes, kindness matters.

  4. I am a pgy2 and I kinda made an internal vow to be more of a jerk because some of these inefficiencies at my hospital are killing me.

    There are many little daily frustrations that I am starting to feel obligated to combat or else I will go insane.

    1. After a few years of frustrations I started doing the same thing just to get by. I don't like being like this, but I'd rather be a jerk / lash out / "be assertive" / stop caring who I step on than feel helpless or depressed. There doesn't seem to be any good options when the things around you cannot be improved.

    2. Question: When you see someone being unfairly treated because they
      are in a subordinate position, do you feel the "assertive one" is strong
      or weak? Being in control of your emotions makes you strong, not helpless. Yes, there are times when we're in situations that are beyond
      our control. As you rightfully pointed out, you don't want to be the one
      who is doing the hurting. Do your job, accept the limitations that cannot
      be changed and leave the rest to God.

  5. I am an MS2 at a school that puts a really great emphasis on communication skills. We have already practiced (with standardized patients) delivering serious news, informing patients of an error we were involved in, etc. We watch video of ourselves interacting with patients and memorize brief mnemonics about patient-interactions. … Then I do shadowing at some of the very big, very inefficient, very complex, very high acuity hospitals associated with my school. I quickly get the impression that we will have all of the empathy and enthusiasm quickly drained out of us. I do think that some of the training we are doing, however, will stick with us. I believe in training that way. … I think these "micro skills" will come in handy. I think I will remember and use them. … But I worry in informal situations we will, many of us, soon be jerks. So I do think our school is doing a good job at changing some of the shortcomings of medicine as far as some aspects of patient communication. But I fear that the inter professional and informal communication we will still be jerks. Thoughts about this?

    1. Imagine yourself in one of these practice situations, but wearing a wireless earpiece in one ear and a pager on your belt. While you are talking to the patient, once every minute a voice in the earpiece yells "What is taking you so long! Why are the notes not done?!! Why have you not sent Mrs. Smith home yet?!!!
      Every 5 minutes the pager goes off, and you have to leave the room and call back because you cannot tell whether a page is a code or an expiring foley order until you call. When you call, the person who answers does not know why you were paged or who paged you, but they will find out. So you are on hold for two minutes. When the person who paged you comes to the phone you learn that no, it was not a code, it was an expiring medication order (your hospital sets all pain medication orders to expire in three days regardless of the patient's status), and the patient is not one you are covering. The nice doctor thing to do at this point is to help the caller identify the correct team. If you do this, your pager will go off before you return to your very important patient conversation. Also do not forget you still have the voice in your other ear. This is the point where you think about how nice it would be to be known as the mean doctor, the one no one wants to call unless they are absolutely sure they are calling the correct team, and when they do call they wait by the phone. At this point becoming a jerk seems like the right thing to do for your patients.
      It is not. You do need to be firm at times, and you will need to be direct all the time. You will need to fight with hospital administration. You will need to ask to speak with the supervisor, and the supervisor's supervisor. You will need to request a printed copy of the policy that prohibits you from doing what your patient needs done.
      And when you have an important conversation with a patient, try to get someone to cover your pager.

    2. For the second time, General Surgery. To the MS2 above, match the first time.

  6. No disrespect to the subject of this post, but a NYC physician has tested positive
    for the Ebola virus. Do we get our collective asses out of West Africa or do we
    stay put, offer our assistance in spite of the risk involved?

  7. In response to off-subject post about Ebola. … This person got Ebola in West Africa. Not here. … We are doing more to protect ourselves by helping to combat it where it is rather than letting it go pandemic there and be a bigger threat in the longer term here. IMHO.