When patients yell at staff, they end up hurting themselves

For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was picked up and slammed down.  My staff had no better luck and therefore, I decided to try once more and then send a registered letter.

The phone rang four times.

“Hello, who is this?  Who keeps calling?”

“Hi, this is Dr. Salwitz, I was trying to get a hold of Stan.”

“Dr. Salwitz’s office?  You should never call this number.  I am sick and tired of people bothering us and calling all the time!  Can’t you people ever get things right?!  What a way to run an office!!  How unprofessional! I am going to call Dr. Salwitz and tell him! What is your name?!”

“Ah … This is Dr. Salwitz.”

“What?”

“This is Dr. Salwitz.  Is Stan home?”

It turns out we had an old number, which Stan was planning to disconnect, and we had failed to change it in our file.  But, shaken, a little, I considered the conversation.

With notable exceptions, patient’s rarely yell directly at their treating physicians.  In the eloquent words of Stan’s wife, the proverbial drek really needs to hit the spinning blades for patient’s to think they will advance their health care by pissing off their doctors.  However, being sick is infinitely hard, emotionally draining, psychologically confusing, and you often feel, well sick, so it is difficult not to express mortal frustration.  Therefore, patients yell at front desk staff, nurses and other critical supporting caregivers.

I understand and am sympathetic to why this happens.  You feel bad, really need help, relief, and then something “stupid” gets screwed up.  The prescription is not called in.  The appointment is not scheduled or even more frustrating, is at the wrong time.  The insurance precertification comes late or not at all.  The doctor is running two hours behind, when you already feel so rotten you belong in bed.  Bad news happens or threatens.   So, you blow up.  But, at the staff, not the doc.

The problem is that patients and their doctors really need support staff.  They are vital to each patient’s team, but vulnerable. They often do not have the training, experience, motivation, or, to be honest, salary, to bounce back well from personal assault.  They may mean their best, but after a few dozen abusive interactions, their best might have an edge of mean.  Burnout rates for staff can be high, which affects patient service, resulting in deteriorating care.

Like it or not, we yell at our own risk.  The person we hurt the most, may be ourselves.  So, I have two suggestions.  Try to take a deep breath and remain civil, even when things are not going well.  It will result in a better outcome and be deeply appreciated.  Second, if things are not getting better, ask gently to speak to a supervisor. Perhaps, they can solve the problem without fireworks.  Try to see the person in front of you as a core part of your care team.   If you do lose your stack, remember to apologize.  A “sorry about that” goes a long way; it probably heals better than donuts or pizza.  Stan’s wife was immediately apologetic, which mended any bad feelings either one of us might have had.

Perhaps, we all should use a simple rule: Try never to yell.  That does not mean we do not get mad, just recognizing that projecting anger is often counterproductive.  There are two types of people in this world.  The ones we want to work with, and those we do not.  The ones we want on our team, we should treat with respect and support.  No reason to yell.  The ones we do not want are not worth the energy of shouting.  It just accelerates the dramatic.  When things get bad, remember that everyone in the doctor’s office is part of your team.  The better you are able to treat them, the better they are able to care for you.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Lisa

    Several of the people I support are known for loosing their temper when they don’t get their way. As I part of function is a ‘gate keeper,’ I sometimes have to tell them no and risk getting yelled at. It comes with the territory and I know enough not to reward their bad temper by changing my advice. They can always talk to my boss, who will back me up based on facts.

    While I have never yelled at doctor’s staff member and would never do so, I have been tempted to. Or at least say something sarcastic . . . I have repeatedly told the front desk at my pcp’s office that the best number to reach me at is my work number. That number has never been put into my files, so I frequently have to play phone tag with the office. Ah well, at least my oncologist’s office staff gets it right.

    • Mark Wheatley

      Why has the number never been put into your files, can you explain on that a bit please? Have you given it to them? When you do your first of the calendar year update your info form checkover of everything do you update it then?

      • Lisa

        I gave them the number when I first started seeing my pcpc. I have given them the number on a yearly basis when I update my info and history. If I have to leave a call back number, I give my work number. I think the problem has its origins in their switch from a pure paper record to electronic records, but I don’t know. Or else they have privacy concerns about calling a work number. I have told them it is a private line and they can leave messages there. The whole thing is odd because the staff is normally efficient.

        • NewMexicoRam

          Could be. In our system, if you don’t hit “save,” the effort to change the number is useless.

    • guest

      Yes, I have had lots of lots of experiences just like this. You would never encounter that type of inefficiency in a retail business, but it is endemic in medical practices.

  • NewMexicoRam

    Yelling or swearing at my staff always leads to immediate termination of our physician/patient relationship. I have excellent staff and misunderstandings or disappointments should never lead to abuses of my employees. We don’t abuse patients (which I also would never put up with) and we expect the same treatment from our patients.
    Dr. Spock did us all wrong.

    • PrimaryCareDoc

      I agree. I’d rather lose a bad patient than a good staff member.

    • NPPCP

      Bingo!! First time is the last time. We always try our hardest. You get to raise your voice one time in my clinic.

  • JPedersenB

    I have also had a doctor yell at me when I was speaking in a normal tone. It’s not very nice to go through! Needless to say, I terminated that relationship…

    • NewMexicoRam

      As you well should have.

      • rbthe4th2

        The problem is when the doctor provides needed care. Apparently it is ok to crap on patients if your specialty is in short supply and only 1 to 2 days a week do you see patients in the office.

  • doc99

    Savvy patients don’t yell or swear anymore. They run to fill out uncomplimentary patient satisfaction surveys.

    • Suzi Q 38

      I have done both.

  • guest

    Speaking not as a physician, but as a patient (or rather, as the mother of patients), I do have to say that in general, medical offices are among the most badly disorganized/dysfunctional businesses I deal with in my daily life. Just in the last six months, I have had to deal with our pediatrician’s office, dermatologists’ practices in two different states, the Student Health Center of a boarding school, the Dance Medicine clinic of a childrens’ hospital on the East Coast, the radiology department of the same hospital, the sleep medicine division of our local children’s hospital and a local sleep lab.

    Almost every conversation I had to have with all of these practices, except for the ones scheduling appointments (and sometimes even those) was marked by a startling level of inefficiency on the part of the staff. I did not yell, but I certainly wanted to, and I also did not appreciate the several occasions on which the staff took out their frustration on me by adopting a condescending tone (which generally vanished once I re-explained the matter I was calling about in a different way, along with mentioning that I was a physician). For the most part, all of these calls related to relatively routine matters, such as insurance reimbursement, getting prescriptions filled, getting records sent from one place to another, and getting studies scheduled that had been ordered by the physician.

    In my opinion, the problem is that in order to be an effective healthcare worker these days, you need to be incredibly detail oriented, and it also helps to have worked in the same place for a long time, so that you are intimately familiar with all the policies and procedures involved in supporting the work that the practice does. A lot of office workers just don’t have that level of experience and when you add in the confusion created by the use of half-baked technology., it makes for an incredibly disorganized and inefficient system, which is quite frustrating for the patient to have to deal with.

    • SteveCaley

      Amen. Amen, amen, amen. The system has imbued a heavy-handed, bureaucratic divorce from responsibility – an inhumanity that has already shown up long ago in many other fields.
      Doctors treat humans. Doctors ARE humans. Why is this not seen as the point of the lancet, the one thing to which all others are subservient.

      • Anne-Marie

        It’s easier to blame the regulations than to turn the lens of scrutiny on oneself, yes?

        Most of the doctors I know tend to hold themselves to high standards and have a well-developed sense of accountability. Sometimes they naively assume the rest of their staff is the same way and they fail to recognize when there’s a problem – preferring instead to blame the patient or blame some external force.

        I’m not a yeller and I usually cut people plenty of slack when things don’t go smoothly. This does not mean I have to meekly tolerate bad behavior, especially when it compromises safe quality care. I put up for years with a nurse who was disorganized, careless and openly rude – rx’s not refilled on time, labs not ordered, referrals not made, condescending and argumentative attitude, etc. Some of her lapses in clinical judgment were downright scary – GUESSING when she didn’t know what the plan of care was supposed to be? Really?

        Medical offices are busy, chaotic places and we all need to be able to tolerate the occasional screwup. Doctors and their staff shouldn’t have to deal with abusive behavior from patients. But sometimes when patients yell, it’s justified.

        • SteveCaley

          “Some of her lapses in clinical judgment were downright scary – GUESSING when she didn’t know what the plan of care was supposed to be? Really?” My tolerance for that is about a microsecond. How did such a toxic person survive in that environment? That is what concerns me. We have an environment that tolerates such rudeness. In some cultures, like Japan, anyone with such flagrant rudeness is assumed to be dangerously mad, and is sequestered from danger to society in some way. Here, we just elect them.

          • Anne-Marie

            I dunno, my overwhelming impression was that no one seemed to see this for the problem it really was. I’m sure the doctor was at least slightly aware of it, because he had to intervene a few times to set the record straight.

            I lodged a formal complaint but it didn’t seem to make any difference. Overall this was a really good medical practice, so I’m left scratching my head over why no one seemed to see the risk to patients. Maybe no one else ever spoke up and they assumed I was just being critical and demanding, i.e., “yelling”.

            Complaints from angry patients are hard to hear, but it’s really important to learn how to separate garden-variety crabbing from valid concerns. Patients often can see gaps in the system that doctors and their staff don’t. Listening to those patients who yell can be one of your best early-warning systems for small problems that might mushroom into something serious.

          • querywoman

            Currently, any formal complaint gets you nowhere.
            Being able to blast a doc with an online review is a new social tool, and one we never had before.

  • SteveCaley

    Rage is a human emotion; disrespect is a character choice. I don’t mind if a patient is enraged at me – why, what is so wrong? Sometimes the best patient relationships have the rockiest beginnings.
    Disrespect and discourtesy are different things entirely. They may be forgiven; they certainly do not need to be tolerated.

  • guest

    I do inpatient work in a public hospital; for the most part, when I handle these sorts of matters for my patients, things go relatively smoothly, mostly because the facility is well-staffed with intelligent people who are long-term employees. I agree that it’s not comparable to private practice, though, and I also agree that most glitches are in some way attributable to insurers, regulations and IT.

    My only point was that it takes a smart, detail-oriented and experienced employee to efficiently navigate the morass that our healthcare system has become, and not every medical practice is fully staffed with smart, detail-oriented and experienced people. I think for the employees who are overwhelmed by the complexity of the system, a certain learned helplessness gets adopted and they become even less effective (or, as described below a “bureaucratic divorce from responsibility.)

  • guest

    Well, I’m on record in many other places on this blog as saying that the number one thing ruining our healthcare system is third-party payment.

    Why docs ever allowed themselves to get bamboozled into accepting payment from the insurance company, rather than the patient is a complete mystery to me, and I think speaks to the general naivete of our profession.

  • Lisa

    I’ve never had a problem with getting pre authorizations from my insurance or with scheduling ordered tests. The problems I have had as a patient involve staff not using common sense. One example, I had an appointment with a radiologist to get biopsy results. I showed up for the appiontment on time and was told that my results were not in. There was not attempt to call me and reschedule.
    As I had taken time off work for the appointment, I asked if I could get the results by phone when they came it. It took a lot of persuading and sweet talking on my part to achieve that. Sigh…

  • iphone12

    As a patient, I have tried very hard to be polite to staff at all times because I know they have a very tough and many times, impossible job. But as other comments have inferred, many times, due to feeling like I was treated disrespectfully even though I am sure folks had good intentions, it is hard to keep my cool, especially if I am not feeling so well.

    One issue is I have felt when I don’t ask the typical newbie questions but ones that indicate I am quite familiar with certain issues, that seems to be quite threatening even though I feel I was polite. But in all fairness, I have also dealt with staff members who were quite impressed that I had done research and weren’t threatened at all. They found it quite refreshing.

    Anyway, I just wanted to point out that when it seems that staff is disrespected, there might be another side to the story.

    Thanks!

  • Suzi Q 38

    Some doctors are so busy that they don’t pay attention to what the patient is actually saying.

    When not listening to a patient (me ) resulted in my being in a wheelchair during my vacation and a cervical spine surgery a couple of months after I got back. I had been talking about my symptoms for over a year, so yelling was the next obvious decision. That, and telling my doctors that I had to leave because they could not figure out what was wrong with me and probably did not care.

    I was planning on leaving for their competition, so a gastroenterologist diagnosed my problem when the neurologist should have diagnosed it at least the previous year. The new teaching hospital was embarrassed for them and ridiculed them for taking too long to figure it out. By then I had some nerve damage on my right side that could have been prevented with early detection and treatment.
    I was on my 6th physician specialist at the same teaching hospital, and not one talked to each other…..
    Numbness in hands and feet, urinary and bowel changes, PAD symptoms…what more could I have done???
    When the doctor finally figured out that I was right,was not faking it and I was a “near miss,” he called me and got yelled at.

    He took it for 2 hours. I say he deserved it.
    I limp everyday now thanks to him.

    • rbthe4th2

      Would have killed to be able to do this. The surgeon I had took revenge on me, as he said he would.

      • Suzi Q 38

        Yes, I realize that I was lucky enough to be able to do this.
        I chose not to sue, and it gave me vindication and closure. I appreciated the rare opportunity I had.

        It had come as the direct result of having to see the teaching hospitals’ neurosurgeon. I told him that I needed to get another opinion, as I didn’t trust any of them, including DR. X. I also told him why and that I “hated” him, which is a very strong word and emotion.

        Apparently, he called Dr. X right away and demanded that Dr. X call me to convince me to have a much needed surgery to save my mobility. They had ignored my pleas for help for a year and a half.

        Since I looked fairly healthy, they kept putting me off.

    • querywoman

      Yelling before probably would have got you terminated as a patient, and that’s a blessing.
      I have not been able to reason with a hard-nosed doctor.
      Of course, you were just a crazy woman with post-hysterectomy problems.
      Patient advocates are in the medical gods’ best interest.
      I have found that I have to fire a doctor and move on. Now they get bad online reviews, too.

  • Lee

    Doctor, as a recent Stage 3 throat cancer survivor, I have enormous respect and gratitude for the skills of you and your fellow oncologists whose treatment and caring helped me fight this beast into remission. However, I am also a c-level exec and customer service expert with a couple of thoughts I’d like to respectfully share with you.

    Let me be perfectly clear. I do not condone disrespectful behavior by either patient or provider. However, a couple of thoughts. “They often do not have the training, experience, motivation, or, to be honest, salary, to bounce back well from personal assault.” And, therein lies the problem. Hiring people who interact on a regular basis with clients/patients who are not “motivated” nor have the “experience” to provide the great care and service needed to retain your most precious asset, your patient/customers, is penny wise and pound foolish. And, then to not train them to do so merely compounds the problem. Great patient-centered care, customer service, call it what you like, is not about how much you pay people. It’s about hiring right, training them, setting high standards and then holding people accountable to those standards. And, recognizing that these people ARE important enough to your overall business to be paid better. Not telling your customer/patients that they had better shape up or you’ll fire them. IF it’s happening regularly in your practice perhaps the problem is not with your patients, but more with your untrained, underpaid, under-motivated employees. The customer/patient is NOT always right, but they are, after all, always the customer/patient. Blaming the patient for not being angry “correctly” and even firing them, hurts you and your practice more than anything. Doing that just makes them angrier and will result in them excoriating you online and in-person for a long time to come And, who loses in that equation? You and your practice. Don’t believe it? Take a look at all of the companies who have gone out of business because they forgot that customers are the life-blood of that business. When in doubt may I suggest the advice given to medical professionals by Hippocrates when he said: “Treat often. Cure sometimes. Comfort ALWAYS.”

    • T H

      Feel free to educate MDs on the way to economically hire the personnel we need who have the necessary medical knowledge and customer service skills. Business classes are not regularly offered as part of the curriculum at any level of education, either in college, med school, or residency training. And hiring good people for front desk jobs is always tricky – no matter the profession.

      We see people when they are not at their best: it is always a personal issue for the patient. I don’t think Dr. S was talking about the patient just blowing off a little steam… or perhaps he was.

      In my corner of the medical profession (ED), I routinely deal with fists, verbal and physical threats, full-throated yelling and bellowing with swearing that would make a sailor blush. Customer service in this case generally means calling the police and the person being arrested because it isn’t so much as that particular patient being a problem, it is the problem he (sometimes she) is cause with all the rest of the patients and the disruption of their medical care.

      • Lee

        I believe that Doctors have arguably the most difficult job on the face of the planet. When you make a mistake people die or are injured. Even when you perform perfectly, the outcomes might still be dire. On top of that type of constant pressure there is the challenge of keeping up with medical advancements, the switch to electronic record keeping, crazy long hours, all performed in a hospital, which the last dozen or so times I’ve been in one as a patient or othewise, are not by any standard pleasant places to work because the pain and suffering of your “customers”. When people get as out of control as you describe it moves way, way beyond customer service into self-protection. You deserve nothing less than to have a relatively safe environment in which to do your life saving work. Thank you for putting up with it all and helping to heal us when we need you. If you thought I was condoning that extreme behavior, forgive me. NOTHING could be further from the truth. I’m talking simply about having staff and providers develop the skills to get past the occasional rude, sarcastic, sometimes mean communications from angry patients. You’ll never, nor will we, ever like it. But that kind of crummy behavior can be dealt with in a way that allows you to keep the patient as a patient and diffuse the situation without material loss then or in the future. That’s all I’m saying.

    • ninguem

      I have no idea what a “c-level” means.

      My wife worked in a startup company in production as a corporate officer in the startup company. When we got married, she cashed out her stock options, we are raising a family and all that. She runs my practice from a business standpoint.

      One thing she has always found remarkable in the medical business, as opposed to manufacturing, is the disconnect between getting the product or service, and PAYMENT for that product or service.

      It’s real direct in manufacturing. No pay, no product.

      In medicine, it’s provide service, and maybe you’ll get paid.

      Or maybe not.

      • Lee

        Oh, so sorry. It’s a very “self-important” way to say I’ve performed professional at the “C”EO, “C”FO, level for many years. I’m also a customer service educator, published author, and consultant. And a patient for most of my life for one thing including cancer recently. As such I view medicine from from a patient, business and customer service perspective. I work with hospitals and practices to improve the patient experience in order to increase revenue, expand medical professionals job satisfaction and improve patient outcomes. Hope this helps.

      • Lisa

        I think it is always been provide service and maybe get paid in medicine. I spent some time in my youth doing temp work and did stents in our local hospital’s collections department and in the billing department for a medical practice. A lot of effort went into collecting money from patients.

    • Patient

      EXACTLY!!!!!! Your comments are perfect!!!

      • Lee

        Well, thanks! Glad you thought so.

  • querywoman

    I am infamous for not answering my phone and not checking my voice mail. Plus, I tend to sleep heavily until 3 pm, and if I must take doxepin for itching, I really go out cold.
    My decease mother and I both made much of our living on telephones, which left us hating phones.
    Turnabout is fair play.
    I do not need a doctor blowing up about the blood pressure cuff, cancer screening, or weight and trying to terrorize me into some preventive such and such.
    In the past I put up with it.
    I will not put up with that now.
    I find it very rude when someone wraps a blood pressure cuff on my arm and frowns. I also find it appalling that doctors often walk in with a blood pressure reading taken by an associate and come in popping off about that instead of why I am paying to there.

    Many years when I worked on the phone, I just hated calling medical offices and hearing a sweet voice say, “Doctor’s Office.” Who is the doctor?

  • querywoman

    Doctors have always been employees.

    • Kristy Sokoloski

      True indeed.

  • Lisa

    The downside of using a spell checker is that it doesn’t catch correctly spelled misspellings….

  • rational2012

    Who needs to yell to be labeled a jerk by self-righteous hospital staff? At 2 AM I recently asked an RN if she was blind, after telling her that my pee “hat” needed measuring and emptying. It was full to the brim and I had set it on the countertop right next to the pee-hat rack rather than leave it in the toilet. If I had put it in the (tilted – why?) rack, it would have spilled over. (I was in a semi-private room with a roommate. Why should the roommate be inconvenienced by my leavings?)
    The nurse could not see it sitting on the countertop in a tiny bare room, even after checking on it a minute before and then going back in after I alerted her to it.
    Simply put, she missed a bucket of urine in plain sight even after being told it was there. Excuse me, but what else could I have assumed, other than that this person certified to do all sorts of potentially lethal things to sleeping sick people WAS BLIND? Even the fact that it was in neither the rack nor the toilet should have been a clue.
    Next time I will just not bother leaving the pee in the hat. I’ll ask my doctor if it matters and give him my own measurements if he wants them. In the interests of flexibility, I guess we patients could just go ahead and empty the thing and tell the nursie-pies the numbers. Maybe they could tell people that is an option. But then I have a list of other gripes, each of them more serious than the invisible hat trick.
    Ta Ta,
    Pissed Off Patient

  • rational2012

    And when there are two surgeons working on one patient at the same time, after-surgery instructions need to be coordinated. Having a nurse tell me in elaborate detail how to shower the day after discharge with drains in when in fact the second surgeon wants ZERO showering with drains in does not instill confidence.

  • Suzi Q 38

    “Thank you for choosing me as your doctor” can go a long way with most patients.
    In California, for instance, there are many physicians to choose from. It may get tougher in the rural areas to find a doctor, but not in the busy cities.

  • Kristy Sokoloski

    Joan Marie, I agree with you. I had a doctor once yell at me also. I did not like it one single bit. That was a number of years ago that this happened, but that still doesn’t change the fact that even today I still didn’t like that it happened.