Good doctors don’t trash-talk their patients

“Bounce-back.”

That was the term I used to describe a patient to the team one morning on rounds. I was a medical student, and was delivering a summary of the patient’s care to the small crowd of fellow students, residents and one attending physician clumped there in the hallway. I could not now tell you a single thing about him, other than that he had been recently discharged and later readmitted for the same condition. Hence “bounce-back,” the piece of medical slang I employed to sum that fact up.

I hadn’t really meant it pejoratively, merely descriptively. Medical communication is all about efficiency, after all, and “bounce-back” quickly conveyed something about the patient. Like its cousin term “frequent flier,” used for patients who were often admitted over and over, it wasn’t entirely respectful, but I hadn’t meant it to be insulting, either.

My attending physician was not in the mood for leniency about such things. There in front of everybody he explained to me quite pointedly that using dehumanizing terms to describe patients was unacceptable, and not something he would tolerate. My ears were a deep shade of crimson when it was over.

I never called a patient a bounce-back again.

However, compared to another piece of medical slang, “bounce-back” and “frequent flier” are practically “beautiful darling.” In a rather startling article for Slate, Dr. Anne Skomorowsky introduces the non-medical world to “SHPOS,” short for “sub-human piece of shit.”

Truth be told, I can’t remember ever actually hearing a doctor call one of his or her patients a SHPOS in real life. I’ve only heard it referred to, never used. In her book “What Doctors Feel,” Dr. Danielle Ofri renders it “shpoz,” and describes it as a term of contempt medical providers use for patients they feel are less deserving of compassion — the drug addicted, the alcoholic, the morbidly obese. When I came across that passage not long ago, it took me a few moments to parse the term before I dredged up its meaning from some dusty corner of my memory.

But Dr. Skomorowsky, a Columbia psychiatrist, goes a little bit further. Not only does she indicate that use of the term is commonplace amongst doctors, an insinuation I would vehemently dispute, but she further implies that some patients kind of have it coming.

“Not surprisingly,” she writes, “the SHPOS is often alone in the world. He may have just been released from jail, or his loved ones may have refused to take him in. He may have been fired from his job or banned from seeing his children. On top of that, now he is ill. The SHPOS comes to the hospital in a state of social despair, isolated and unhelpable, and the only person left to absorb his rage is the health care worker who must care for him, no matter how hateful he is.”

She goes on to describe certain things as “SHPOS behavior.” While she concludes with a rather tepid declaration that “no one is proud” to call another subhuman, apparently in some cases the shoe just fits. Doctors simply call it like it is, in her apparent estimation.

I reject that attitude outright.

Make no mistake, medical providers often see people at the utter, utter worst. I was once one of about ten emergency department personnel literally kneeling atop an extremely violent patient who had taken some bad PCP, attempting valiantly to restrain him as we waited for the whopping dose of sedatives to calm his combativeness. (He was also a spitter.) During residency a mother accused me of stealing a bracelet from her toddler, and when she later found it in his bed didn’t apologize but claimed I had planted it there. In my current practice, it is all too common for bitterly divorced parents to spare no opportunity to lacerate each other, using their child’s medical care are yet one more battlefield in their endless war of attrition.

People can be awful. Patients can be horrible. But it’s not because they’re subhuman, even at their worst. It’s because they’re human.

If one cannot deal with this immutable fact, that we often find ourselves taking care of human beings at their most desperate and vulnerable and wretched, then medicine is not the right profession. If being made to care for people who are ungrateful, rude, mean or otherwise horrible allows one to justify calling them pieces of shit, then one needs to reexamine what one is doing try to care for them in the first place.

Doctors are human, too, and we will naturally respond negatively when people lash out at us, try to manipulate us for their own ends, or are otherwise baldly nasty. Protecting ourselves from the toll this can take is difficult, and none of us do it perfectly. But finding a way to hold onto our own integrity while treating people as we find them, rather than how we want them to be, is a necessary skill. It’s part of the deal going in.

What we don’t get to do is start telling ourselves that the most unpleasant people are beneath our care. We don’t get to call them subhuman or try to rationalize our own nastiness. They aren’t pieces of shit. They’re our patients.