Good doctors don’t trash-talk their patients

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

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23 Responses

  1. Kazzy says:

    First, good to see you, Doc!

    Second, it does not surprise me that Slate engaged in this sort of hyperbole.

    Third, my profession (teaching) has some in it who similarly use disrespectful language when discussing students. In bothers me to no end. Just this morning, I had to sit in a meeting where a teacher talked about two 3-year-olds — 3-year-olds! — as if the difficulties they presented were an inconvenience for her. It took all my energy to not say, “Actually, the difficulties they present are the reason you are here! Your job is to support them through the difficult moments and arm them with the learning or skills to manage their difficulties!” Students and patients are not and should not be seen as an impediment to the work of teachers and doctors but rather as the people we are charged with supporting no matter what. I’m glad to hear that the language discussed in the Slate article is not as pervasive as they try to make it seem. And while the phenomenon I describe in education is real, it is similarly not the norm.

    Now, talking shit about parents, on the other hand… well, that’s what gets us through the day.Report

    • Snarky McSnarkSnark in reply to Kazzy says:

      I am completely unperturbed by these nicknames, or even darker ones. I think it’s a natural inclination of any subculture to have its own cynical language of affiliation–it’s a encoded way of bonding and commiserating. And other subcultures have far more disturbing dismissals of the other humans they encounter. The LAPD refers to civilians as “assholes,” and many military dismiss their targets as “Charlies,” “haji”, “camel jockey”, or “skins.”

      The slang of the physicians seems to me as a way of creating a little psychic distance between themselves and a job that can sometimes seem futile.

      By the way: I was gratified to see that you haven’t given up on us yet. I’m hoping that your blogging time has been consumed by completely-satisfying family time, but still–What about us??? It’s good to see you back.Report

      • Thanks, guys. Writing on deadline elsewhere plus demands from family life and my day job have sucked up a lot of my writing time here, to my chagrin. The demand for freelance stuff at one of my other outlets is tapering off, which may end up freeing up some time.

        It’s always so nice to be here.Report

  2. Burt Likko says:

    Once again, I am struck by the parallels and divergences between our respective professions. Law, and in particular litigation, is very much about understanding and communicating what makes people do the things they do, the kinds of actual behaviors we might expect from people.Report

    • Burt Likko in reply to Burt Likko says:

      Press the wrong button too fast. To continue…

      If I were to see a defendant in an eviction case whose name I recognized from a previous eviction, I would call this defendant a “repeat customer.” My client, the plaintiff in the second case, will typically find this amusing. Granted, the characterization is just a little bit cruel. At the same time, it provides a measure of psychological respite for my client. Many of my clients have expressed confusion about their tenants’ failure to pay rent. A pithy description often helps them understand the situation, and let them realize that they personally are not being insulted by their tenant. (Yes, many of them come into the process feeling personally insulted.) it isn’t about them, it’s about the tenant.

      Of course, some of them get more confused. “You mean, they didn’t pay their previous landlord, either? What kind of a person does that?”

      In response to this, I have a wide range of things I might say. A very nuanced description of the situation might refer to the fact that some people lack significant economic opportunities owing to a wide variety of sociological factors which are the legacy of a painful and unfair history, a problem that is the fault of no one living, but nevertheless which creates fallout that must be dealt with on a daily basis. Further, the people on the receiving end of these disadvantages develop psychological coping skills which include responses to short-term economic incentives, anddefenses and deflecting moral justification for doing what they believe is necessary to survive notwithstanding a broader normative sense perhaps those decisions are not altogether morally or legally justified. Perhaps they find a way to rank moral imperatives such that while they are not doing the morally best thing imaginable, from their perspective, they are doing the morally least bad thing available, and the landlord’s contractual due comes out lower than their own well-being in that calculus.

      Or, I could say, “What kind of person does that? A thief.”

      Is it entirely fair to call someone who has not paid rent to two or more landlords for more than a year “a thief?” My more nuanced description is indeed more nuanced. But it’s not what the confused and upset plaintiff in the courthouse hallway needs to hear.Report

      • Troublesome Frog in reply to Burt Likko says:

        I read an interesting article on bounty hunters a few years back that noted that the most successful ones were the really friendly ones who were nice to the people they chased down and polite to the families in the process. Why? Because they get a lot of business from repeat customers. They often have to track down the same people over and over, so it pays to be able to just give the mother a friendly call and say, “Hey, is he hiding out at the usual spot? Can you let him know I’m coming to pick him up?”

        I bet that most professions that deal with their customers’ self-inflicted wounds tend to get a lot of repeat business.Report

  3. zic says:

    I’ve actually heard a lot more derisive talk about patients from health-care professionals who are not doctors then from doctors; but I think perhaps the non-doctors have to deal with a lot more of the challenges that difficult, socially-inept patients present to health care workers after a hospitalization, too; and of course, my experience is anecdotal. But I think nurses, technicians, etc. get a lot of abuse from difficult patients, and while I expect them to act professionally, I think the harm they cause by venting this is (somewhat) balanced by the importance of expressing the stress it causes.

    A really good friend of mine, a neonatologist, tried to save Scott and Laci Peterson’s baby; and while Peterson was an outlier (and outright lier), it was really important for the staff that dealt with him to process what happened. Less significant events may not seem as crucial; but I think they aggregate, rather like cat-calling and internet misogyny aggregate in women’s psyches. I don’t know if this is an issue strong enough to suggest better mental-health support for medical professionals (and teachers and cops and retail workers and . . . ) but I do think the drain of difficult people, and the way it taints our ability to see people as human, merits consideration from the perspective of the burden that might trigger dehumanizing in the first place.Report

  4. Wonderful piece, Doc! Good to see you ’round here still with all of your interests and children to fend off!

    I’m kind of wondering what the point of the Slate article was – there’d be an interesting and informative piece there if it had just stuck to describing abusive patients and the effect they have on doctors and how doctors put up with them. That some doctors have less than kind lingo for such patients is also not surprising, but what is the point of proudly telling the world what that lingo is and making that lingo the point of such a piece – it’d be one thing if it was a piece on a medical listserv, where its purpose would presumably just be to provide a place to vent, but why write such a piece for public consumption? I just don’t see the point, especially if the lingo isn’t merely an aside but the entire focus of the piece.

    What makes the piece particularly appalling, though, is that it’s written by a psychiatrist. Had it been written by a regular ER doc, then you could perhaps understand the lack of empathy and the scorn involved even if you couldn’t excuse it; at worst, such a doctor would still be stepping into the role of a veterinarian treating a cat.

    But a psychiatrist willing to heap such scorn on abusive patients with obvious mental illnesses? To refer to them as “subhuman pieces of shit” is to effectively deny the patients have a mental illness at all, but instead say that are simply not human and are incapable of receiving psychiatric treatment. It is to sit in judgment of the patient, to define that patient by a bout or bouts of abusive behavior, when the entire point of psychiatry is so often to show the patient that their mental illness shouldn’t and doesn’t define them, to treat them as people who “have” a mental illness rather than as people who “are” mentally ill.

    The equivalent would be treating patients suffering from leprosy as lepers. Viewing such people as persons suffering from a disease is to express a willingness to treat them regardless of whether the disease is curable. A doctor who views them as lepers defined by their illness is a doctor who believes they should just be removed from society and left to die in a colony. A psychiatrist who calls his most difficult patients “subhuman pieces of shit” is a psychiatrist who would have no qualms just locking them in a rubber room for the rest of their lives and then walking away from them.Report

  5. Damon says:

    I’m totally 100% behind this. As you said Russel, they aren’t sub human, they are human. That, however, does not aren’t a total POS. But neither does that absolve anyone in the medical profession from dealing with a POS in a professional manner. This is also why I’m not in any field where I deal with these types of people. 🙂 Kudos to those that do.Report

  6. Tod Kelly says:

    I wonder to what degree you *can* be an effective care provider for people you think are SHPOS. It’s hard for me to imagine that no matter how stoic you thought you were, it would have to creep in there somewhere.

    And I have to say, I kind of wonder that about a psychiatrist especially.Report

  7. Chris says:

    Wasn’t there a Seinfeld episode about this?Report

  8. Will Truman says:

    As I mentioned on Twitter, my wife has never heard of the term. I tested her by asking what it stood for, and she had no idea. She was aware of another acronym that she’s seen once, that basically means the same thing, but that was all she could come up with.

    “Frequent flier” and “bounce back”, though, are terms I do hear a fair amount.Report

  9. Jaybird says:

    I have heard that sports journalists do what they can to out-Herod Herod in the newsroom because investigative journalists tease that sports journalists don’t have to engage in journalism. Sports journalists just say that the Lightning got X points, the Thunder got Y points, and come up with a handy narrative of X and Y using the videotape. This results in some serious “I’m a Journalist!” posturing on the part of the sports guys.

    (Aside: I’ve written a handful of articles talking about the various Professional Wrestling house shows I’ve been to reporting who fought who, who won, and what the finish was. The hard part was reading notes a few hours later that I wrote in the dark.)

    All that to say: it wouldn’t surprise me to hear that there is a plurality of psychiatrists out there that have some serious real medical doctor envy.Report

  10. Jim Heffman says:

    I remember hearing SHPOS on “e.r.” back in the day. (“Couple of shpoes”. “What?” “You know, sub human piece of–” “I know what it means, Carter. Why are you saying it?”)Report

  11. ScarletNumbers says:

    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.

    One is trying to earn a living.Report

  12. Shelley says:

    From the long sit in the waiting room onward, it’s such an uphill battle to try to get respect as a patient.

    Thank heaven for a few good doctors. Because the system is set up to make you feel small.Report