zissieg@walla.com
Preface
Some of my closest friends and relatives are doctors and nurses. I wonder how they'll feel after reading this post.
Introduction
I debated long and hard whether or not to include this column, because it really does not provide any guide to services available. Rather it reflects my feelings of frustration with the system. So, I won’t be insulted if you choose not to read this post. If, however, you do choose to read it, and your feelings resemble mine, maybe you can add your voice to mine in trying to improve how we are treated by members of the health professions.
I’d like to talk about the people I’ve met along the way on this challenging road. As you can imagine they come in all kinds. Somehow those that manage to get under your skin are the most memorable, unfortunately, and we tend to forget the many wonderful people out there who really care. I believe in giving credit where credit is due, and I also believe that inexcusable behavior should be brought to the attention of those in authority. In the process I have become an expert letter-writer. Some of my more successful letter-writing experiences will remain secret, as part of the legal agreement we reached restrains me from implicating the institution at fault. My apologies in advance to every person in the health field whose performance characterizes how people in the medical profession should act.
A Trip Down Memory Lane
So let’s take a trip down memory lane and review some of the highlights, instances that provoked some of my letters of commendation and condemnation. There is no excuse for rudeness, particularly when dealing with those who are ill and the family members who are frazzled enough by coping with the illness that the last thing they need is the apathy or outright nastiness of the very people who control the fate of the patient. To me it seems that anyone who has chosen medicine as a profession would actually strive to be courteous and helpful to patients and their caregivers. Why then is it that when I have to go to kupat cholim I start to break out in a cold sweat, my blood pressure rises and my stomach starts turning somersaults? Could it be because I know what’s in store for me there? Before I even start dealing with solving the dilemma of the day, the mood is set by the patients around me. Does this prelude to dealing with the receptionists sound familiar?
"I have to (insert your favorite excuse), but I’m after you in line if anyone else comes.”
“I don’t care what time your appointment is scheduled for, my number is before yours, so I’m going in first.”
“I was here earlier and just have to ask one more question that I forgot.”
“I’m only here for a prescription—it will take just two seconds.”
WHY DO I BREAK OUT IN A COLD SWEAT JUST THINKING
ABOUT GOING TO KUPAT CHOLIM?And the list goes on. Then, when at long last it's your turn to sit down and discuss your matters you get “the attitude” from the clerks. They seem to indicate that you are nothing but an inconvenience that has shown up to bother them with your petty problems when it’s time for a coffee break. Often you get the feeling that they are trying do everything within their power to throw as many obstacles as possible in the way of your achieving your goal. I do not believe that “the customer is always right.” Of course, there are times when the customer is wrong, but the preconceived attitude that the customer is a nuisance non-deserving of a helping hand is a far cry from providing a service, especially a medical service, adequately.
The Customer is Not Always Right
I will be the first one to admit that many times I have been in the wrong. One of those times I not only messed up which date my father was supposed to arrive for his test, but also showed up there without the Tofess 17-Hitchayvut (the form stating the kupat cholim’s agreement to cover the cost of the service) and the orders for the test. It’s a long story. I’m not usually so absentminded. The test had been set up a month before by the hospital where my father had at the time been hospitalized. A few days after his discharge, the nurse from the hospital phoned me and told me they had set up an appointment for an outpatient test for him on such and such a date. I asked if he needed any paperwork to take with him or any hitchayvut, and she said that it was unnecessary because the hospital had taken care of providing all the details to the testing facility. I admit I should have done my homework, but I accepted what the nurse said to be accurate, recorded the date and time in my Palm Pilot, and we dutifully showed up for the appointment on the date the nurse had told me. Well—you can imagine my surprise when we arrived and the receptionist informed me that my father was not scheduled for a test that day. The test was actually scheduled for the same date but the following month!! I looked at the receptionist pleadingly and pointed out my father. I explained his frail condition and how difficult it was to transport him. With a sympathetic look she told me she would see if they could fit him in anyway that day. Then she asked for the requisite paperwork. I told her that the appointment had been set up by the hospital while he was an inpatient, and they had assured me that no paperwork was needed. You should have seen the look of incredulity on her face. She explained that without the orders and the hitchayvut they could not perform the test. But, she told me, she would try to contact the family doctor’s office to get them to fax the necessary paperwork on the spot. And that’s exactly what she did. In the twenty years or so that I had been living in Israel this was the first time I was presented with a real live caring individual who, although she would have been perfectly within her rights to send us packing, went out of her way to help the patient. After I recovered from the shock and thanked her a million times, I left my father sitting supervised in the waiting room while I went and bought pastries for the whole staff.
Then there is the kupat cholim receptionist who, when I asked her for advice on how to go about getting a hitchayvut that would cover monthly hospital treatments for a whole year, saving me
the time of having to request and pick up the hitchayvut each month, told me that to her “the patient is king,” and she will run the paperwork through to the highest levels of administration to make sure it gets done properly, saving the family the aggravation of having to deal with all the red tape. After all, she said, if you’re going to do a mitzvah you should see it through from start to finish.
There Really are Some Angels of Mercy out there in the Medical FieldHow about the doctors who, when they see how hard it is for the patient to come into their hospital examining room, actually go out to see the patient and speak to him/her in a more spacious area, saving the patient and the family the difficulty of navigating small spaces and getting up and sitting down numerous times? Or those who unsolicited phone the patient’s home to check on the patient’s recovery? There are even some who cheerfully make house calls without any reference to how much they have to go out of their way to do this and how pressed they are for time. Rare breeds, these doctors.
If you are in the medical profession and don’t recognize these dispositions as part of your makeup, you should ask yourself, “why not?” What has made me so callous that I act in a way that belittles the importance of the patient and his/her family as human beings and turns them into “cases” referred to by their diagnoses rather than their names who, to me, only represent added paperwork? Why should a patient be forced to feel that his/her respect and dignity are being violated by the sometimes flippant attitude directed towards him/her—anything from ignoring his requests to outright disrespect of his privacy, acting in an unprofessional manner often bordering on total negligence?
If you are in the medical profession and don’t recognize these dispositions as part of your makeup, you should ask yourself, “why not?” What has made me so callous that I act in a way that belittles the importance of the patient and his/her family as human beings and turns them into “cases” referred to by their diagnoses rather than their names who, to me, only represent added paperwork? Why should a patient be forced to feel that his/her respect and dignity are being violated by the sometimes flippant attitude directed towards him/her—anything from ignoring his requests to outright disrespect of his privacy, acting in an unprofessional manner often bordering on total negligence?
How would you like a dose of your own medicine?Now I’m about to do some serious receptionist/nurse/doctor bashing, so, if you don’t want to hang around for it, stop reading now.
Before coming on Aliyah I worked as a medical assistant, first for an oncologist for 10 years, and then for a group of neurologists for about 10 years. I’ve seen pretty much the worst of what can befall humans when illness or accident strikes, and I’ve worked with some wonderful, caring medical practitioners who have gone beyond the call of duty to reassure family members, to work extra hours, to treat patients with the dignity and respect and compassion that is their due. My husband also worked in the medical field in hospitals both in the USA and Israel, and we both are privy to what goes on in that world. We have sat at both sides of the desk, so to speak, and have come to know some very considerate, polite, and compassionate professionals in the field of medicine.
It is the others that give medicine its bad name. What happened to the work ethic of performing your job to the best of your abilities? Not slacking? Not looking for every reason to avoid having to put in a little extra effort to bring a result that will be agreeable to both the service provider and the recipient? The motto of many of these workers seems to be “Work slowly and carry a big lip” (with apologies to Theodore Roosevelt).
The Hierarchy of Power and its Abuse
The receptionist, who is first in the line of hurdles to overcome, wields an enormous amount of power in his/her small corner of the world. And in many cases he/she will try to demonstrate to you just exactly how much control he/she has over the outcome of your request. These workers are no doubt underpaid and unappreciated, and the quality of their work usually reflects the grudge they bear on these accounts. This, however, does not excuse rudeness and unwillingness to do the job properly. You can accomplish much more by doing something right and thoroughly the first time than by cutting corners and trying to see how much work you can save yourself. If you’re sitting there already, you may as well smile and be user-friendly.
If You Aren’t Doing What You Love, At Least Love What You Are Doing
Let’s move on from pkidim/ot (clerks/receptionists) to the next human in the medical hierarchy—nurses. There are many species. For instance, the nurses who will do nothing more than the minimum to care for you, and act like they’re doing you a favor to boot. One of my favorites was the nurse at the specialist’s office who started yelling at me for not following her instructions properly in exposing enough of the patient’s body for the test she was going to perform. (God forbid that she should overextend herself and pull the clothing down another two inches on her own. Maybe that wasn’t part of her job description.) I lost my temper and yelled back at her, because her outburst was so uncalled for. It was amazing how, when I asked what her name was and started writing it down, she became the absolute picture of courtesy and developed a sweet personality.
Her nastiness pales, though, in comparison with that of the impudent nurse who told me she could tell I was “the daughter-in-law and not the daughter of the patient,” because, had I been the daughter of the patient I would have shown more concern and would have brought an undershirt to put on her for going home. There I was—all alone with a demented wheelchair-bound woman, taking care of releasing her from the hospital, arranging for an ambulance, dealing with discharge reports and all the other bureaucracy involved in getting my mother-in-law from the hospital to her nursing home, and I was greeted with the audacity of that nurse. I thought perhaps I had misheard what she said because it was so outrageous, so I asked her to repeat it, and sure enough that’s what she had said. It totally unglued me. I could hardly describe to the head nurse what had happened to upset me so much because I was crying and trembling so hard. That nurse was immediately called into a room for a good bawling out by the head nurse in charge, and, when I calmed down sufficiently a few days later, I wrote a scathing letter describing the incident to the hospital director. I have more stories about less than exemplary nurses but if I told them all, this article could go on forever.
Contrast this with the visiting nurses who are usually models of kindness and patience. They
take the time to listen to the patient and to teach different techniques to family members unfamiliar with procedures necessary to care for the patient. I don’t envy any nurses, with the complicated and often unpleasant tasks demanded of their job. I hold in high esteem those nurses who are truly dedicated and proficient. Without them the patient and family would be at a total loss. If only there were more of them around...
Ahhh, now we come to doctors. There is some question whether they come below or above the nurses in this hierarchy, but for our purposes we will put them at the top. It is beyond my understanding why there are so many doctors (I’m referring primarily to doctors on staff in the hospitals) who treat patients and their families like some kind of dust they have to brush off their clothing. I enclose links to several oaths recognized by the medical profession, namely the Hippocratic Oath (for doctors), Maimonides Physician’s Oath (apparently a prayer he said before he started working each day), and The Nightingale Pledge (used by many nursing schools when nurses achieve their R.N. degree). Nowhere do I see a reference in any of these oaths that family and patients should be treated by doctors and staff like they are not deserving of courtesy and compassion. I’m reminded of one of my favorite stories:
A Jewish man dies after having lived a long observant life. When he enters the Gates of Heaven, he is warmly greeted by the welcoming angel and escorted on a tour of the grounds. They start walking along, and the angel points to a bearded gentleman sitting outside a tent, “That’s our forefather Abraham,” he says to the newcomer. Jacob stares in awe and can’t believe he is actually in the presence of such a renowned person. They walk on a little and come across a man with a glowing face polishing two tablets. “You probably realize that that is Moses,” the angel says. “And over there you can see King David and King Solomon.”
“Wow,” Jacob says to himself. As they continue their tour he notices someone walking along in a white coat with a stethoscope slung around his neck. Everywhere this guy goes people bow their head to him. He turns to the angel and says, “Who is that? He really must be somebody important the way everyone is treating him.” And the angel says, “Oh, Him, that’s God—He thinks He’s a doctor.”
WHAT EVER HAPPENED TO THE HIPPOCRATIC OATH?
Shall I start with emergency room doctors or ward doctors? They are pretty much the same in their behavior patterns. ‘Don’t bother me now’ is the general attitude. Well, in the emergency room, if I wait for later, it may be too late. I personally know someone who suffered this fate, and the litigation is still in progress. And, in the ward, if I wait to talk to you during your posted hours, the chances are 50/50 you will actually show up there, and why should I once again lose a whole day’s work waiting for someone who may or may not show up to speak to me? And, if I accidentally ask you a question that is beneath the dignity you ascribe to your level of expertise and not part of your job description to deign to answer, do not contemptuously say “I’m a doctor, not a receptionist.” A polite “I’m afraid I don’t know the answer to your question but I think …. can help you,” would be received with much more understanding.
Finding a Cure
Is there a solution to this attitude problem? Probably not. I think all medical professionals should see the film The Doctor, starring William Hurt, based on a true story described in the book written by Dr. Ed Rosenbaum (and subtitled “A Taste of My Own Medicine”), and read the book Tuesdays with Morrie by Mitch Albom, just for starters. Frequently I will make a comment to a service employee such as “If you smiled you would look so much more pleasant.” To those employees who indeed go the extra mile I shower praise and comment on how wonderful it is to be treated so graciously. I write letters not only about those who disappoint me but also about those who are outstanding in their approach. Whenever I can, I tell them that I
am going to write a letter in their praise and try to ascertain exactly to whom the letter should be directed to have the most impact. I don’t know that my letters help, but I would like to think that maybe, little by little, we can make inroads into improving how we as recipients of treatment during critical times of our lives can at least feel that those who are out there to help us through those times really do care.
You, too, can state your opinion when you see an injustice or some extraordinary behavior worthy of comment. Perhaps together we can make a change.
*********
Originally I was going to end this column right here. I decided, however, that in all fairness something should be said about us as consumers and our attitudes. It is incumbent upon us to be as courteous to the person serving us as we would expect them to be to us. Coming in with a fighting attitude and aggressive behavior does not serve our purposes. It immediately puts the
other person on the defensive and sets up a barricade before we even get started with our negotiations. So let’s all try to set an example, and we just may be able to work out our problems to everyone’s satisfaction in an atmosphere devoid of animosity and dedicated to achieving what is in everyone’s best interests.
For your reading pleasure I enclose a link to the Patient’s Bill of Rights and some tips for writing effective letters.
Her nastiness pales, though, in comparison with that of the impudent nurse who told me she could tell I was “the daughter-in-law and not the daughter of the patient,” because, had I been the daughter of the patient I would have shown more concern and would have brought an undershirt to put on her for going home. There I was—all alone with a demented wheelchair-bound woman, taking care of releasing her from the hospital, arranging for an ambulance, dealing with discharge reports and all the other bureaucracy involved in getting my mother-in-law from the hospital to her nursing home, and I was greeted with the audacity of that nurse. I thought perhaps I had misheard what she said because it was so outrageous, so I asked her to repeat it, and sure enough that’s what she had said. It totally unglued me. I could hardly describe to the head nurse what had happened to upset me so much because I was crying and trembling so hard. That nurse was immediately called into a room for a good bawling out by the head nurse in charge, and, when I calmed down sufficiently a few days later, I wrote a scathing letter describing the incident to the hospital director. I have more stories about less than exemplary nurses but if I told them all, this article could go on forever.
Contrast this with the visiting nurses who are usually models of kindness and patience. They
take the time to listen to the patient and to teach different techniques to family members unfamiliar with procedures necessary to care for the patient. I don’t envy any nurses, with the complicated and often unpleasant tasks demanded of their job. I hold in high esteem those nurses who are truly dedicated and proficient. Without them the patient and family would be at a total loss. If only there were more of them around...Ahhh, now we come to doctors. There is some question whether they come below or above the nurses in this hierarchy, but for our purposes we will put them at the top. It is beyond my understanding why there are so many doctors (I’m referring primarily to doctors on staff in the hospitals) who treat patients and their families like some kind of dust they have to brush off their clothing. I enclose links to several oaths recognized by the medical profession, namely the Hippocratic Oath (for doctors), Maimonides Physician’s Oath (apparently a prayer he said before he started working each day), and The Nightingale Pledge (used by many nursing schools when nurses achieve their R.N. degree). Nowhere do I see a reference in any of these oaths that family and patients should be treated by doctors and staff like they are not deserving of courtesy and compassion. I’m reminded of one of my favorite stories:
A Jewish man dies after having lived a long observant life. When he enters the Gates of Heaven, he is warmly greeted by the welcoming angel and escorted on a tour of the grounds. They start walking along, and the angel points to a bearded gentleman sitting outside a tent, “That’s our forefather Abraham,” he says to the newcomer. Jacob stares in awe and can’t believe he is actually in the presence of such a renowned person. They walk on a little and come across a man with a glowing face polishing two tablets. “You probably realize that that is Moses,” the angel says. “And over there you can see King David and King Solomon.”
“Wow,” Jacob says to himself. As they continue their tour he notices someone walking along in a white coat with a stethoscope slung around his neck. Everywhere this guy goes people bow their head to him. He turns to the angel and says, “Who is that? He really must be somebody important the way everyone is treating him.” And the angel says, “Oh, Him, that’s God—He thinks He’s a doctor.”
WHAT EVER HAPPENED TO THE HIPPOCRATIC OATH?Shall I start with emergency room doctors or ward doctors? They are pretty much the same in their behavior patterns. ‘Don’t bother me now’ is the general attitude. Well, in the emergency room, if I wait for later, it may be too late. I personally know someone who suffered this fate, and the litigation is still in progress. And, in the ward, if I wait to talk to you during your posted hours, the chances are 50/50 you will actually show up there, and why should I once again lose a whole day’s work waiting for someone who may or may not show up to speak to me? And, if I accidentally ask you a question that is beneath the dignity you ascribe to your level of expertise and not part of your job description to deign to answer, do not contemptuously say “I’m a doctor, not a receptionist.” A polite “I’m afraid I don’t know the answer to your question but I think …. can help you,” would be received with much more understanding.
Finding a Cure
Is there a solution to this attitude problem? Probably not. I think all medical professionals should see the film The Doctor, starring William Hurt, based on a true story described in the book written by Dr. Ed Rosenbaum (and subtitled “A Taste of My Own Medicine”), and read the book Tuesdays with Morrie by Mitch Albom, just for starters. Frequently I will make a comment to a service employee such as “If you smiled you would look so much more pleasant.” To those employees who indeed go the extra mile I shower praise and comment on how wonderful it is to be treated so graciously. I write letters not only about those who disappoint me but also about those who are outstanding in their approach. Whenever I can, I tell them that I
am going to write a letter in their praise and try to ascertain exactly to whom the letter should be directed to have the most impact. I don’t know that my letters help, but I would like to think that maybe, little by little, we can make inroads into improving how we as recipients of treatment during critical times of our lives can at least feel that those who are out there to help us through those times really do care.You, too, can state your opinion when you see an injustice or some extraordinary behavior worthy of comment. Perhaps together we can make a change.
*********
Originally I was going to end this column right here. I decided, however, that in all fairness something should be said about us as consumers and our attitudes. It is incumbent upon us to be as courteous to the person serving us as we would expect them to be to us. Coming in with a fighting attitude and aggressive behavior does not serve our purposes. It immediately puts the
other person on the defensive and sets up a barricade before we even get started with our negotiations. So let’s all try to set an example, and we just may be able to work out our problems to everyone’s satisfaction in an atmosphere devoid of animosity and dedicated to achieving what is in everyone’s best interests.For your reading pleasure I enclose a link to the Patient’s Bill of Rights and some tips for writing effective letters.
Letter Writing Tips:
1) Organize your thoughts on paper omitting any emotional references
2) Ascertain the title, name and address of the person in authority to whom the correspondence should be mailed
3) Compose the letter sticking to the facts with as much detail as possible
- Date
- Time
- Location
- Patient Name
- Employee Name
- Unemotional description of the incident
- Request for action, whether disciplinary, monetary or to draw attention to behavior worthy of emulation
- Signature and contact information
Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
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