A Note to Providers About Professionalism

Professionalism goes a very long way in patient relationships. Even if you don’t feel compassion, sympathy or empathy for your patients the fact that healthcare is a business and good business requires good customer service, I strongly suggest you learn how to at least fake it and fake it well. Openly doodling and blatantly leaving it for your patient to find does not instill a sense of professionalism a provider should hope for.

While not my first, and certainly not the last example of a poor encounter given the way healthcare is in today’s system, I just had an extremely unsettling encounter with a physician’s assistant (PA) this morning. This was one in which I was even more distressed by his attitude because I’ve encountered this PA before and was, at that time, extremely impressed with both his professionalism and diagnostic exam and recognition of the symptoms as being a serious nature which warranted immediately presenting my case to the neurosurgeon.

His prompt attention, ability to listen, in detail, to my symptoms, complete a thorough history and exam led me to feel confident in his ability as during that encounter it ultimately led to the diagnosis of a spinal cord injury requiring surgical intervention. Without said surgical intervention, it would have continued to progress worse than it already had up to that point by all the physicians who missed the diagnosis prior to that point.

Prior to that first encounter with him, there had been multiple physicians and specialists who had mentioned Multiple Sclerosis as a potential cause for my symptoms, one of whom actually made the diagnosis only to retract it later taking the “let’s wait and see approach”. (We’re still waiting…)

As a result, when symptoms began to progress and become more troublesome I decided to go back for a follow-up visit to ensure that the hardware placed in multiple areas in both the front and back of my neck was still intact and that there was no other obvious cause of the symptoms. I contacted the neurosurgeon’s office and they agreed that a follow-up was needed to ensure the same thing, especially given the recurrence and even worsening of previous symptoms from prior to surgery to present day as well as some new symptoms.

However, today when I went to the appointment rather than relief that the hardware was intact and things were healing as expected, I felt extremely ignored by the attitude of the PA who saw me. He was dismissive of almost every symptom discussed as well as downright rude and insulting at times. He didn’t seem to take my symptoms seriously and regularly blew them off as “well you do have a spinal cord injury”, which is true. At one point he said that “at 18 months post-op you’ve pretty much got what you’re going to get” in terms of healing. This is generally a fair and accurate statement as the generally accepted rule of thumb is 18 to 24 months healing post-surgical intervention and you should have regained whatever you will regain.

Like many things in medicine, this is not a hard and fast rule, but my reply to his statement was that while I understand that to be the case, I also would have never suspected symptoms to worsen or for new symptoms to appear. To this he didn’t even reply, rather he simply stated “well, what do you want to do?”

I could detail the entire encounter, but it went on like this through the entire appointment and then through his partial examination prior to him going to discuss my case with the neurosurgeon. He returned to tell me that the neurosurgeon concurs that my X-rays looked great and that all the hardware was in the right place. At one point during the visit, while we discussed some lingering swallowing issues, he reached over, patted my belly and stated “it’s not like you’re malnourished”. I was both appalled and insulted at the same time, but once again I bit my tongue.

He then once again asked what I wanted to do? He could write a referral to neurology (long story but I don’t trust that physician even one percent), or to pain management (I asked for NO medications whatsoever), or to a physiatrist to try physical therapy. I replied that respectfully I was coming to him for his input and expert opinion as to what I should do next, and he simply repeated that it isn’t up to him. I can do whatever I want.  This went on in varying forms of me trying to ascertain what he, the professional in this case, felt was the best and most appropriate path for me to take given the symptoms and such. He ignored this and kept repeating “well, tell me what you want me to do”.

So, out of sheer frustration and not being able to think of anything else to do at that moment I simply asked him to refer me back to the local physical rehabilitation hospital I had been in twice and have attended outpatient therapy many times. I trust their physical therapy team incredibly and already have a relationship with the physician there from him managing my inpatient care on two separate occasions.

Nearly immediately upon saying this he simply said okay, got up, and left the room. After he left the room my daughter pointed to the paper on the exam table where the PA had been sitting and writing on my chart. Apparently, this is what a PA does when they are disinterested, disengaged, and bored with their patient and fails to actively participate in the appointment with the patient who, regardless of insurance or self-pay, is essentially paying for their undivided attention.

Bored PA doodling during office visit.
Bored PA doodling on exam table paper during an office visit. Not a great way to instill confidence of your ability in your patient.

I totally understand that our health system is overworking our providers and expecting them to do more in less time than ever before in the history of healthcare. However, if a provider is that disengaged during a visit, the patient can’t help but wonder how much attention was paid to detail and the intricacies of that patient’s particular condition, symptoms, and complaints. If he was busy doodling during the office visit did he potentially miss what could have been a key fact in determining the cause of the symptoms?

Lastly, it implies a lack of professionalism in a provider whom I had previously trusted, valued as a dedicated provider, and had referred many people to in the last few years. Whether he had a bad day or has what is often called compassion fatigue in the healthcare profession, or just plain didn’t give a damn, he is paid to fake it. Not to insult and demean the patient before him simply asking (and might I add paying) to draw upon his expertise and experience, which he then refuses to share. Further, if you are that burned out or just care that little, at least try to hide this from your patient by doodling on a piece of paper and taking it with you when you leave the exam room. The fact that he openly did this during the visit and then left it for me, the patient, and my family member to see is disgraceful, reprehensible to me personally, and could conceivably create disdain and a lack of respect for the profession as a whole.

I have been both a provider and a patient and try incredibly hard to be understanding of the viewpoint of both parties in any encounter. However, this is an absolute, unequivocal show of disrespect for me as a patient with legitimate and documentable symptoms, not to mention unprofessional and downright contempt for me as a human being who is seeking their professional judgment.

This flippancy continued throughout the entire visit. At another point in the discussion he stated I should try medication X which has been shown to help with symptoms from a spinal cord injury. I politely and respectfully explained that while I had tried it briefly with limited benefit that it was cost prohibitive since I do not have prescription coverage. He proceeded to hold out his hands, palm up, and coarsely and rudely explained to me that in one hand is a problem for which there exists a medication that might help with that problem. In the other is money. If the money hand chooses not to address the problem then there is nothing that can be done, as if I was making a conscious choice to not avail myself of this medication.

For a moment let’s ignore the fact that this, and nearly every medication available, carries with it a risk/benefit profile with side effects and the like. After taking a pause to determine the best way to respectfully reply to this I calmly explained it wasn’t that simple when the money to pay for said medication would mean I can’t pay my mortgage and would therefore not only be homeless myself but would put everyone in my family into the homeless population. I don’t think he meant to but I perceived a slight shrug as he simply stated, “what’s next on your list”.

To be fair and totally transparent, I don’t expect the medical profession to be able to fix everything that’s wrong with everybody. Some people, like myself, are extremely complex cases with multiple health conditions and some symptoms may very well have to be something we learn to live with as a result our particular illness and if that is the case, then I absolutely expect them to be forthcoming and honest with me in telling me so. However, there is a huge difference in being forthcoming and honest and then being downright disdainful and disrespectful in the process.

Throughout the duration of the encounter, I was made to feel like I was being unreasonable and unnecessarily wasting his precious time. Each statement I made was summarily dismissed. When I asked a question it was consistently ignored or pooh-pooed away as unimportant or irrelevant. To find that not only did I suspect he was doodling during the visit, but that he actually was and didn’t seem to care if I knew it was incredibly insulting to me as a patient and a human being. I was made to feel as if I was being unreasonable in expecting him to give an accurate, educated, and experienced opinion as to whether the symptoms were related to the cervical spinal cord injury or a potentially new or even a previous yet entirely separate issue.

Yet, as it turned out, I left there feeling belittled, shamed for even asking, and more bewildered than when I arrived. I comprehend that even out technologically advanced healthcare system may not always be able to provide answers, but that is where I would expect a competent, ethical, and morally responsible provider to at least provide their clinical expertise and opinion as to what the most appropriate course of action would be given the circumstances.

I honestly don’t know what to say that I haven’t said without further beating the topic of this one visit that I cannot change. I will close with some relatively simple advice to providers and patients alike.

Providers: Take the time to truly at least try to connect with your patients in order to treat them properly as patients, people seeking your wisdom and experience, and as human beings. Yes, you may have heard their questions a few thousand times before and you may know that they are normal and expected, or maybe you have no clue what could be behind the myriad of symptoms. In any case it would be beneficial to keep in mind that honesty and transparency goes a long way especially when combined with tact and respect. In the event that you are suffering from compassion fatigue, aka burnout, or you don’t truly care then you must either become a master at either faking it while doing your job anyway or make the move to get out of healthcare. Both you and your patients deserve at least that much.

Patients: While I’ve heard many horror stories that are either eerily similar or even worse, I did not expect this from a provider I had previously both respected and looked up to as a highly competent and skilled individual. While we as patients must look to these providers for their skill and knowledge, please try to remember that at the end of the day they too, like us, are simply human. Remember that they may simply be having a horrible day, suffering from an illness themselves, or to put it succinctly, they are mere mortals and fallible. This may not negate their poor display of professionalism or atrocious behavior, but the fact remains that patients and providers alike are, at the end of the day, simply human. Keep advocating for yourself, don’t give up, and persevere until either you have answers or all avenues have been exhausted. Do not let one bad experience take away your hope!

Do you have a story to share? We’d love to hear it! What would you do in this situation? How would you have handled it? What would you have done differently?

Leave a Reply