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The price of appeasement

The occasional methadone patient is not happy with the doctor so he raises his voice and shouts expletives as he is leaving the room, while at the same time slamming the door with a thud.

‘That doctor is a *****!’

The purpose of this theatre, one can only assume, is to manipulate the doctor, and the crowd, so that the next time he gets his own way, on his own terms.

If this patient is the first client of the day, this display of hysterics can affect the mood and the subsequent decisions of the doctor. It can also cause some degree of chaos in the waiting room. It can affect how the waiting clients see the clinic and the doctor. This is because we often make weak decisions based on the emotional outbursts of others. Emotion is often equated with truth and justice. Tears, equally so. They cried, so it must have happened. And sure, isn’t this often the purpose of the emotional outburst of a vexed patient? They want to show the power of patients and ‘people power’.

‘Give me my way or I will ruin your practice’s reputation.’

Clearing up misunderstandings, getting clarity and negotiating a reasonable solution for patient and practice is not half as sexy.

Some say that the most flexible person in a system is the most powerful. A baby will try whatever works to get its way. Some patients have developed a range of methods to get their way. Asking quietly is followed by tears, followed by shouting, followed by a complaint about the doctor, followed by flowers to the doctor.

During the good times and the bad, you are still there, left standing, because of strong roots

A GP must be like a big, mature tree. Like being a good parent, you have to have long and strong roots coming with time, maturity and experience. This means that when the winds flow fiercely, your branches move with the wind, but only so much. During the good times and the bad, you are still there, left standing, because of strong roots.

The occasional use of the reception area as theatre of exploitation by patients is understandable with drugs of addiction. But it is interesting to explore the reception area as one of the bottlenecks of controversy and vulnerability, even for allegedly more moderate situations.

Many GPs work as private practitioners, fully or partially. Like any business, our reputation is important. Trust is important. So if a patient or a loose cannon comes out of the doctor’s room and wants to spread the message of discontent (or misunderstanding) to a wider and trapped audience, it is not difficult. Because there is no private space where patients can talk to receptionists. This comes back to planning of the medical centres we work in. Some practices have discrete glass offices, separate from the waiting room, where easy and difficult conversations can be undertaken. The banks don’t understand this yet but the pharmacies are coming around to the idea of the private room, separate from the reception.

It is often easier to go with the flow of the loud, assertive or abusive patient, client or customer. Parents experience the same problem with a child who knows when and where to scream. They scream at the till, where the chocolates are, but more importantly where the crowds are. The bigger the crowd, the bigger the manipulative effect.

Of course a mature, rooted parent can ride out this storm of public manipulation, like a strong tree, in the same way that Dr Harry Barry advises that we must ride out the terror of panic attacks. As time goes by, the child gets the message that this screaming gets her nowhere. Of course, this does not stop at least one person in the queue berating the dad for not controlling the child or giving in to the child for the sake of ‘peace’.

‘Peace in our time’, I suspect.

So back to the hollering patient in the doctor’s reception area while bored and waiting patients light up to a bit of gossip. They can’t help but listen in the open reception area to some version of truth about ‘that’ doctor, in Monica Lewinsky tones. The receptionists try to calm matters and go with the flow and do damage limitation. The doctor may not have been told about the abusive behaviour due to the shaming effect of public outbursts.

But the practice culture is being built. ‘We can, it seems, shout and abuse reception staff in this practice. If fact, we must shout in this practice. This is acceptable and normal in this practice.’ This is what the witnesses see.

Speaking of Monica Lewinsky. Her courageous TED Talks presentation on public shaming has much to teach us about the new culture of shaming doctors in public arenas.

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