Crozet Annals of Medicine: On Being Less Judgmental

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By Guest Columnist Amita Sudhir, MD

Lately, there have been a lot of articles on medical blogs and other online media in which doctors deride their patients for their lifestyle choices and what they see as their general lack of respectability. A favorite target of these diatribes is the patient with a $400 smartphone. How dare they have the gall to bandy such a trinket about, all the while expecting healthcare that they probably can’t afford? Never mind that the patient’s only access to the Internet may be that smartphone, because they are homeless, or because they can’t afford cable, or because their credit is bad.

More disturbing was the article that explained the use of the term “SHPOS” to describe patients, which the author claimed was widespread amongst medical personnel. I was aghast to discover that the “SH” was an acronym for “sub-human,” and the “POS,” well, I don’t need to explain that part. (I was also quite relieved, afterwards, to find, upon conducting an informal poll of my colleagues, that none of them had even heard of the term.) The author justified the use of this moniker aimed at patients who harass their physicians, are rude to them, and behave otherwise generally undeserving of their care.

Of course, there are times when it is understandable for a physician to judge patients for their choices, when those choices have directly led to their need for medical care. Riding a motorcycle without a helmet is one example that comes to mind. But to place a value judgment on decisions made by your patient that have little or no bearing on their medical care, just because they are poor is not only in bad taste, but also detracts from the emergency physician’s ability to be an advocate for her patients.

You also have to be thick-skinned to work in the ED. Patients are not always going to be grateful for their care. They often didn’t choose to come to the hospital, but were forced to by circumstances beyond their control and being polite is the last thing on their minds. Maybe they are staring at that $400 smartphone and ignoring you because that touchscreen is the only semblance of control they have left in their lives. Internal validation is the mainstay of an ED physician’s well-being. You are just not going to get a lot of thank-yous.

Many people that seek help in the ED are not sympathetic characters. You are often seeing humanity at its worst. Some people behave well in a crisis and others behave badly; you still have to take care of them all. It only makes your job more difficult to start thinking that only some of the people that come to us are truly deserving of our care.

Another common theme in today’s media portrayals of the ED is that emergency departments are modern-day cathedrals, places where people seek refuge. This is not in any way a new idea, since the original hospitals were religiously based, attached to monasteries or churches, and fueled by a charitable imperative to help the sick. Caring for the sick was a vocation and not a profession. And sickness was a lot gorier back in those days. When you think of it that way, judging your patient for their electronic toys seems even pettier. If the doctors of yore could commit themselves to their patients despite their maggots and leprosy-mangled digits, we can commit ourselves to ours despite their perceived wasting of money on things we don’t think they should have.

If EDs are cathedrals, then perhaps emergency physicians should be more like priests; support our patients through difficult times, and leave the judging to someone else.

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