So in my wandering around the internets I came across this blog entry that someone had described as offensive to ED workers in that it seemed to blame ED violence on the employees. I actually found the post itself to be relatively neutral- there was a blurb about verbal de-escalation and basically responding calmly and with compassion when someone acts a fool, which I really do believe in- I've dealt first hand with many an agitated patient who I've been able to talk down by apologizing and showing concern. No, I got all irritated by some troll who is supposedly a patient advocate who thinks that if all emergency medical staff are not Jesus incarnate that they should just shut up and GTFO of the medical field.
I won't sit here and quote this hateful person who obviously has some serious issues with med professionals and ED staff particularly, but I do want to address this idea that I've seen brought up multiple times, almost always by someone in health administration, that if medical staff were just kind and compassionate enough that all our patients would stop acting out and being violent and verbally abusive.
Theoretically this doesn't sound so offensive, but think of it in any other scenario. What if my husband comes home after a really awful day. Work sucked, he got sick, the car broke down. Let's say in this scenario that I reply in a less than chipper tone about his request to get him a drink, to which he responds to by hitting me and calling me a series of obscenities. That's wrong, isn't it? Now, what if he does to the gas station attendant on the way home instead because the line is too long and they had an attitude? It's a felony, isn't it? Would anyone say to either of these people, "If you had just been a little nicer and more understanding, you wouldn't have gotten beaten. You should have known he was upset and treated him better"? No. Because that is victim blaming and excusing abusive behavior.
I have no idea why people think that it is then acceptable to act that way in a hospital setting. Look, I understand that people get agitated and frustrated, that they're having the worst day of their lives and most people in the ED just want to know what is going on, be made comfortable and be listened to. I make it a point to address those needs for each patient I take care of every time I come to work, to the extent that I often neglect my own basic needs like eating, drinking and going pee. I give everyone who walks into my room the benefit of the doubt about being sick and in pain, and even if I'm suspicious I still treat them with respect and kindness. Despite all that, guess what? The ER is a pretty good representation of the world in that most people are just there minding their business but some people are assholes. Some people lie to and manipulate the staff trying to help them to try and get something. Some people are high or drunk or just abusive and think it's acceptable to grope the staff. Some people have minor ailments but are abusive and threatening about waiting behind the sick and dying.
There are the cases where a patient is so sick that they're hysterical and rude and very difficult to deal with. I have a great deal of patience for people like this. I fall short with them sometimes and when I do I apologize. This is very seldom the case, though. As I'm sure many other ED doctors and nurses have observed before, the sickest patients are generally the most sweet and polite. A good friend of mine still tears up telling the story of the dying cancer patient she took care of last year-despite her horribly painful condition, she was so grateful for her care that she gave my friend a hug and a kiss for just bringing her some orange juice.
On the other end of the spectrum, I got cussed out the other day by a completely pain free, healthy and ambulatory patient because I relayed the message from the NP that she would have to get a urine sample prior getting the pelvic exam she demanded. I can't speak for anywhere else, but where I work this is usually where the problems come from- mostly healthy people who use the ED as a clinic who have figured out that aggressive and abusive behavior goes unpunished, as opposed to fragile sick people at the end of their rope.
There's no way of knowing whether violent behavior could always or ever be prevented with better communication. Ultimately it doesn't matter. Unless you have some kind of neurological problem, you are still responsible for your actions, and that kind of behavior isn't okay. I invite anyone who says otherwise to try to work a shift with me in the hood for one day.