Tuesday, January 16, 2007


A pediatrician friend told me of a patient of hers who went to a pediatric emergency room a couple of weeks ago. The patient is a toddler of a single mother without much money. I don't know many details of the encounter except that at one point the emergency room pediatrician snipped at the mother "How come you can afford a cell phone but can't pay for your child's medicines?"

The mother was offended and complained to my friend, her regular pediatrician. When my friend related it to someone in management at the pediatric emergency room, she discovered that it was not the first time the emergency room pediatrician had done something like this.

I think most of you would agree with me that doctors should not say such things to patients, for several reasons. For one thing, it's just plain rude. For another thing, the doctor might not know the whole situation. In this case, the mother used a pre-paid cell phone as her only phone, which was the most inexpensive way for her to have a phone. Also, saying such things to patients doesn't do any good. Did the ER doc really expect the mother to get rid of her cell phone because of that comment? Finally, it belittles people, and there is little to ever be gained by doing that.

I must admit, though, that there are times when it's tempting to make some snide comment to a patient. A few days ago we had a 21 year old in the labor and delivery area having her fifth child. I was tempted to say to her "What's the problem here? Is birth control too difficult for you to master? Or do you just not give a shit about yourself or anyone else?" (Kids, don't use these words at home!) We can all agree it's best I left those words unsaid. On the other hand, if I were to a have a compassionate talk with her at the appropriate time about her problems with multiple pregnancies, that would be a different matter.

I'm not sure what's going to happen to the snippy emergency room doctor. Maybe she needs some counselling. Maybe, though, she just needs a blog where she can get those things out of her system.

P.S. Check out a new pediatric grand rounds at Parenting Solved.


Anonymous J.net said...

Neonatal Doc wrote: "I think most of you would agree with me that doctors should not say such things to patients, for several reasons. For one thing, it's just plain rude. For another thing, the doctor might not know the whole situation."

Right! As a mother of three, I have encountered such attitudes occasionally. The first time was when our premature twins were in separate hospitals in the same city. One was transferred out of the original hospital for intestinal surgery, while the other had gone home, then was readmitted elsewhere due to RSV pneumonia. Visiting both of them two hours away from our town was especially difficult since we also had a 2-year-old; a close family member had recently died, and we were also trying to take care of my aging father and disabled brother. The few times we got to visit, it had to be quick so we could drive across the city to visit the other baby, then get home to our other responsibilities. At Hospital A, the staff would comment negatively about our infrequent, fast visits as if we didn't care about our child. (They never asked about our family situation.) At Hospital B, the entire medical staff was interested in us and because of that, knew our situation. They understood. They also called us with updates about this child's condition. At Hospital A, we would call them, and sometimes the staff did not even know which stepdown unit our child was in!

A few years later, one of my children developed a high fever in the the middle of the night. Ibuprofen did not bring it down, and since he was prone to seizures, especially with fever, I decided to take him to the emergency room. (My husband was out of town on business, so I had to call a neighbor to stay with my other two children.) I went to the emergency room sans makeup or fixed-up hair, and I wore comfortable jeans. My child was screaming the whole time, and when the elderly, out-of-town ER doc finally got to us, my little boy had finally gone to sleep. So, I quipped to the doc, "Well, he finally konked out!" I am not sure what the doc thought I meant by that, but I meant he had gotten so tired of screaming that he finally went to sleep. The doc immediately began questioning me as to what had happened to the child to make him "konk out." I said I didn't know, but whatever was wrong with him was why I brought him to the ER. He wanted to know what was done to the child to make him scream. Then, the doc said I looked a bit young to have three children already,and he wanted to know if I ever got tired of taking care of three little ones all by myself, etc. etc. I finally told him that while I appreciated the compliment that he thought I looked too young to manage the care of three little ones all by myself, I was actually 40 years old, had a husband and was married, though that was none of his business. I said my child must be seriously ill with either an ear or sinus infection and would he please be kind enough to check him out and do a WBC. Well, the WBC showed infection, and after that the doc treated me with respect, but he didn't apologize.

2:52 PM  
Blogger Flea said...

Rudeness is never acceptable. Neither is excessive niceness where niceness is not appropriate. If an ED patient is abusing the system and wasting the taxpayers' money, he needs to be told this (in non-offensive language) and tough titty if he's offended.


4:01 PM  
Anonymous Shamhat said...

In my hospital last night I heard judgmental comments about a woman having her second child at the age of 25! Just because most of our clients, most of our nurses, and most of our doctors had their children in their late 30's, with varying degrees of difficulty, doesn't mean it's the new normal, does it?

4:36 PM  
Blogger WendyLou said...

When I was at the ER with a possible misscarraige, I was told, well, now you know you can get pregnant by a nurse.

UMMM, she had not heard my reproductive history, but this was my first pregnancy in over 4 years of trying. So no, I don't know I'll get pregnant again.

I took DD to the ER for her femur, and was treated like I had two heads when I said we were not waiting in their waiting room with people with RSV signs out there. I don't care if we got Synagis or not.

We ended up waiting in the car, and they called us.

In my profession, as a social worker, I've wanted to say such things, as You are coming to me for rent money, but you clearly have a new manicure.

I did once ask while doing budgeting about the manicure. She and her friend got together and did them for each other while their children watched Disney. I learned a lesson for judging. I would often go into a home where they are broke to find a big screen TV. I asked once, and it was someone elses, and they were being lent it while that person was gone on a deployment. I try to reserve judgement, but I fail.

I have asked people if they know about birth control and offer a referral to planned parenthood, and leave it there.

5:34 PM  
Anonymous chris and vic said...

Is it critical?
Is it holier-than-thou?
Is it "My-values-are-better-than-your-values"?
The snippy ones need to walk a mile in the other person's shoes;
needs to open up her/his mind to other perspectives;
needs to mind their own business!

When I was a single mother of 5, trying to get through nursing school, and on welfare for the duration, people used to watch what foods I bought with food stamps, as if I had no right to buy anything they thought extravagant . . . such as soda or sweet rolls. The critical tax-payers who were paying for me to be on welfare didn't know if it was someone's birthday at my home, or if we were having company, or if I had promised the kids a reward for some good thing they'd done.

Not only should snippy people try in their imaginations to walk a mile in my shoes, they should allow that there are extenuating circumstances that they could not imagine, even with very active and charitable imaginations . . .
CAK (Chris and Vic)

5:39 PM  
Blogger my4kids said...

I only complained about a dr one time when my son was admitted to the hospital with a 104 fever. I had originally taken him to an urgent care since it was a weekend (figuring it was the resposible thing instead of wasting ER time if unnecessary) but the ER sent us to the ER the dr in the ER decided to admit him for observation. When the ped dr came in the next morning telling me my son was fine with his 102 fever since he was acting what she thought was normal (it wasn't) she told my son that if his mother didn't feel like taking care of him when he was sick he could come and play with her kids. I wonder what she would think about having him play with her kids when his ped saw him that day sent him to a different ER that diagnosis him with meningitis?
Bringing him to the hospital was not an easy thing to do when he had 3 other siblings at home and we had to coordinate care for them while I stayed with him the hospital is definetly not a place I go unless absolutly necessary with my kids.

6:21 PM  
Blogger Misti said...

Everytime I hear about snippy doctors, I immediately think about the TV show "House". As a former ER employee, I know what I have thought in the back of my mind but have never said. This is one of my favorite quotes from "House":

I am a board... certified diagnostician with a double specialty of infectious disease and nephrology. I am also the only doctor currently employed at this hospital who is forced to be here against his will. But not to worry, because for most of you, this job could be done by a monkey with a bottle of Motrin. Speaking of which, if you're particularly annoying, you may see me reach for this: this is Vicodin. It's mine! You can't have any! And no, I do not have a pain management problem, I have a pain problem... but who knows? Maybe I'm wrong. Maybe I'm too stoned to tell. So, who wants me?

8:34 PM  
Blogger Fat Doctor said...

I'm snippy all the damn time. Then again, I get "reported" to the Keep Patients Happy office all the damn time, too. Think there's a correlation?

9:40 PM  
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9:50 AM  
Anonymous Claire said...

As I was prone to pre-eclampsia, it was decided, during my second pregnancy, in discussion with my doctor, that I shouldn't have more children. (I'd've liked to, but realised it wasn't a good idea). We agreed that I would have a tubal ligation during the C section. The young woman doctor who brought the consent form prior to delivery clearly disapproved of this decision, and tried to talk me out of it. Failing, she bounced out of the room saying "All right then. No more babies." As it was by no means certain this second child would make it (she did) I really appreciated her compassion and tact. Twenty five years ago, and I would still like to slap her.

9:57 AM  
Blogger Evil HR Lady said...

Snippy, bad. Telling the truth is good. The key is being in a position to know what the truth is. Wendylou had good examples about making premature judgments.

10:37 AM  
Blogger Bardiac said...

From the title, I thought you were having another go at the circumcision thing. Hmm.

8:41 PM  
Blogger fancypantsnancy said...

There is nothing "wrong" with her! She is just a typical doctor; arrogant, judgemental and totally devoid of social skills. You should name her "legion" for there are thousands of MD's like her. In my 30 year career I've had contact with dozens. Ususally they are male, but with more women going to medical school, more of these social retards are female.

12:09 AM  
Blogger neonataldoc said...

Amazing - other people have had experience with snippy doctors, too? Who would have guessed that? Although I'm not willing to quite agree with fancypantsnancy. There are a lot of good, compassionate doctors out there.

Kudos to Fat Doctor for giving me another laugh. The Keep Patients Happy office - perfect.

10:59 AM  
Blogger MotownRunnerGirl said...

i see you have strong feelings about young moms having lots of babies. how could you not, right? you see things most of us don't. as a 36 year old single chick with no kids, a nice job, car, house and a dog, i read those posts and wonder what my life would be like had i been one of those girls. i might have perhaps been harsh and judgemental at some point but i no longer am. i would not want to bring a child into the world who i wouldn't be able to provide for but i do feel sadness and sometimes, yes, a little jealousy. also, on the snippy thing, yeah, it's always best to reserve judgement. you never know what drama is going on in a person's life. i really appreciate this blog.

11:07 AM  
Anonymous BUGS said...

Someday this doctor is gonna say something "snippy" to an overworked, underpaid, harried mom of many, maybe has a differently abled child...and will be knocked flat on her butt.

I know if a doc spoke to me in that way, I'd be leaving a trail directly to the head of peds. I've done it before, I'd do it again. Judgements have no place in taking care of a sick child.

Reminds me (somehow) of the time I was battling bronchitis and finally took myself to the doctor. She took a look at my Buddy Walk t-shirt and asked who I knew with Down syndrome. I told her that my (then) 2 year old son had it. She then asked "OH! So you didn't have an amnio????"

The look on her face was priceless when I said "Yes, as a matter of fact I did...why do you ask?"

She stammered and left the room to "look for some puffer samples"

11:55 AM  
Blogger neonataldoc said...

Bugs: well said.

6:10 PM  

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