Yell at your own risk

For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was picked-up and slammed down.  My staff had no better luck and therefore, I decided to try once more and then send a registered letter.

 

The phone rang four times.

“Hello, who is this?  Who keeps calling?”

“Hi, this is Dr. Salwitz, I was trying to get a hold of Stan.”

“Dr. Salwitz’s office?  You should never call this number.  I am sick and tired of people bothering us and calling all the time!  Can’t you people ever get things right?!   What a s**ty way to run an office!!  How unprofessional!!  I am going to call Dr. Salwitz and tell him! What is your name?!”

“Ah…. This is Dr. Salwitz.”

“What?”

“This is Dr. Salwitz.  Is Stan home?”

 

It turns out we had an old number, which Stan was planning to disconnect, and we had failed to change it in our file.  But, shaken, a little, I considered the conversation.

With notable exceptions, patient’s rarely yell directly at their treating physicians.  In the eloquent words of Stan’s wife, the proverbial drek really needs to hit the spinning blades for patient’s to think they will advance their healthcare by pissing off their doctors.  However, being sick is infinitely hard, emotionally draining, psychologically confusing, and you often feel, well sick, so it is difficult not to express mortal frustration.  Therefore, patients yell at front desk staff, nurses and other critical supporting caregivers.

I understand and am sympathetic to why this happens.  You feel bad, really need help, relief, and then something “stupid” gets screwed up.  The prescription is not called in.  The appointment is not scheduled or even more frustrating, is at the wrong time.  The insurance precertification comes late or not at all.  The doctor is running two hours behind, when you already feel so rotten you belong in bed.  Bad news happens or threatens.   So, you blow up.  But, at the staff, not the doc.

The problem is that patients and their doctors, really need support staff.  They are vital to each patient’s team, but vulnerable. They often do not have the training, experience, motivation, or, to be honest, salary, to bounce back well from personal assault.  They may mean their best, but after a few dozen abusive interactions, their best might have an edge of mean.  Burnout rates for staff can be high, which affects patient service, resulting in deteriorating care.

Like it or not, we yell at our own risk.  The person we hurt the most, may be ourselves.  So, I have two suggestions.  Try to take a deep breath and remain civil, even when things are not going well.  It will result in a better outcome and be deeply appreciated.  Second, if things are not getting better, ask gently to speak to a supervisor. Perhaps, they can solve the problem without fireworks.  Try to see the person in front of you as a core part of your care team.   If you do lose your stack, remember to apologize.  A “sorry, about that,” goes a long way; it probably heals better than donuts or pizza.  Stan’s wife was immediately apologetic, which mended any bad feelings either one of us might have had.

Perhaps, we all should use a simple rule; try never to yell.  That does not mean we do not get mad, just recognizing that projecting anger is often counterproductive.  There are two types of people in this world.  The ones we want to work with, and those we do not.  The ones we want on our team, we should treat with respect and support.  No reason to yell.  The ones we do not want are not worth the energy of shouting.  It just accelerates the dramatic.  When things get bad, remember that everyone in the doctor’s office is part of your team.  The better you are able to treat them, the better they are able to care for you.

 

 

25 Comments

  • Iris
    Dr. S, it's just that patients need time too. Because an unknown MD in a close hospital went up to my family and told them basically I am dying. So my son hired a caregiver 24/7, and since my son is my POA, I'm angry. So now apparently I bought myself a ranch too but still living with my son. I HATE the woman that sits down and watches me. I can do everything by myself. I am paying a woman that doesn't understand English a fortune to upset me. She's going to be my roommate...Now what do I tell these nosey people that press their noses against the panes of my windows to snoop and yenta? "Hi sweetie, want to meet me for a game of tennis?" BUT I may know someone just perfect for you :) "How perfect?" "She will do anything you want Cooks! cleans! (doesn't speak the language and argues only with me..) She's strong also. I have never gotten angry since 6th grade. This is like tasting tart pickles that give me heart burn! A cancer patient's entire life is turned around. Someone should run a class for the families of the caregiver, I'm a little afraid of new things and people. Hopefully, I can fall asleep soon. There's not a pill that even works. Is it bad to lie and say, "Yup...I have cancer." I also don't lie (; A Pal patient
    • James Salwitz, MD
      Your comment is remarkable and intense. Don't forget that as long as you are competent to make decisions, your POA cannot decide for you. You remain in control. As much as possible make sure that your family knows your continued need for personal space and privacy. You are right, a cancer patients entire life is turned around, but it is still important to find moments of dignity and peace. Hang in there, We hear you, jcs
      • meyati
        Suggest that people give a limited Power of Attorney, where the patient authorizes only medical care. On all of the blogs, nothing is being said about a limited power of attorney-sometimes saying he bought me a ranch is literal, not figuratively.
  • Liz
    Dr. Salwitz you are not going to like my response here… Support staff aren't always just the convenient whipping post for patients as you are assuming. Some support staff ARE the problem and patients are well aware it is highly unlikely the doctor will do anything about it, further if they complain they risk being fired as a patient. Even if you, personally, don't behave like that enough doctors - even competent nice doctors - do that patients are unlikely to take the risk. Also the other part of this equation is that the doctor needs a way to hear about complaints without the patient having to pay a copay to see him/her again and without having the complaint filtered through the very staff whose neck(s) you'd like to wring, without the risk of being fired as a patient. The doctor then needs to do something about the complaints. You might want to think about why a particular support staff is being "abused" by the patient. Perhaps that person should not be in that job due to their behavior towards patients. Do not automatically make it the patient's fault and essentially cop out by saying patients have to deal with it rather than the doctor firing the support staff's sorry a$$. It is after all the responsibility of the doctor to have support staff who will do their job and behave professionally. It is not the responsibly of the patient to coddle a support staff jerk - although it appears that is the usual medical profession expectation and not to coddle you do at your own peril. You see support staff are generally not held accountable for *their* behavior, in part because the doctor has no clue, generally speaking, about what goes on "out there". And because so many doctors these days are quick to blame the patient for problems of the doctor's office and then fire the patient I'd bet that fear of being fired by the doctor is behind a lot of failure to even complain to (let alone yell at) the doctor about abuse from the support staff. And trust me on this, there can be significant verbal, passive aggressive behavior, failure to do their job, etc, abuse. It has happened to me repeatedly over the years and I have witnessed it on multiple occasions. Let me give you a very recent example. I had a surgical test Wed. I was told to call the office Friday and I'd be given the pathology results. I questioned if this would really happen (mostly this kind of stuff does not). The surgeon assured me I would. I called Friday and was told someone would call me back. I called a second time hours later and was assured someone would call me back. No one called me back. It is now the weekend. I get to wait. At this stage of the cancer gig game I do not do waiting well for biopsy test results and do even less well waiting when that waiting is due to someone not doing their job. I plan to show up at their door step Monday morning and ask for a copy of the pathology report. And to complain no one called me (but to complain after I have the report in my hand so they can't retaliate by not giving it to me - retaliation by support staff is a common occurrence for patient offenses real and imagined). I do not want to have to pay a $40 copay to see the doctor to complain but I doubt he will ever hear about my complaint since it will filtered by the very same people who are part of the problem unless I actually make an apt just for the purpose of complaining. In my opinion a doctor's office full of "I don't care and I am only sometimes going to do my job" with respect to patients (they often to it with respect to the doctor as they know they will be fired if that part of their job is not done and they know the odds of the doctor finding out they are abusing patients is low) support staff is inexcusable and negligent. I understand these jerks have power over me, can make my life miserable, I need to suck it up and kiss their a$$'s, be the adult, etc. even when the screw up is their fault and they don't care and I feel like sh*t; even when their screwup causes me considerable anxiety and stress, in order to get my concerns met because many of them do not act professionally and they will then make my life as miserable as possible… after all the expectation is the patient will put up with all kinds of inexcusable behavior and if they won't they will be fired as a patient because doctors don't want their support staff "upset" (and that is a direct quote). Yeah well the doctor often has no friggin clue how some of their support staff behave, the parts of their job they don't do… especially in larger offices - especially if said support staff is friends with the office manager. The doctor may personally like a support staff who behaves like a jerk and ignore/not believe they are a jerk.. Heck my vet's vet tech is a jerk. When she was incredibly rude to me when I asked a question about why they were taking my cat back without me, two other pet owners in the waiting room told me to blow her off because she was nasty to everyone, don't even bother complaining to the vet because the vet liked her and won't believe you. I tried complaining anyway and asked to speak to the vet without the vet tech present and was blown off, the vet told me she was not going to have the vet tech leave the room, and made it very clear that any negative comment about the vet tech was not going to be viewed kindly. The vet is very very good, so I deal with the situation. I wouldn't if the vet was average or knew of a vet as good. If the doctors actually knew (I often find out mine generally do not because they have no communication method that does not require making an apt, paying the copay, or being filtered through the support staff - and the patient fear of being fired by the doctor for complaining) what kinds of things actually went on with their support staff then perhaps THEY might yell at their support staff - or even better yet fire a few of them. It is my belief that the doctor needs to have a method to get feedback from patients about what is going on in his/her office that goes straight to them, does not require making an appointment and paying, etc. and also does not risk the patient being fired for complaining. It is my belief that it is the responsibility of the doctor not to have a$$holes working for them. It should not be only and exclusively the patient's responsibility to deal with this kind of crap in a calm, understanding, kind manner. The doctor needs to fix the situation and get rid of support staff that create conditions that cause stressed out, sick patients to finally lose it and yell (and yes there are jerk patients too, but I am not talking about those - I am talking about the reasonable ones who have had enough from jerk support staff). The doctor needs to apologize to the patients for the behavior of their jerk support staff. If it was easy to "vote with your feet" then doctors would have incentive to find out what is going on beyond the confines of the exam room. But often there are only limited choices, even fewer competent choices - sometimes only one choice - that are in network and so voting with one's feet is not an option. So as long as their office is running smoothly from the doctor point of view, it is open season on patients because support staff are not held accountable and there is no easy, risk free way to let doctors know what screw ups, treatment by staff, failure to do their job, created the situation that finally caused a sick patient not to be able to suck it up any longer and deal with it.
    • James Salwitz, MD
      Wonderful comment. While I hope that doctors rarely fire patients just because they are not nice to front desk staff, I do agree that it is really important for doctors to set up a method for patients to "complain" in a non-judgemental manner and in a way that does not require a formal MD visit. For example, we have a comment box, frequently run patient surveys and have occasionally held patient work groups to discuss our service. In the end patients often do "vote with their feet" because of poor front desk support. Clearly, this serves neither the patient's need, nor educates the stafff about what needs to be improved. jcs
      • meyati
        Dr. Salwitz, who reads the patients' comments? the staff that you are complaining about. A mysterious charge showed up on my infant grandson's bill. I took in all paperwork to billing, and proved we were out of state when this office visit appeared. SORRY- I even got a lettof apology. The charge was put on my daughter's bill- still out of state. I took proof-and went to billing. I tried to talk to the doctor, and he told me that he did medicine-not billing-Talk to billing. Finally, I went in with my grandson, and asked the good doctor how long had it been since he saw my husband. Several years, and is he still my patient? I showed him a bill for my husband's care, I showed him the amount that was passed from one family member to another. There had been some small errors and I just paid them, but the bookkeeper got greedy. The doctor remembered that other patients had complained off and on about billing, so he got hold of them. A single parent in church did some bookkeeping, and she could save the doctors lots of money. Things went well for a year. She had a warrant out for in Colorado for embellsiment. Then I had a problem not caused by staff or doctors, but by administration. I needed a different doctor. It was at the point that my family said they would not allow me to be cared by the creep. They didn't have any procedure to change doctors. I wrote letters, made phone calls, sent Emails, and went up in person. After 3 months, I threatened to sue. I got a lovely, good-natured and extremely competent doctor from Africa. He didn't have very many patients. It didn't bother me to have a black doctor touch my white-irish body. He listens to me. He answers me. He has understanding and knowledge. I began saying that "I'm living the Vampire Life-style" I have a vitamin D deficiency-he listened and ordered the test. I went in with my bottles of vitamin D & C. I get new lab work for vitamin D in 3 weeks. I always told the front desk that I know that they are following clinic regs, but I was mad at an incompetent doctor-that nobody in administration was getting back to me or doing anything. They kept getting a supervisor-I'd talk-then nothing happened-and after an appropirate length of time- I was back at the front desk demanding a new doctor-and asking what did it take to get one around here. Remember you might want to empty the complaint box out yourself, not the front desk people or administration. Then read the complaints and complements yourself.
      • Liz
        Ohhh plenty of docs fire patients that complain… plenty of venting at cancer patient support meetings or even sometimes in the waiting areas. You can't always vote with your feet in a smaller town with limited options or with health insurance with a limited network (and that is going to start becoming a bigger problem with Obama care insurance - limited network and few in network). An even bigger risk is being fired by entire large hospital network if you (a) complain or (b) vote with your feet. In many places it is impossible to see a different doctor in a large practice if you fire one of them. This town has 3 large hospital based practices and several independent docs. That is it. For me one of them is out of network. All I need is to be fired by 2 doc, one in each large practice (includes all the specialists) and I no longer have access to medical care in this town. And I second others - you need a secure way that ONLY the doc can access the survey's because if someone else can they may well filter what you see by either removing negative ones about themselves or a friend or if things are in pencil erasing stuff or adding stuff to suit them. And the key to the lock box should be on your personal key ring, not in the office anywhere. RIght now I have three sets of office support staff that I have imaginary voodoo dolls that I am sticking pins in because I don't dare do anything about the situations. And one billing office set of staff. I do not have the money to make an apt to complain. I was able to complain to one doc and she told me she was trying to fire, or at least remove from her office and pass the problem on elsewhere (this is the nurse assigned to her), the person I was complaining about (one of the big practices and she has no direct control who is in there). I only dared tell her as I know her well enough that I knew I would not be fired. Glad you take care of things, but what you do is NOT the norm. Print out this blog and comments and ask your medical students just how the heck they will keep tabs on stuff like this. Research in business documents that many (certainly not all) managers have no clue what is going on with their employees, people's opinions about the employees, what they actually are doing or are not doing... Well doctors offices are a "business" too and I'd suspect that the same holds true there as well.
        • meyati
          Ditto
  • Jo Turner
    I agree Dr. Salwitz, I think most dr.'s support staff are trying to keep things running smoothly. They deal with many patients day in and day out. There may sometimes be some staff that should be in another profession, but hopefully they are weeded out. I can understand a patient "yelling" or getting upset if something being done is dangerous to their well-being..they should speak up. But taking their frustrations out on office staff is not right, or yelling at and picking on staff just because they don't feel well isn't right. The office staff are people too and they have feelings and they may even be dealing with difficult things in their own home, like a sick child or sick parent.
    • Liz
      Or that office staff person might be a jerk and is standing on the patient's last nerve… I agree yelling at someone for no reason is unjust… however office staff chose to work in a place where there are sick people, some of whom are so stressed out that they don't handle stupidity on the part of office staff very well - or at least not as well as they'd handle it if they were not already sick. As a result they need to realize there is going to be a certain level of patient frustration they will need to deal with and be professional about.
      • Jo Turner
        You're right Liz. I worked as a CNA with elderly clients mostly and I know that sometimes the patient reacts because of sickness or dementia and we are supposed to act professional at all times. Sometimes it's hard, but, like you said, those in the medical profession chose to work with sick people and that goes along with the job.
  • Thanks for the reminder. A calm voice with determined respectful words goes a long way. I think it is okay to be upset about things falling apart and it is more effective stating your "complaint" in a calm manner.
    • meyati
      But what do you do, when calm and logical doesn't work, and you give them 2 weeks to resolve the problem? You politely go up and start all over again. For me it was to get a different oncologist and get rid of a useless Nurse Navigator. I was running out of time.
  • Bridget
    Yelling rarely accomplishes anything, unless you're alerting folks to a true emergency. A shouted HELP gets attention! When I ended my relationship with the first oncologist, I met with him for 15 minutes to outline what issues I had with his practice, including the front office and waiting room. I remember that he was sweating along his forehead and upper lip. When I shook his hand good-bye, he remarked that I was only the second person in his 20+ years of practice to sit down with him to calmly talk about issues, and that in his experience, people who were unhappy simply failed to show up for appointments, or came in and yelled and ranted. My calm approach made him a little nervous since he was waiting for a confrontation, but I just wanted him to understand my experience and perspective, and where possible, to make some changes that might benefit others. Yelling would not have communicated anything and would not have honored the dignity both of us possess as human beings striving to get through cancer. I found an oncologist who is a better fit, and I hope he learned that my perspective was worthy of consideration in his practice going forward. Your essay is a good reminder that we're all in this mess together and a kind word resonates, while the harsh one simply hurts.
    • Liz
      Probably many of the others waited until they couldn't stand it any longer and did a combination of venting and talking about it and were so frustrated that once they got going they couldn't remain calm. Of course it would be better if problems were mentioned early on before things got to the point of no return but that doesn't happen partly for reasons I have already expressed in other posts. I'd also put that partly on the MD though as it is their responsibility to find out if there are, and deal with, problems with the support staff before it becomes the kind of problem that some patients blow up about. Yes it is a two way street here, however the patient should not be expected to take the greater responsibility in this kind of situation.
      • Kathleen
        I totally relate. Yes, of course, we all know the proverb about honey and vinegar, but patients should not be expected to shoulder the entire burden, and with a smile yet. Doctors often fail to realize the deep inequality of power in most relations with their patients. If we find docs who are good at what they do, most of us really do need them, and often issues beyond our health are concerned - like job status and paperwork. Too many docs don't understand that the wrong answer on a given question can have a severe impact on a patient's future. And if their staff doesn't relay messages with care or accuracy, these non-medical results can be disastrous to a given patient. I'm thinking of when I blew up right at the desk of my surgeon's office. And this is a brilliant surgeon who made an enormous difference in eventually recovering my function after a severe injury. Nothing about my case was going in a "typical" manner. The month before I had called the office and asked them to make a report that the company required, and persistently called, left messages to followup. Nobody returned the messages at all, even when I spoke with a human being, so I had no way to know that they never delivered them correctly to the doc in the first place. When I hobbled into the office the day before this report was due, I learned that there was no report. They had completely misunderstood or misrepresented the nature of the requested report, so the doc decided it was unnecessary. Maybe not medically necessary, but I could be fired without it. And nobody bothered to tell me that no report was coming. Already In hideous pain with very limited function, I realized that because of their negligence and incompetence I might very well lose my livelihood and medical insurance as well. But until I arrived I had no idea how bad it was. Imagine my shock. Yes, I was loud. So they go get the surgeon who yells that I may not berate his staff. But what am I supposed to do when nobody returns my messages? No matter how often I leave them? And when, despite my efforts, it took me a month to learn that they never delivered them correctly to the doc in the first place?
    • meyati
      My first one hid from me- no appointments for anything, and he wouldn't release me to a different oncologist.
  • Penny H.
    I'm quite impressed that you actually call your patients yourself instead of having support staff do it. One of my biggest irritations in cancer care is the fact that I rarely get to sit down and talk to my oncologist. If I have questions in between my twice yearly visits, I must relay such to a nurse who then asks him and gets back to me. The possibility of miscommunication is huge because support staff doesn't quote my words, but rather interprets and sometimes makes wrong assumptions. My other current irritation is him using my office visit as the time to train (yet another) physician's assistant. Last visit, I swear he could have done the whole thing without me. Wasted my time and the insurance people's money, as far as I was concerned. Now, I realize that what I have is considered an "indolent" blood cancer, but it's my body, my life, my health at stake here and I think he should pay attention when I show up every 6 months and take up 5-10 minutes of this busy doctor's time. My total M-spike has doubled in the last 6 months since I saw him last. He failed to do a specific test which separates out my normal IgM from the cancerous IgM, saying, "Well, I was trying to save a dollar or two. We'll do it again in 3 months." I wanted to ask him how on earth this was saving money, much less taking care of knowing what's up with my Waldenstrom's. But since, the new PA training took precedence here, I was left watching them whisk out of the office and thinking, "WTH?" Would I, deep down and in all honesty, love to yell his house down over all of it? Sure. But it would jeopardize my relationship with him and this is a rare cancer we're talking about. He's the only oncologist within driving distance that I know of who treats it. I sometimes wonder which is tougher, the stress from this kind of frustration or the cancer itself. I seriously don't know how to deal with this sort of thing; so I don't do anything. I just take it, but I really don't like it.
    • meyati
      This where the electronic chart is helpful. I make my complaints few, concise, precise-almost terse-with a thank you at the bottom. My problem is my PCP. I avoid him like the plague. Last time I was in Urgent Care, the man in front of me asked if he could use urgent care as primary, and he never wanted to return to the clinic in the South Valley. I told them that I never wanted to return to the Heights clinic. I don't know if my PCP bothered reading or the lab didn't make a notation that I didn't fast. They didn't ask me, and a patient should be asked about fasting before the lab work is done, not 2 weeks later. While he was trying to declare me diabetic, I asked him if the lab noted that I didn't fast. I told him that I should find out in his office if I'm being tested for glucose before the test-I pigged out on cake the night before and had a piece on my way to the lab. #1-I now back to the old lab by my house that does ask me if I did fast, and the lab notes on the results that I didn't fast. #2-I called and called, demanding to talk to my PCP's office manager about these communication problems in the lab and PCP. The problem is that you can't directly call the doctor's office. A patient gets a phone bank that answers calls for all clinics, and doctors. I said right off- I know that I'm calling a phone bank, but I do need to talk to the office manager @ the Heights. There isn't good communication between the lab, the doctor and I'm stuck in the middle. #3-I told my PCP that I'd make it simple-I would refuse to take any glucose tests for him-then we wouldn't be arguing. #4- My head oncologists says he'll manage these labs- I look healthy, I act healthy, my liver and kidneys have excellent lab work. I have severe IBS- I was supposed to have died last century from it according to USN and Air Force specialists. Fasting, and then being in a moving vehicle causes me to barf all over the place-and on staff. I feel fainty too. That causes drivers to freak out. As the person from the hospital that called me said, "That wouldn't give you accurate lab work either." I did get a call from the office manager. I was polite, but I told her about the lack of communication between me, PCP, and lab, and the lack of communication between him and the lab.
  • me
    We were in your 'system' for 4 years before my wife passed away. We ALWAYS were impressed, and I still am, with the sensitive manner in which we were treated by your staff. In fact we often talked on the way home about how they consistently showed concern and empathy. Of course we all have bad days and of course yelling never does anything except make communication more difficult. My hats off to your staff, they are the best.
  • Sadly I think the world is a meaner place these days. People are stretched thin trying to make ends meet and illness just jacks up the stress level one more notch. One of my veterinarian's technician told me she left human nursing because of all the patient's yelling at her and giving her migraines. And I have met my share of Nurse "Racheds" who have made me switch health care providers. A little kindness from both sides - patient and provider - would sure help.
  • :) Great post!
  • […] via Yell at your own risk – Sunrise Rounds | Sunrise Rounds. […]
  • D Someya Reed
    "remember that everyone in the doctor’s office is part of your team" Everyone would like to believe this but it is not always, not even mostly true. Many support staff are just "doing a job" for which the patient is nothing more than a roadblock (and an irritant) to them getting their "other" work done. Even fewer support staff have any customer service skills or training or desire to have either. I'm not supporting those who yell but all patients need a way to relay their concerns directly and immediately to their doctor (or to someone over their doctor's head, if need be). I, personally, do not yell as it never proves to be of any value. I am firm, though, sometimes very firm and I speak in terms consistent with medical language. When I have been accused of yelling, I have asked either my wife, those with me or even people in line if I did indeed yell. The only person who has ever said I was yelling was a support staffer. She was not backed up by anyone else in the room. Oh, and the "H" people. They never said (verbally) that I yelled but that was what they wrote in the medical file in order to create their desired version of events. Although not necessarily within your realm of oversight, you forgot to mention the support staff for other departments where you might send a patient. They, in theory, then become "part of your team." After a fine needle aspiration biopsy proved inconclusive, my wife was sent for a vacuum-assisted core biopsy. The tech (support staff, though of a slightly different nature) was angry at our doctor for sending my wife to her...don't know why, never found out. She made the appropriate incision (under a quarter inch) and inserted the core drill. 3-6 samples is normal. 12 would be rare. This tech, while fuming over our doctor's orders, took 18! My wife, forgive my saying, Sweetie, was a smallish "B" cup. These were not small tissue cores. These hunks of flesh (on the tray in front of me) were chunks of breast tissue ripped from her body. When the tech didn't like the way the drill was moving, she opened the incision to 3/4 inch. Blood just poured from my wife's breast into a bucket below the table upon which she lay face down. I didn't yell but I told the tech that was enough as she wanted to remove more. I also told her the incision was too big, needed stitches and the bleeding needed to be brought under control. You would be correct if you guessed that she said all this was "perfectly normal." I called our doctor. Again, I didn't yell but, boy oh boy, he did. And guess what? She did need stitches. My wife's surgeon said that he would try to minimize the scar. He did a fine job of that but ultimately she lost the breast and then her life. How likely do you suppose it was that her metastases was a result of the ripping apart of her breast tissue? And I can still hear those staff and administrators in the background saying (or thinking) "prove it." Yelling gets you nowhere. Intervention gets you thrown out. Incompetence gets you dead! Who is the "trained professional" in this equation? Who has the greater responsibility in this dynamic...the patient or the medical staff?
    • Kathleen
      Excellent post.

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