‘I’m only human after all. Don’t put your blame on me’

Anger, as we know, is of two types, an apparent and a hidden one. The apparent type is what everyone sees when people get angry, and this is not the anger that the vast majority of physicians display. When a doctor gets angry, they usually suppress their anger and act, or try to act, normally. This is because they have no other choice, otherwise they will lose their humanity and perhaps their license. We deal with patients who may be going through difficult situations and times. Patients may act in different ways and some may be unacceptable and reach the point of transgression or perhaps injustice to the doctor who sits in front of them trying to help. Read: Dr. Jabir Jassam: Bureaucracy hampers FP training However, we must admit that it is not easy for a doctor to sit in front of a person for the purpose of helping—yet that person speaks in an angry tone and screams and uses inappropriate language because they are in pain or because they suffer from a difficult or chronic condition. The doctor in the end is a human being like any other and has feelings and dignity. Some may say, as long as you agreed to be a doctor, you have to put up with everything, including patients’ abuse. I totally disagree with that as there is an end and a limit for everything. Suppression of anger, generally, can lead to depression, passive aggression, paranoia, intense anxiety, burnout and sudden outbursts over minor and unrelated issues. When doctors get angry, they react differently. Most of them tend to subjugate by focusing on patients’ needs rather than theirs. They become more focused, caring and empathizing to avoid conflicts which is basically a self-distraction but in reality, it is a self-destruction. Some of them project their hidden and suppressed anger on the staff or family members—which can cause countless unnecessary conflicts and troubles. The visit Mrs. C is 45 years old, and I have known her for more than ten years. She was recently diagnosed with papillary thyroid cancer and had her thyroid removed. She came to see me because she doesn’t feel well mentally. “Hello Mrs. C, good to see you after your surgery.” “Oh, so you know I had surgery,” she immediately replied in a satiric tone. “Of course, I know, they updated me step by step since I referred you for the biopsy.” “But it took me six months to get the surgery!” “I understand it is difficult to wait for such kinds of surgery and the anxiety the waiting can cause.” “And also, the wrong test result….” she added. “I am not sure what you were referring to,” I said. “Well, you told me I had a normal thyroid blood test.” “Yes, I did, people can get thyroid cancer with a normal blood test and vice versa but I however didn’t depend on the test only but sent you for an ultrasound which showed the nodule and then we started from there. It seems you want to blame me for something.” “Yes, you could have discovered my cancer earlier if you had sent me for a thyroid ultrasound last year.” “We don’t do ultrasound routinely for the thyroid unless we have a concern but as you are aware your cancer is still in your thyroid only and the type of cancer you have is the best one—people don’t die because of it so you really don’t need to worry,” I said trying to reassure her. “I am not afraid of death,” she said in a sharp tone. “I am not here to be judged by you and have my condition underestimated and accused of being fearful of death.” “I am not sure if you are serious Mrs. C. I didn’t mean to judge you or underestimate your condition. I am trying to reassure you based on evidence,” I said. “How about we talk about the reason for your visit today and to see how I can help you?” “I am depressed,” she said loudly and angrily. “OK, I totally understand, what you went through was not easy and can cause depression—especially as you have had depression before.” “Stop judging me,” she screamed at me. “I am not weak. Why did you even mention my past?” “OK, it seems like you are reacting angrily to everything I say which makes it very difficult to have a conversation with you. Would you like to reschedule another appointment? Or I can leave the room for 10 minutes until you calm down?” “No, I am good. I am calm and ready to talk but you have no idea what I went through. Do you know how long I waited? Do you even know I have had surgery? Do you even know what was my diagnosis? Do you even know the complications of my surgery? Do you even imagine the pain after surgery?” “Mrs. C: First, I am the one who diagnosed you with the cancer and started your treatment journey. And, yes, I know all of that. I understand you went through a tough time but you are in front of me now cancer-free but I believe we have to talk about your depression.” The talk Then we talked about her depression which I managed with antidepressants and a referral for therapy. We met a few times after that for follow up. Yes, I admit, I became angry during that visit, but I suppressed it until she became better. A few months later, I saw her for follow up and she had completely recovered and said: “I am back to normal.” Then I said: “Now you are better, I have to talk to you.” I reminded her about that visit and the way she treated me. “I didn’t react to your anger because you were going through a difficult time, but I can’t see myself sitting in front of you again listening to the same insults and disrespectful tone and talk. So, we have two options: I will let it go but what had happened should not happen again, so this is basically a warning for you. Or we end our physician-patient relationship.” The patient didn’t respond to either option at the time, but she has never come back. Some of you may say I should have let it go and continued with her without any further discussion. But I had to do it. Otherwise, it would happen again as she didn’t see it as inappropriate. She might think this is the norm and would continue doing it. And I did it because: “I’m no prophet or Messiah / Should go looking somewhere higher / I’m only human after all / Don’t put your blame on me.” Dr. Jabir Jassam is a family physician in Ottawa.

‘I’m only human after all. Don’t put your blame on me’

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