Friday, 20 January 2017

Influenza and our moral compass

This is what happens in the average family doctor's office on a morning during cold and flu season.   The doctor's day is already packed with patients being seen for routine visits, chronic illnesses and major psychiatric disorders.  The aging population and the rising epidemic of people suffering from mental illnesses have strained our capacity beyond limits that I ever imagined possible. The phones start ringing at 8:45 and by 9:10, upwards of thirty patients have called in asking to be seen.  The doctor has 10 spots open at the end of the day.  The triage nurse frantically triages all these patients hoping to screen for those who must be seen and reassure those whose complaints are legitimate but minor.

It's a daunting task.  Within 30 minutes, the doctor's ten open spots are full.  While starting the day and in between the first few appointments, he or she is reviewing all of the patients who have been triaged by the nurse.  He or she is also taking calls from other physicians, renewing prescriptions and reviewing all the lab and diagnostic test results that have been streaming in since the lines opened.

Here is where it gets sticky.  This early morning onslaught is usually manageable and all of the patients receive either an appointment or advice, but during cold and flu season the number of ill people triples or quadruples and some patients bypass the phones and show up without appointments. This can be managed as well;  most of the time.

By 10 am, the reception staff, the nursing staff and the physicians have been pushed to their limits with 8 hours of patient care still ahead of them.  We do this everyday and, on most days, this gargantuan feat is accomplished professionally, respectfully and cheerfully.  It is also accomplished with absolutely no fee required from the patient.

I'd call this a win, win situation for the patients.  But something disturbing has been happening with increasing frequency over the last 5 years or so.  This amazing service that is free of charge is no longer appreciated by a good number of the patients receiving it.  People have forgotten how to say, "Please" and "Thank you".  They have lost the ability to treat with respect,  the staff that waits on them.  They no longer trust the nurse or the doctor who, in their well trained and deeply instilled judgement, advise the patient that they do not require an appointment but to please call back if things get worse.

I am writing this because I am worried for the emotional well being of my staff when, on top of providing care in a highly emotionally charged and deeply stressful environment,  must also navigate through conversations with angry patients;  conversations that even the best conflict negotiator would have trouble juggling.

We have all become much more self-absorbed, self focused and self-concerned.  We have adopted a sense of entitlement that erodes away at our cultural codes of conduct and moral standards.  We don't hold the door open for others anymore.  We don't wait until the elevator has emptied before pushing our way inside.  We don't greet people in the street with a gracious nod or hello.  We don't give way on the road to the other car and sometimes, most shamefully, we don't give way to the pedestrian while driving our cars.

We no longer treat with respect that check out clerk at the grocery store, the teller at the bank, the employee behind the Tim Horton's counter or the receptionist who takes your call at your doctor's office and sadly, too many times, we stoop to behaviour that is undignified and abusive.

My heart aches when I see evidence of this moral erosion.  It concerns me deeply.  It makes me feel unsafe and on guard in a community where our freedom and privilege should erase any fear of interacting with our fellow man.  Maybe we have too much freedom and too much privilege.  Maybe we have become too affluent and self sufficient to care about our neighbour or that treasured person behind the counter.

Yesterday was a particularly difficult day.  It is a bad cold and flu season out there folks.  Only the sickest should be seen and, yes, the flu makes you feel like you are dying and lasts an unfairly long time but the vast majority of people recover to excellent health.

Several patients restored my faith in humanity during this trying day.  One in particular reminded me of what strong, sturdy, dignified and respectful human stock looks like.  One of my patients had to have a terrible and extremely painful surgical procedure done during her 15 hour stay in the emergency room last week.  I felt so bad for her.  She said that she had nothing to complain about.  She lives in a country where the doctors and nurses will save your life with that surgical procedure and  do it under horrendously stressful circumstances with a waiting room full of impatient people waiting to be next.  And the beauty of it, you don't have to mortgage your house to pay for it.

My apologies for anyone whose feathers are ruffled by this post.  Maybe you are one of the folks that needs to congratulate and thank that amazing front line person who takes care of you on a daily basis. For those of you who are nodding your heads in agreement, keep up the good work.  We need your shining example is this increasingly unsteady world.

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