When we strengthen, deepen, and broaden our ethical awareness, we hone our skills at catching ourselves whenever we fail to fully respect the dignity of our patients, perhaps by not paying careful attention to them. Most of us learn about this failure when we are on the receiving end. For instance, have you led a charmed life free of the sinking realization that the other person, who supposedly is there to help, was either not showing you the basic respect of paying attention or seemed intent on slowing or blocking you from getting the help you need? Consider the following scenarios to see if any feel familiar:
You walk into the store to buy a new coat and (good!) there are no other customers—just four sales clerks near the back of the store telling each other jokes—so you should be able to get in and out of there without standing in line to check out. You go over to the coats but no sales person comes over to ask if you need help. You pick out the coat you want, try it on to make sure it fits, and walk over to the register. The sales clerks seem blissfully unaware of your existence, even after you clear your throat a couple of times. Finally, you say, “I’d like to buy this coat. Would one of you be able to check me out?” The sales clerk nearest you turns around to see who’s talking, looking at you as if you’d burped loudly at a formal dinner. The clerk holds up an index finger, indicating that your opportunity to give the store your money will come soon and you should show some patience. Finally, one of the longest jokes in recorded history reaches its long-anticipated punch line, and not too long after, you have left the store with your new coat. Another “satisfied” customer.
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You walk into another store and this time a manager, their face full of concern, practically runs over to you and asks, “Can I help you?” When you say, “just browsing,” they follow you around the store, a look of disdain on their face. It’s clear they didn’t think you belonged in the store, didn’t want you in the store, thought you came to shoplift, or cause some kind of trouble. Why would they think that? Did they think you couldn’t afford what the store had to sell? Was it your skin color? Your Rainbow Coalition pin? Your yarmulka? Your burqa? Your Black Lives Matter shirt? Why did the manager decide, just by looking, that you were not to be treated with dignity and respect?
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You (calling a clinic near closing time to reach your child’s pediatrician before he leaves the country on a 2-week vacation): Hi, I’m hoping to reach Dr. Guzman before he heads for the airport. My child has come down with something and no one knows her like Dr. Guzman. Any chance he’s still there?
Receptionist: Oh, I just saw him packing his briefcase in his office. Let me run to catch him before he leaves, and I have to chase him across the parking lot! [puts you on hold]
[You wait. And wait. You see in your mind’s eye the old movie convention of clock hands whirring around to show the passage of time. Then you see calendar pages flying off the wall. And then finally!]
Receptionist: What were you waiting for? Oh, I’m sorry, he left a while ago.
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You’re on the phone with tech support: Hi, I’m hoping you can help me get my internet connection up and running again quickly because I’ve got a Zoom session scheduled for a patient in crisis in 5 minutes. Let me tell you what I’ve already tried so that we can save time not going through those initial steps. I’ve tried disconnecting everything from my router, unplugging it from the wall socket, waiting 10 seconds, then plugging it again, and reconnecting everything. Then I tried checking all the settings on my computer to make sure they were correct. Then I made sure my computer didn’t have a virus that was messing things up. Anything else we could try?
Tech support: I am so sorry you are having trouble with our company’s services, but I am sure that I will be able to help you reconnect to the internet. Let’s start with this: First, please disconnect everything from your router, unplug it from the electrical socket, and wait about 10 seconds before we plug everything back in to see if that works.
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Anyone who speaks to you using sentences that begin with: “No offense intended but …”, “I hope you won’t take this the wrong way but …”, “With all due respect …”, or “You know I love you but …”
For most of us, realizing when others cut us short on respect and dignity comes easier than realizing when we do it to others. What may be completely understandable under the circumstances and hardly worth noticing when we do it, becomes very clear when it is done to us—arrogance, intentional disrespect, veiled hostility, a personality disorder, a lack of human decency, unforgivable, and part of a clear and consistent pattern of high crimes and misdemeanors.
This ethical responsibility often slips easily from our awareness. Even if treating others with full respect for their dignity is our goal and our custom, we are likely to face countless obstacles. Here are a few examples:
DIAGNOSTIC CATEGORIES
We work in a world in which most of us must manage the DSM (Diagnostic and Statistical Manual of Mental Disorders), the ICD (International Classification of Diseases), insurance forms, and other forces that draw our attention to diagnostic categories and invite us to think of our patients in terms of which diagnostic labels apply. The powerful language of labels can distort or blot out completely the person behind the label. Some clinicians, particularly in inpatient and forensic settings, may stop using the patient’s name entirely and use only the label, often in a way that seems to lack respect or dignity (e.g., “Time to see if that schizophrenic is ready for a home visit. You gotta be careful with schizos”).
FINANCIAL CONCERNS
We also work in a world where most of us must pay the bills and many of us face financial pressures. If we are in independent practice, the gain or loss of one patient, particularly one who promptly pays our full fee, can mark the difference in whether we’re in the red or black that month and whether we can pay the office rent and our other bills on time. When each patient’s fee can produce such an immediate powerful impact, it is hard not to have financial issues weighing on our mind as we decide whether this long-term patient is ready for termination or whether we’re truly competent to work with that new patient we just screened.
FATIGUE
When we’re tired, it’s hard to pay full attention to our patients, to take in what they may be telling us between the lines of what they say, and to respond sensitively. When we’re dragging through the day, it’s easy to be short with others, to take things the wrong way, and to miss what’s important.
PERSONAL PREDISPOSITIONS, BIASES, AND PREJUDICES
We all have them—certain things we like and, of course, dislike about other people. Each of us could get a good start on our own private list of negative reactions by completing the following sentences, as many ways as possible, with complete honesty and without censoring ourselves:
I can’t stand it when someone …
I’d rather not be around someone who …
The worst kind of person is someone who …
The people who are responsible for more trouble in the world than anyone else are the …
The kind of person I’d hate to be seated next to on a long car trip is …
It’s not politically correct to say it, but personally …
You may not like it but there’s a good reason everyone says that all [members of some racial, ethnic, religious, or other group] are [name of some characteristic, usually negative]—It’s true!
Our personal list may