“Miss, are you even old enough to be my doctor?” I have lost count of the number of times patients have stripped my doctor title away while commenting on my age. Many of my patients allow me to treat their medical ailments while sharing incredibly intimate details about their lives with me, yet they still refer to me as “miss” or “ma’am.”
Even if this is not an intentional insult, it is insulting to me and to my fellow female physicians who constantly go unrecognized as leaders, even if they have a seat at the leadership table. But this isn’t even the worst of it.
I have witnessed patients making rude remarks to interns and residents, saying, “They are not real doctors.” I have also witnessed patients make racist remarks toward their physicians, commenting on their religion or the color of their skin.
As physicians, we often see patients at their lowest and most vulnerable states. As a result, they may lash out at us, not as an intentional personal attack but as a way to cope with what they are going through. Physicians are often targeted because we are the ones in the room delivering the bad or unwanted news. Many of us try to avoid reacting negatively, but at what point do we put our foot down and refuse to tolerate this abusive behavior?
"These disturbing encounters with patients can leave us feeling small and disregarded; they can have a tremendous toll on our mental health and self-esteem."
— Kristen Fuller, MD
The scope of abuse from patients
The most common insults toward physicians include those about gender, racial slurs, and youth/inexperience.
One survey of 800 US physicians found that 59% of surveyed doctors had experienced offensive remarks like these in the past 5 years, with 47% of saying they had experienced a patient request a different doctor due to their preconceived notions related to the above factors.
Imagine if the tables were turned and we verbally lashed out at our patients. We would be immediately disciplined and possibly lose our jobs. This is why I find it so frustrating the medical system barely acknowledges the issue of abusive patients. So, how can we as physicians navigate these difficult situations and stand up for ourselves?
Have a reply ready
I have become so accustomed to patients commenting on my youthful appearance and potential lack of experience that I have learned to have a response ready. I also have responses prepared for when I witness racial slurs or other disrespectful behavior toward my colleagues or any of my staff.
My responses usually include some or all of the following:
“My name is Doctor Fuller, and that is what I expect to be called.”
“I will not tolerate that kind of behavior in my clinic.”
“That is inappropriate. We don’t tolerate that kind of speech.”
“Let’s please keep this professional.”
Most patients will generally apologize and/or modify their speech and behavior after hearing these simple replies—they recognize the responses are meant to be firm and set boundaries without being overly aggressive.
If the behavior continues, you should feel free to leave the exam room or the bedside while simply explaining that you are uncomfortable with this behavior. You may re-circle the bedside at a later time when you feel ready.
If you supervise younger doctors or other staff, keep in mind that medical school students, residents, and members of your office staff may not know how to handle these comments or behaviors, so you should consider it part of your job to teach them how to set boundaries with patients and how to respond firmly but respectively.
Maintain your composure, but stay strong
"Even in the face of adversity, and in some cases, verbal abuse, we as physicians must remain calm and treat our patients with compassion and respect, no matter how hurtful their words or actions may feel."
— Kristen Fuller, MD
However, if the behavior or language continues after you have given verbal warnings and have set clear boundaries, you have the right to transfer care to another physician or treatment team.
The AMA Journal of Ethics states that disrespectful language or conduct can “undermine trust and compromise the integrity of the patient-physician relationship.” That’s why requesting a transfer of care, from the physician’s side, is the best thing you can do for yourself if the abuse continues.
It may be your job to provide quality patient care, but in the face of continued disrespect and even potentially dangerous acts that result, you are allowed to stand up for yourself.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.