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Another patient complain

The trend continues, once on the administration’s radar it seems complaints just fall from the sky. Until recently there were four. Now there are five. Sadly, seven has always been the infamous total of which the administration loses confidence with regard to my contribution to their organization and I am labeled a risk.

The morning after Thanksgiving, after working a 12-hour shift Thanksgiving night, I met the “new” emergency department director. And because, again, I am not able to decipher the hidden agenda of others I missed this one as well.

“Hi, I am so and so, the “new” emergency director. I been here a couple months but have not been able to meet you,” the “new” director said when we met for the first time. Wow, a healthcare administrator who is grateful for the good work I do and on what better day to show that appreciation than Thanksgiving.

Interestingly, and likely what should have been clue #1, the director has the department’s schedule thus I would think if the director wanted to meet me, or any of us on staff, all that was needed was to look on the schedule to see when I was on, simple.

No big deal.

After the introduction I am asked to stop by the office when I finish the shift at 7am. No big deal either. Although it should have been clue #2.

After 7am, I grab my things and head for the director’s office where I am asked to “come in and have a seat.” Blah blah blah blah…not much of a greet and meet but rather more of, “I have to ask you about a patient complaint,” as the director said to me.

Ah shit! And here I thought it was the morning after Thanksgiving and I was being recognized for the good I do. Instead, and once again, I am being lectured about patient complaints. I have been working at the current job for almost two years. A job where I have found patients to be the most grateful than any other place I have worked at and I have worked at many. In those two years I been told by the previous director that I was appreciated a handful of times. Nothing formal but the few times the formal director and I saw each other it was more common than not that the formal director thank me for the work I do for the organization. But never was I asked to come to the office to be told of such appreciation. Not that I am looking for such recognition but I thought that was what this moment was. NOT!

Again, not that I need an administrator, or anyone for that matter, thanking me (despite it leaves a warm and fuzzy feeling in our bosom—a colleague’s words), because either way, recognized or not I am going to show up to work, do my job and go home. As long as I am getting paid of course as that is appreciation enough for me. Having said that, being valued is appreciated and it is recognized when an administrator does such as the previous director did.

Having said that, the previous director did talk to me about complaints after four complaints suddenly surfaced within a month. However, my take of that interaction with the previous director was that that director was more concerned if anything was going on with me rather than concern for the complaints.

Nonetheless, the conversation with the “new” director went on for an hour. Talk about an ambush. Or maybe just another fault of mine, one that even the director was amazed of, that, again, I have no idea what others are up to. Meaning, I cannot decipher if a patient is going to complain or not or even if a director, who claims wants to meet me, is more interested in confronting me with a patient complaint and not wanting to meet me so much. Maybe some day I might figure it out but for now, again, I show up, do my job, and go home. Rinse and repeat. Shift after shift after shift. And, unfortunately, job after job after job.

On that note, let’s consider this latest complaint the “new” director wanted to talk about. Once again, a patient, events, conversation and interaction I do not recall and why I suggested in the past, and to this “new” director as well, that the patient be present. Otherwise, these conversations are no more than he said she said rather contested accounts that could be adjudicated by the director who would serve as a facilitator. However, the director mentioned the patient did not want to talk to me to which I immediately thought, “Imagine that.” Because a debate about what actually occurred between the patient and I might discount the patient’s claims if there was an impartial third person that could facilitate the discussion. The reason why the law of the land permits one to defend themselves against accusers, otherwise, these are no more than defamation charades where and when anyone can say whatever they wish without consequences and much less responsibility. However, to this “new” director’s credit, the chart, my documentation, was available. Something other directors and administrators were NOT willing to review.

From what I understood from the director the patient did not like my demeanor. Imagine that. The patient also did not like my questions and how I asked them either. Imagine that as well.

The patient, a 50s year-old female. The complaint, from a visit some two months earlier. In the book, I mention that satisfactions are based on emotions and those emotions are best captured within days of an event otherwise the emotional sway, positive or negative, fizzles to neutral or being no big thing after those first few days. In that regard this was a first. That being a complaint that surfaced so long after the interaction. But why?

I also mentioned in the book that these negative interactions between patients and I are due to transferences—“the technical or psychoanalytic term used to describe the redirection of feelings and desires toward a new object [me being the new object when patients meet me for the first time].” These transferences are multidimensional and able of distorting “perception and communications.” Meaning, people just do not like it when their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS are not met and much less they do NOT like being told, No!

Anyhow, the patient was having pelvic pain for two months, maybe more, when I saw her two months ago. Pain that had not changed in those two months and for which the patient had been seen for by her PCP, gynecology and general surgery with her PCP ordering an ultrasound before I saw her, “that one cold wintery night.” It wasn’t such a “cold wintery night” but just adlibbing and adding to the drama to mock just how ridiculous these complaints are.

Adding to the ridiculousness, not of only the complaint but more so of why the patient was in the emergency department at all, the results of an ultrasound. An ultrasound the patient had done the day before I saw her and, AND(!), had an appointment in the next day or so to see her PCP to get the results, I must add.

I mention the ultrasound because, according to the director, the patient was also disappointed that I did not review the ultrasound findings with her. Although, after the fact, I believe the patient was only disappointed in the fact that I did not review the ultrasound for her and why the whole interaction mushroomed into a formal complaint. The director adding that I had told the patient I did “not care” what the ultrasound findings were. The director asking if I had said that. My answer, “I do not know.” It is possible I might have said that although not likely in those words but I could have used those words as well. I could not recall. I could not recall what I said yesterday much less what I said two months ago.

The director commenting, “I hope you would have looked at the report.” Meaning, it would be good practice to have looked at the ultrasound. I, of course disagreed but offered, “Well let’s see,” and added, “If I looked at it I would have documented that I did and would have added any findings to the diagnoses.”

So we looked at the ultrasound report and my notes and long and behold no mention of the ultrasound findings, not in the notes where I commonly would place those findings and not in the diagnoses. So no, I must not have looked at the ultrasound and something the director was not content with.

Unfortunately, and a missed opportunity on my behalf, I failed to share with the director that I do not commonly look through the chart just to look. In my practice, if I can reach a diagnosis and disposition without diagnostics I do. Meaning, if someone else ordered diagnostics before I saw the patient I likely will not look at those results unless they were diagnostics I would have ordered myself. Actually, there have been a number of times when patients have asked me, “What about my results (blood, x-rays, CAT scan, urine, whatever)?” after someone else ordered those diagnostics and I will commonly say, “Really? They ordered those? I would not have ordered any of those.” Sometimes, ironically, even the patient will add, “I did not think I needed any of them either.”

Nonetheless, for this patient I did not need an ultrasound for her two-plus month old pelvic pain for which she had been seen by a number of providers and was scheduled to see her PCP in a day or so.

Now, what I recall about this patient was that she specifically said she came to the emergency department to get the results of the ultrasound she had completed a day earlier.

“When do you see your doctor again,” I asked.

“In two days,” the patient replied.

“You can get the results then,” I informed the patient, which did not go well.

“Why can’t you [NP J. Torres] give them to me now?” she asked.

“I did not order it. Nor do I have a need for it to discharge you right now,” I replied.

What? WHAT? WHAT THE HELL IS GOING ON HERE? DID YOU JUST TELL ME NO!?! Not her words. Not that I recall. But now that the patient complained this must have been the reason.

Why not just give the patient the ultrasound results? For a number of reasons but most logic such would set a precedence of coming to the emergency department for convenient non-emergent conditions or the all to popular “one-stop shopping”. For example, diagnostic interpretations, medicine refills, yada, yada, yada.

Like what? Like the all to common, “I just want to get checked out.” Checked out for what? A common request might be an exaggerated statement. What I mean by common are the vague asymptomatic medical complaints patients present to the emergency department with to find out if they have thyroid issues, diabetes, high blood pressure, yada, yada, yada. And rather seek out a clinic where they can have those evaluated appropriately the patient presents to the emergency department with a barrage of symptoms, many of which they may not have at the moment but have had in the past week or month or whatever. But I digress.

So then, back to the complaining patient, why would I have to look at an ultrasound I did not order and much less need to disposition the patient? The patient was not in distress. Not ill or toxic. Has had the same pain for more than two months and seen by her PCP, gynecology and general surgery and they all sent her home. Again, although now after the fact with the director, of course, what I believe I told the patient was, “If there was a significant or emergency finding on the ultrasound your doctor would have called you with the results.” Actually, the PCP would have referred the patient to emergency department for further evaluation. Something I did not share with the patient as it would have been a better reason for her to have used in order to get what she was looking for than, “I came in to check the results of the ultrasound I had done yesterday.” And, again, what the patient stated as her reason for seeking care in the emergency department.

Likely that was what the patient was so upset about and what I might have told her, “I did not order the ultrasound and do not need it to reach a disposition this moment.” Thus my demeanor, the questions I asked or how I asked them had nothing to do with why the patient “actually” complained. However, those three, my demeanor, how and what questions I asked, being what most complain about and NEVER sharing their half of the story. Imagine that!

Oh! Wait! There was that one family who did mention calling me “an asshole” on his complaint form. But that was an anomaly, most make no mention of their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS or their inappropriate behavior when they complain.

Nonetheless, the director also added that I might have suggested or the patient got the perception that I thought she was drug seeking.

“Not likely,” is what I told the director and added, “Bad stuff happens to bad people too.” Meaning, I do not discount patients even if they are drug seeking. My job in the emergency department is to NOT miss an emergent medical condition. In doing so I must evaluate patients and obtain a diagnosis I can treat and disposition. And some times that diagnosis is “Drug Seeking Behavior” and if so, although rarely a diagnosis of mine, I will document it “IS” their diagnosis after excluding differentials. I am sure the director is aware that “Drug Seeking Behavior” is a diagnosis.

Behavior (ICD 10)
-antisocial
-adult Z72.811
-child or adolescent Z72.810
-disorder, disturbance - see Disorder, conduct
-disruptive - see Disorder, conduct
-inexplicable R46.2
-marked evasiveness R46.5
-obsessive-compulsive R46.81
-overactivity R46.3
-poor responsiveness R46.4
-self-damaging (life-style) Z72.89
-sleep-incompatible Z72.821
-slowness R46.4
-specified NEC R46.89
-strange (and inexplicable) R46.2
-suspiciousness R46.5
-type A pattern Z73.1
-undue concern or preoccupation with stressful events R46.6
-verbosity and circumstantial detail obscuring reason for contact R46.7

And there it is. Behavior, drug seeking. ICD 10 Z72.89. Between “disruptive” and “inexplicable” behaviors and although the list is alphabetically for this patient I would say a continuum.
 
And. And. Just because a patient or family deny such does not mean that is not their diagnosis as negativistic, disorder of personality is a diagnosis as well.
 
The following ICD-10-CM Index entries contain back-references to ICD-10-CM F60.89: Other specific personality disorders:
·Amoral traits F60.89
     ·    personality (enduring) F68.8
          ·    secondary (nonspecific) F60.89
·Disorder (of) - see also Disease
      -personality - see also PersonalityF60.9
         -immature F60.89
          -mixed (nonspecific) F60.89
          -negativistic F60.89
          -passive-aggressive F60.89
          -specified NEC F60.89
 
Clinical Information
·    A personality disorder characterized by an indirect resistance to demands for adequate social and occupational performance; anger and opposition to authority and the expectations of others that is expressed covertly by obstructionism, procrastination, stubbornness, dawdling, forgetfulness, and intentional inefficiency. (Dorland, 27th ed)
Applicable To
•  Eccentric personality disorder
•  'Haltlose' type personality disorder
•  Immature personality disorder
•  Passive-aggressive personality disorder
•  Psychoneurotic personality disorder
•  Self-defeating personality disorder
Description Synonyms
-Introverted personality disorder
-Passive aggressive personality disorder
 
Having pointed that out, although I did not think of them at the time, now that I think of it any number of those listed, in the two list, would have fit this patient. Not to mention, from what I understand, but not sure if correct or not, although I have read about such claims, patients with behavioral health diagnoses are excluded from taking customer satisfaction surveys. Again, not sure if correct or not, so do not take my word from it, but nonetheless, my specialty is emergency medicine and NOT psychiatry so I do not include psychiatry or behavioral health diagnoses unless related to their emergency, such as depression with suicidal ideation, psychotic with homicidal ideation and the likes and rarely, if appropriate and not just because, drug seeking behavior. But maybe, just maybe, I should add some of those listed above only because doing so might just save me from so many of these bogus patient dissatisfaction complaints. Again, no one who is sick has EVER complained, EVER.

Unfortunately, as mentioned, I am not able to decipher who is going to complain and who isn’t. So adding those additional diagnoses might not help unless added to everyone I see.

Interestingly, and something I mentioned to the director while we looked at the chart, I did not offer or give the patient anything for pain. That does not mean I thought the patient was drug seeking or not. What it means is that the patient did not ask for anything because even if I disagreed I would have ordered something even if something she did not want, a refusal I would have documented. Or, and likely the circumstances after reading the chart and recalling the patient came in for the ultrasound results and not pain, the patient in no obvious discomfort to which I would have not offered and why nothing was documented.

Anyhow, nowhere was there any mention of analgesic meaning the patient did not get anything for pain. So then, whether she asked and it was declined or she never ask, why would I think she was drug seeking? What I believe was that the accusation that I thought the patient was drug seeking was fabricated by either the patient or the director. Why would I include the director? Because a previous director had fabricated claims, for whatever reason, when the patient or staff had not made such claims. Why would a director make such false claims? If the case, a hidden agenda and a statement of that individual’s poor character.

Nonetheless, why this patient complained does not matter to me. And that is why I always say that patient complaints are between the patient and administrators as I treat everyone the same. Incidentally, treating everyone the same was something else the director found unusual. So much so, the director went to the extent of telling me how he had to make a diagram for a patient who was a lawyer in order to capture the lawyer’s attention as to why the lawyer needed to be admitted versus being discharged. Whatever that was I thought.

My point, which I believe the director missed, was that I treat everyone the same. No one is an exception or a VIP for me, lawyer or not. Meaning, if I treat everyone the same then why do some complain but the majority are grateful? I have no idea. Some, like the director, see that as my fault. I disagree. Instead, I see myself as being consistent. The variable that is different are the persons I interact with. In other words, my personality is me. My attitude, on the other hand, is the interpretation of others, which I have no control over.

On top of that, and as I have said over and over and over, I am not able to decipher who is going to complain and who is going to be appreciative, to include directors. Another characteristic the director found a flaw. So much so the director thought that if I could identify who was going to complain that I would do myself a huge favor. Again, some would say I could fix that. I disagree. If I could I would, especially if it meant I could keep my job.

However, if what is meant by recognizing those interaction means, as the director suggested, to start over by catering to or accommodating those who might complain then likely I would not be willing to change. Why? Because I see that special treatment as unfair to those you were appreciative and the ones I would rather keep over the petulant, unreasonable, angry and demanding ones.

Not that this is about me versus patients. Instead, this is about convincing those who complain that I am looking out for their best interest and if they desire that help then they must stand with us. If they decline then they must leave because asking to be accommodated until they get what they want is being manipulative and not what we are there to do. Not to mention, it divides us, the healthcare workers, because rather trying to help them and others we are instead placating to those who will complain and we delaying the care of others. And that is not for me. NO!

The greater irony about this patient was that complaint came months after I saw the patient. Actually, the complaint came after the patient had surgery, a surgery that did not go well from what the director told me. I, of course, had nothing to do with the surgery.
Did the patient complain to those who did the surgery? The director was not sure. Oh, so the patient is upset with me because I did not share the ultrasound result with her, did not smile, or she did not appreciate the questions I asked and how I asked the questions but she is not upset with those who botched her surgery. How does any of that make sense?

Having said that, not for a moment do I see myself a victim, a scapegoat or the person at the bottom of the totem pole. However, the patient is not present to ask her as to why she is upset with me and not with those who botched her surgery?

Adding insult to injury, when I saw the patient during the visit the director was referring to, I did not know this was a patient I had seen before for the same pain. Actually, if I recall correctly, after the conversation with the director and seeing the chart, it was I who referred the patient to gynecology because of the initial findings after her PCP had dismissed her complaint of pelvic pain. Not that I am pointing fingers at her PCP. However, it was I, and not her PCP, who found the likely cause of her pelvic pain and referred her to gynecology.

Unfortunately, because I see patients at the moment I missed the opportunity to point that out to the director that it was I who diagnosed and referred her to follow up with gynecology after her PCP dismissed her. Maybe, just maybe, it was her PCP who diagnosed with Drug Seeking Behavior and not I?

Not to mention, if I had seen the patient before and she did not complain about me not smiling, the questions and how I ask those questions then why was she complaining now? Unfortunately for me, something else I forgot to mention to the director.

After all that there was no convincing the director I was a greater asset to the organization than a risk. Interesting, when the director commented that he appreciated my clinical skills he added that the conversation was not about clinical skills but solely about bedside manners and patient complaints. The director also hinting, in almost the same sentence about how much I was appreciated by the administration, that my contract could be terminated at any moment. Spoken like a true manage—threats and fear. Imagine that!

Again, I thought, terminated not because of incompetence, breach of duty, or negligence, not because of injury, disability, or death to a patient, not because of prejudice, alcohol, or drug addiction, not because I am unreliable or cannot be trusted, and not because I undermine those I work with, but because of patient complaints.

To which I replied, “So you rather have providers whose clinical skills lack but who stay off the patient dissatisfaction radar.” A comment that made the director uncomfortable to where he felt compelled to draw the above attached four-box management tool on the whiteboard. A graphic that labels good and poor clinical skills over good and poor bedside manners and illustrates what management desires, those with good clinical skills and good bedside manners. However, the graphic also shows, although not admitted to, healthcare management’s current secret, the acceptance of those with poor clinical skills for good bedside manners and something else I mention in the book.

Despite I pointed that out the director added that I had generated more complaints than the other fourteen providers combined.

Seeing the four boxes on the whiteboard and the director speaking over my observation I wanted to suggest the iceberg analogy. Not the one a previous director illustrated but my version, both which are mentioned in the book. Both versions being that the tip of the iceberg represents complaining patients but after that the two versions differ. The director’s version stating that underneath the waterline were other dissatisfied customer who did not formally complain.

I, on the other hand, say those underneath the waterline are satisfied patients drowning. Drowning because it is hard for them to swim as those who complain take up all the oxygen with their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTIONS. Drowning because those who complain stand on the heads of satisfied patients and by standing on their heads those who complain drown the voices of those who appreciate us. Ironically, as in the analogy, it is because of the satisfied drowning patients that complaining patients have a platform to complain on. Because, without the satisfied patients to stand on there would be no iceberg and much less an iceberg tip, and that is true in any industry. That is why I say dismiss those who annoy us so that we can attend to those who appreciate us for what we do, help others, and not because we don’t smile or how we ask the questions we ask.

But, instead, I decided against sharing my version with this director as it was the director’s show. Not to mention, he already seemed overwhelmed with not being able to make his point that it was in healthcare’s best interest if I bowed, as he does.

As usual, for these one-sided conversations, the director went on then to lecture me about customer service, customer satisfaction and, one new one, customer recovery. Really!?!

As I have said many times before, I am not a customer service subject matter expert. However, I thought I had already heard it all when it came to customer service, customer satisfaction, customer satisfaction scores, and even the newest of the new, customer excellence and referring to customers as guest rather than customers or clients.

But here was a new one, customer recovery. Well, not really a new one. Because after the director lectured me about it what I got out of his rambling and diagrams was that it was nothing new but instead just a cleaner label for “kissing ass”. And. Ah. Not for me.

Not to mention, when I got home, yes after a 12-hour shift, a 1-hour lecture, a 30-minute drive, a 10-minute opportunity to play with the dogs, breakfast, and a shower, I thought I would look it up and I Googled “customer recovery” before waking up after 6-hours of interrupted sleep concerned on whether or not I was going to be employed much longer.

Anyhow, what I learned, well, not really learn, but found out, I guess, was that customer recovery was just what I thought it was, no more and no less, a new label for “kissing ass”. Not that I would but kiss ass for what? Just to keep petulant, unreasonable, angry and demanding customers who likely are abusive and/or manipulative. Ah, NO!

Interestingly, as if kissing ass were not enough, customer recovery resources average to be from 1996, twenty years ago. How is it that such idiotology [sic] guiding healthcare customer anything can be twenty years old? Especially since healthcare would NEVER consider any research in which resources are more than 10 years old. Yet, the management and policies of healthcare as we go into 2016 are from 20 years ago and no one challenges that. Why?

Oh, healthcare’s altruistic, submissive and accommodating culture. That’s why!
On top of that, healthcare administrators are incapable of seeing how misguided, clueless, wrongheaded, oversimplified and misleading these moneymaking idiotologies [sic] they long for really are.

Again, another reason why healthcare is in desperate need of leadership, as most healthcare administrators are not leaders but managers who can merely facilitate policy between subordinates and superiors, the “new” director included.

Healthcare needs change agents who are willing to go against the grain in a new direction even if it means going at it alone. A direction that promotes healthcare workers as valuable and trustworthy and leaders who support our collaboration and professionalism and recognize us as the good-doers we are for our genuine desire to help others over concerns patients may take their business elsewhere.
 
Again, I say dismiss those who annoy us. Dismiss the rude. The entitled. The abusive. The demanding. And dismiss those who have misled us down the wrong tracks. If we dismiss all those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. In this we must stand in solidarity and not waiver otherwise those who annoy us, administrators included, will not change their behavior as long as they can find tolerance elsewhere.
 
On top of that, rather accommodating patient complaints and focusing on customer service, customer satisfaction scores, the customer experience, and let’s not forget, customer recovery, healthcare needs, and would benefit most, if we placed all our energy, time and money on clinical outcomes and the safety of healthcare workers and patients.
 
Because, after all, when the dust settles following an incident where a patient complained what just happened was behavior you and healthcare administrators would NOT, again, would NOT accept at home from loved ones. Yet, healthcare administrators want us to accept that venomous behavior from those we are helping. I say NO!
 
I know I sound like a broken record, for those who recall what that was like or what it means, to be clear, this is not about us versus patients. This is about convincing patients that we are looking out for their best interest and if they desire we help them they must stand with us. If they decline then they must leave because asking to be catered to until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.

To that, as I have said many times before, I am not a customer service subject matter expert. What I am instead is a subject matter expert on patient complaints. And a good one at that as I do not only have more patient complaints than those I work with now but I have more patient complaints than any healthcare worker on the planet and in history. I say that not to brag or because I am proud of it but because it is a fact. However, because of that expertise I have learned and will tell you that complaints come from those with EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS, hidden agendas and grandiose beliefs all extending from entitlement issues or a sense of being VIPs. Rarely, if ever, do complaints come from those who are sick, even if the outcome is death.

By no means am I suggesting that patients cannot or should not complain, as I very well know they are only venting their frustrations, anxieties and feelings of powerlessness. Instead, what I am campaigning against are the knee-jerk reactions from administrator and the sequel JUST because a patient complained. On top of that, and most important of all of this, I suggest putting healthcare workers first because by doing so everything else will fall into place, to include customer retention and profits.

Healthcare is much bigger than any complaint and why complaints need not be feared. Not to mention, the intent of those who complain is not to get anyone fired but simply an opportunity for them to vent. And why I do not buy the idiotology [sic] and fear mongering tactics that they will not come back or tell others. As most of them come back just like this mentioned patient. They come back. Not to mention, in every business, EVERY business, some you gain and some you lose.
 
I get it; I have more complaints than anyone, actually, than everyone the director said. Okay. Fine. However, what is the reason others get complaints at all. That is what needs to be looked at. What triggered a patient to complain at all? Was it really that I did not smile, the questions I ask or how I ask them? Or is it a hidden agenda? The latter being this patient’s reason I believe. But what do I know as I am not a customer recovery expert like the director.
 
This is what I DO know; disagreement is not a hate crime, or a crime at all. Nor is it a lack of compassion or of caring either. Who of us has NEVER had a disagreement with those we love most? Yet, those disagreements were not the end of those relationships or the world for that matter. However, in healthcare, where we attempt to preserve the quality of life and avoid the loss of life at every moment, it is customer service complaints that seem to be the end of the world.
 
I would add, that rather accommodating patient complaints and focusing on customer service and customer satisfaction scores, healthcare needs, and would benefit most, if healthcare placed all its energy, time and money on clinical outcomes and the safety of healthcare workers and patients.
 
One last thing with regard to the chat with the “new” director as it was the most offensive of all that was said. The “new” director mentioned that I was partially to blame for the department’s low morale, something he inherited and I guess is looking to point fingers to. Again, of all that was said that post-Thanksgiving morning, it was this, which I found most offending and for no reason other than I know that I am not the reason, or even partially to blame, for the department’s low morale. NEVER! That is NEVER, all caps, NEVER has that been the case. NEVER! If anything, everywhere I have worked at, and that has been a lot of places, the staff has ALWAYS appreciated my contributions.
 
Not to mention, if it were the case elsewhere I would find it hard to believe those directors would not have piled that on as well.
 
Why now? Why would the director say that?
 
I asked. The answer. According to the director, the emergency manager, a nurse, said that the nurses had expressed that I was disruptive and the nurses felt humiliated when ever they had to intervene and get patients to settle down after I “upset them”.
 
WHAT!?! I have NEVER heard that before. Not having anyone else present, but the director and I, I questioned myself, not a common occurrence, “Could I have now crossed that line as well?” And although I found it hard to believe I was not able to shake that doubt.
 
Despite being unsure, I shared with the director that I have NEVER asked anyone to diffuse any situation that followed me seeing patients nor was it the nurse’s role to intervene. Adding that if nurses found themselves pacifying complaining patients on my behalf they should refrain as I NEVER asked them to resolve any chaos related to me. If anything, not that I shared with the director, I tell nurses to let the patient leave if the patient did not want to be seen by me. To include not asking another provider to see the patient either as that was not the role of nurses to mediate a happy outcome.
 
On that note, as for patients getting upset and something I missed to mention to the director, patients and family get upset on their own. I have nothing to do with that especially since the greater majority of patients I see never get upset despite I treat them all the same.
 
Unsure if what the director said was true or not but knowing healthcare is just an extension from junior high school I tried my hand at some he said she said as well. In doing so I posted the following letter:
 
To Whom It May Concern:
 
My days at here are numbered because of patient complaints and staff who find me intimidating, a bully and partially to blame for the department’s low morale.
 
Because of the latter two and not knowing who might be offended let’s do this—agree to not engage in talk unless related to patient care.
 
I have already apologized to my life. To the rest of you, it was nice to work with you and I wish you well.
The Knitted Brow
 
One nurse in particular was upset by the letter and asked me to remove it. Not because the content was offensive but for two other reasons. (1) I was not the cause for the low morale. If anything, the nurse added, the staff enjoyed working with me. (2) The other reason I argued against but the nurse won. The nurse pointing out that I was digging my own grave if management read the letter. After the nurse took down the letter I posted it again only to have the nurse remove it again and me reconsidering. Not because I feared being asked to resign, as I already know that is not to far away, but that the nurse was looking out for my best interest and I thought I would give the nurse that appreciation.
 
Interestingly, the public exchanged between the nurse and I lead others to jump into the debate and they validated I was not the cause for low morale but rather the opposite someone they and others enjoyed working with. Now that makes anyone “feel warm and fuzzy in the bosom.”
 
NEVER, all caps, have I drummed up support for me or asked anyone to take my side as I know the risk for those companions standing in solidarity with me puts them at high risk of being labeled “co-conspirators” or the like. Because of that I will NEVER ask despite but because I am on tap at our organizations
 
Plagiarizing Mother Theresa’s words, “I alone cannot change healthcare, but I can cast a stone across the waters to create many ripples.” Meaning, in order for us to take healthcare back and steer it in the right direction, a direction that puts healthcare workers and the care we provide first, and away from , and four-box management tools we need companions that are bold and willing to lose it all to include the jobs we love so much. Because, frankly, awill only result in a, n,only frustration and disappointment of us
 
G. K Chesterton, an English journalist, novelist and essayist, said, “The true soldier fights not because he hates what is in front of him, but because he loves what is behind him.” For us, that love is healthcare and healthcare workers and we have our work cut out for us as there are many more of them in front of us leading us in the wrong direction than those of us trying to take healthcare back.
 
Nonetheless, after all that, I know this is the beginning of the end as the writing is on the wall.

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