Rant and Rude Business

I have been thinking about all this rant business, and promised some thoughts on it. I was on the phone the other day trying to get an issue resolved with a telephone person and I was frustrated and trying to get her to understand my dilemma and how it wasn’t my problem, but their problem. I raised my voice a couple times. She remained unfailingly polite, even though she probably wanted to hang up on me or tell me to stop yelling. Maybe she is just used to people yelling at her in her job or maybe if she was rude back to me, she would be fired because after all it is a taped line. You know the “someone may be listening in” message you always get.

I have also over the years been to doctors’ offices and dentists’ offices and always found the people polite and friendly, even if they looked like they were having a bad day. I was a customer and they tried to always at least smile, even if they were making me wait or screwing up my bill. No doubt if they had been rude to me, I would have gone looking for another doctor.

Which brings us to EMS and I will include the ED in this. I have never seen more rude behaviour toward patients or people anywhere. Sure most of the time most of us are polite, but a lot of the time, some of us at least can be real jerks to patients and other people like nursing home staff. Don’t you dare vomit in my truck. Your legs aren’t hurt, you can walk. You’re just going to have to wait, there are sicker people than you. A nonreabreather at 2 liters, what you trying to do, suffacate them? Etc.

Giving someone a good telling off seems to be an admirable thing in EMS.

So why are we rude and why do we rant about the people- the patients — who are such a bother to us?

A part of it, I think is a sense of moral superiority. We are doing this job for crappy pay because we supposedly love it and we are lifesavers, so don’t waste our time if your life doesn’t need saving.

Another part is we at the caregiver level in emergency medicine aren’t paid based on customer satisfaction level at least in the immediate sense. If we saw more pay at the end of the day based on customer surveys, you can bet we would be nicer.

Another part is we have a monopoly. The patient can’t chose who responds. They are stuck with us. Company A is rude to them, the next time they call 911, they can’t ask for company B. They get company A. EDs at least — they can go across town and they often do, where unfortunately they get the same the hell with you treatment because there are more sick people than hospitals can handle so they don’t have to worry about offending people. Business is too good.

The final part is we very rarely get fired for being rude. You have to be pretty out of control to lose your job in EMS for being rude. You make a racial or religious slur, you will be fired. Aside from that, the only people I have ever heard of being fired for being rude to patients are ones who ended up physically assaulting the patient — punching them or trying to smother them with a pillow.

So what of all this rant and rude business — I tend to rant more than I am rude, but I find neither attractive. I will try not to do it if I can help it. I am in this work of my own choosing, so there must be enough rewards in it. Most days there are.

***

I was just talking about this issue with an EMT friend and he said something really funny. In our ambulances we have black boxes that beep when we drive too fast, take a corner too hard, backup without a spotter or don’t wear a seat belt, all the while recording the violation to computer for review and score at the end of the month. He said he was waiting for the day they put black boxes on us. They would beep whenever you swore or raised your voice or were rude.

2 Comments

  • Kurt Potter says:

    Great post! Very close to what I’ve been saying for a long time. Working for a private ambulance company, in the business end, I recently started a blog dealing with the “Business of EMS”. I addressed this very issue as well. The blog is:http://www.emsioam.blogspot.com/This is what I had to say:”EMS: A Customer Service Industry?The medical transport industry has turned into a customer service industry. That’s right. The days of medics telling the patients and the nurses “how things are” is gone. The trend in the industry, of moving away from government run entities and toward privatization and consolidation, has created a competitive situation where we all need to embrace the idea that EMS professionals are not just dispatchers or medics or billing representatives but also customer service professionals or ambassadors of the company and industry.As the field of small local firms shrinks and the larger regional and national firms broadens, municipalities and private facilities have ever expanding demands of transport providers. Even government run EMS and Fire Departments are under increasing pressure to keep constituents happy in order to compete with the threat of privatization. As the Baby Boomers progress into and through retirement, there is a larger group of people who’s primary payer will be Medicare. A recent federal study performed by the GAO (General Accounting Office) showed that ambulance companies are losing 6% a year on average. These two factors alone create an interesting point that I’ll bring up in a future blog. The point is that differentiating your company on the basis of price is becoming ever more difficult.Under these conditions, it is imperative to build a customer service aspect into your quality management process. You can train your employees in customer service techniques and hold them to a customer service standard. The idea is to make medical transports as pleasant an experience as possible for all of your customer segments. The case managers hear a smiling helpful voice on the phone when they call. Not just professional, but friendly. The hospital staff sees smiling friendly faces in their facilities at any hour. The patients have every step of the transfer and transport process explained to them in a step by step fashion by smiling, friendly, helpful medics.The first step in this process is to build a customer service standard. This is critical in that the standard will directly reflect the company leadership philosophy and attitude toward your customers. It also gives you something with which to measure your efforts. Your brand messages will also be held against this standard. Every company must search within to find the attributes that it holds important in order to serve its customer base. Two great places to start are your current customers (what is it that they are asking for?) and your company’s mission statement (what is it that you believe is your purpose as a company?). If this step is not performed properly, then everything else in this effort is wasted.The next step is to set up levels of accountability. This includes which accountability functions are handled at which management level. It includes developing a reward and consequence process for performance issues. It also includes developing a measurement process for customer satisfaction. The importance of quantifying the intangible feelings of your customers cannot be overstated. Customer surveys and comment cards work well provided that you get someone trained in this process to help you develop them.The final step is setting up the training process and executing the plan. Training and materials will need to be developed for all levels of the organization. Customer service is an organizational philosophy, not just something that your people do. Each team member will need to know and understand the company philosophy and attitude toward its customer base, the standard being set, the levels of accountability, the reward and consequence process, the customer satisfaction measurement process and what is directly expected of each of them in their day to day jobs as it pertains to your customer service initiative. Initiate this focus into your new hire orientation program. This will give future employees a “stepping off point” that is different from the one that is currently available.”If we were paid more, it really wouldn’t make much difference. E.D. docs are proof of that. Its the competition that is changing things. Thanks for your blog. I’d love to hear your reply.Best Regards,Kurt Potter

  • Iris says:

    It’s always seemed to me that there should be mutual respect and responsibility between provider and patient, but that burden seems to have shifted almost entirely to the provider. God forbid society request that patients who are mentally able at least make an effort to understand their medical histories, appropriate use of services, what an allergy is, how to get to a free or mostly-free clinic, and that the “asshole” trying to save your life is someone you should respect and listen to because (most of the time) they are trying to respect and listen to you. I don’t know if you already have a fun acronym for the affliction this would cure, but I’ll call it CLCSPR–Chronic Lack of Common Sense and Personal Responsibility.I’m not a medic. Closest I’ve ever been is CPR-certified (and that was a while ago), but I happen to enjoy and read EMS/ER blogs. But…from what I’ve seen this is a common problem in damn near every field. At every job I’ve had I’ve been the functional equivalent of an EMT in my field–when the shit hits the fan and everyone panics I have to walk in and take over and get the job done, no matter what. Sometimes I succeed, sometimes I don’t, sometimes I get really fed up with the room full of panicking co-workers.Anyway. I may as well switch back to the EMS paradigm, since I’ve picked up a lot of terminology and it’s psychologically the same racket.People get jaded and fed up with the frequent flyers and the daily abuse they’re expected to take with a smile, the sniffly noses and hangnails and drug-seekers and various other malingerers. Fairly understandable. And honestly, a lot of those people need a serious lecture on misuse of emergency services. A little rudeness there might be a good thing in the long run. The problem is when the jadedness sets in and you start losing track of the fact that the last thing people who are genuinely sick, confused (or downright psychotic), and in pain need is rudeness from the person they’re supposed to be trusting their medical care to.Certain people at work use my vaguely-tech support jack-of-all-trades position as an excuse to use me as a crutch. They never bother learning the system, because they know that every time they forget where the orders are stored, or how to email an image to the boss, I’m one loud yell away. Never mind that I’m up to my neck in three years of back accounting files, tasked with cleaning up a stockroom that literally looks like a massive earthquake hit it, and personally responsible for half our merchandise ordering. So I get testy, and I start to snap at them, and I start responding a little more sluggishly, and then feel really guilty when I realize that they’re almost always actually willing to learn, and I catch them doing things I taught them last week. Or they’re getting discouraged and walking away because I’m so impatient due to other people’s boneheaded antics.As I said, it happens everywhere.And…well, at least if I go home and rant about it to the hubby, I can vent in a controlled way that’s not directed at the coworkers, and have a lot less pent-up aggression to take out in my interactions with them.Back to the EMS stuff again. From a patient’s point of view, there is a hidden (totally selfish) benefit to all this–those of us who are relatively good at staying calm in emergencies, answering questions, and allowing you guys to assess and prioritize get treated wonderfully. The three times in my adult life I’ve ever landed in the ER (twice by ambulance for grand mal seizures, all three visits relatively late at night) the paramedics and ER staff were the nicest, most professional medical personnel I’ve ever dealt with. I understand that if the paramedics get called, obviously something happened to me, so I tend to answer questions first and try to piece together the situation later. The paramedics were great–they got me hooked up, carried me out of two relatively annoying locations (tiny fourth-floor apartment with no elevator and a graded lecture hall at the end of a long/complicated corridor with multiple bizzarre short flights of stairs). They calmly explained the witness accounts of what had happened and did an amazing job of talking me through the horribly scary postictal confusion while taking my information and maintaining great care. They made sure I immediately got through to at least a hallway bed with fluids and some kind of monitoring, and were there for the full handoff. I’ll never forget those two :). They all seemed amazed that I understood my condition was in no way critical, I was perfectly content getting moved from room to room (or the hallway) as trauma after trauma arrived, that I fully understood a five-car interstate pileup meant I’d definitely have to get their attention if I needed anything (I did once–for a fresh bag of saline when I started feeling pretty dehydrated), that I asked questions about procedures out of curiosity/interest (rather than being combative/defensive). The outcome of this is that all the blood-spattered ER nurses, even ones not actually assigned to me, take the half-second to poke their heads into my room and keep me updated on how many Horrible Traumas they’re trying to cover right now with only X doctors and Y nurses on the night shift, but do I need anything? They treat me with compassion and respect every time, which helps keep me calm, which helps keep them calm, etc.My most recent visit was the one where they got ~5 horrible traumas after I was admitted with bad abdominal pain, referred from their own clinic, that they’d already managed to get a clean CT and ultrasound on. This is also, understandably, the one where I spent stints in 5 different ER rooms, the special gigantic OB/GYN room (the only specialty room not in use by Very Bloody Doctors), and a couple hours in the hallway next to the nursing station, right across the hall from the trauma room. I was out there so long I started chatting with the nurses any time they got a split second to breathe, so when I started feeling really dehydrated (my original bag of saline had been gone for over an hour and I was on dilaudid) they snagged my doctor and got me more as soon as they could. Much later that night, after the crazy trauma rush had subsided, when tests for everything including pregnancy had come back negative, I started to have a panic attack about still not knowing what was going on, then I realized that part of why I was panicking was that I’d missed my nightly meds. They had Ativan for me almost immediately, and not long after that they’d managed to bypass the rule about having to admit a patient before giving their regular meds and were back with my regular dose since they knew the discharge paperwork would still take a while. They were incredibly sweet even when I was losing it, kept me fully informed, controlled my pain well enough that I managed to catch a little cat nap in the hallway while they dealt with Trauma, ruled out every dangerous cause of the pain. They were caring. They were professional. They went above and beyond what they had to do for me.I know that was long winded, but I wanted to throw in some patient-POV. I’m still a little floored that what I consider to be basic respect qualifies me for special treatment.One last shout out to my paramedics. After the second ambulance admit, I ran into the same crew taking a breather in the ambulance bay on my way out. They not only remembered me, they checked in on what had happened, how I was doing, how well the ER had taken care of me, made sure I had a way to get home and someone to stay with me, etc. I’ll never forget those two :).From what I’ve read you’re just the kind of medic I’d really want taking care of me. You take your job seriously but maintain a sense of humor. You don’t seem to really rant unless someone’s done something ridiculously out of line. It sounds like you have a lot more patience in dealing with these CLCSPR sufferers than most people could ever hope to muster.Fuck. That was way more long-winded than I planned on.

    P.S. Hi, I really like your blog.

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