Journal of Community Medicine & Health Education
Open Access

Society has changed so much in the last decade, including healthcare. Medicare (CMS) has endorsed certain patient rights that must be adopted by all hospitals if they accept and bill Medicare. These rights include:

• The Right to determine visitors

• The Right to refuse treatment

• The Right to receive information in a way that they can understand

• The Right to participate in their care decisions

• The Right to complain

This is not a bad thing on the surface, but it has created some unfortunate and unintended consequences for all healthcare workers. Let’s examine three real life incidents.

An eighty-two year old confused man is admitted to the medical unit for pneumonia. He is angry and abusive yelling and swearing at the staff. He refuses to submit to the treatments ordered by his physician. The staff is frustrated by his behavior, but their hands are tied. They cannot put him in restraints; (against CMS standards) and they cannot yell back at the patient (against hospital policy). They try to enlist the help of his family but soon discover that they are dysfunctional and unable to assist. In fact, they support his bad behavior and complain to the nursing supervisor about the “poor” care their father and husband is receiving. They patient eventually pull out his own IV, dress and walks out. The staff attempts to ask him to stay and talk about his illness, but again, they are unable to physically restrain the patient because he has “rights.” The patient leaves the facility with the help of his family; attempts to contact him and his family are unsuccessful. There is no ability to determine if the patient has taken the medications needed to complete his treatment for pneumonia. The family lodges a formal complaint against the hospital staff and the treating physician.

A 50-year-old woman is admitted to the medical unit where she tells the staff that her husband is abusive and asks that he not be allowed to visit. The patient has been in the facility before and is well known to the staff and to the local police. The abuse has been long term and the staff is very interested in helping the patient. The staff locks down the unit which causes inconvenience to all the other patients and visitors.

The husband comes to the hospital multiple times and demands to be let into the facility, but is not allowed in. The police are informed of the problems, but the woman does not want to press any charges. The woman is rude to the staff and uncooperative with her treatment. After three days, the wife recants her story and leaves the hospital with the husband. The staff is unable to do anything to help the woman in spite of many hours of talking and counseling. The patient files a formal complaint against the staff for keeping her husband away from her for three days.

A 21-year-old woman is admitted to the facility for abdominal pain. She is verbally abusive to the entire staff. After 24 hours the physician releases her to go home and she refuses to go. She becomes abusive and violent with the staff. Everyone is reluctant to call the police because she has been ill. Family members come to the facility and support the bad behavior and call the staff names and threaten lawsuits. It is hours before the patient finally agrees to leave the facility. A formal complaint is lodged against the staff for their “bad behavior.”

These types of occurrences are almost a daily problem for healthcare facilities. Staff are punched, spit on and verbally abused. Sometimes law enforcement is called but that often only escalates the behavior and the police are reluctant or unable to take a sick patient to be incarcerated.

How did this happen?

Where did it become acceptable to abuse nurses and other healthcare workers? When did the “rights” of the patient exceed and overrun the rights of their caregivers. I believe it has its roots in a complete change of culture in our society. This change is supported by the media, including social media, and is now so deeply ingrained that there is no turning back. The transformation is easy to see by comparing two television programs, one from the 1970’s and 80’s, Walton’s Mountain; and the other more recent, The Simpson’s. If you watch an episode of Walton’s Mountain, you will see a large family with a mother and father who love each other and their children. You see the family handle crisis by banding together and supporting each other.

If one of them makes a mistake…. they are held responsible for the mistake. They are loved and supported but they have to face the consequences of their own actions. The children talk over their concerns with their parents and respect their answers. However, the parents are supportive of the decisions their children make, even when they do not agree with them. This behavior is shocking when you look at the Simpson’s. Here you also have a mother and father but their relationship is contentious. In fact, hardly an episode goes by that does not spend time demeaning one or the other or the marriage relationship. The children are hostile to the parents and to each other. They are rude and irresponsible. If they make a mistake, it is okay to lie about it, or even point the finger at someone else, but never, ever take responsibility for your actions. The parents make fun of their children but do support them, even if it is in a non-traditional way.

The current Hollywood media will tell you that the Simpson’s is more “realistic” than the Walton’s. This is their reasoning behind many of the sit-coms on the television today. However, our children are watching those programs and thinking that behavior is appropriate. As adults that behavior becomes completely ingrained in their personality and society as a whole and healthcare specifically are forced to deal with their conduct.

Those of us who grew up in the 50’s, 60’s, and 70’s, grew up with traditional families and most of us had traditional values instilled within us. So what happened in the last 40 years to change the environment so much? That is the million dollar question and it does not have an easy answer. There are complex issues involved in the cultural change and there are too many to list. However, let me suggest four things that have entered into the cultural de-evolution.

• Both parents had to enter the workforce –due to economic issues, or because the woman wants a career.

• The ability to discipline our children has been taken away from us.

• We are all winners.

• Civility has disappeared.

Let’s explore each of these items one at a time. Both parents working requires daycare or sitters for 8 hours a day or sometimes more. Daycare is great, but it’s not the same disciplinary environment that the child has at home. The rules at the daycare are often completely different from the home. For instance, at the daycare, the child is required to empty his plate at lunch, but at home, the parents allow the child more latitude. This confusing atmosphere gives the child opportunity to question every rule and argue about every chore they are asked to do.

Parents feel guilty about being gone all day and often overindulge the child at night. Confusing rules equals confused child. As confused adults, they come into the healthcare setting and ignore the rules. They assume that the rules will change to fit their convenience or their situation. When those things don’t happen, they begin to berate and harangue the very people who are trying their best to assist them.

Children from the 50’s and 60’s know what it feels like to be disciplined with a wooden spoon or with Dad’s belt. It certainly instilled a need to do whatever your parents asked without question. I am not suggesting we hit our children with wooden spoons or belts. I admit that some parents take it to a place it should never go, but I am an advocate of a good spanking once in a while. It is a threat that can strike fear in the heart of a young child (it certainly terrified me) and that fear can be translated into obedience. If children are hit with a wooden spoon in today’s world, the parents would go to jail and the children would end up in state custody. We witness children throwing fits in the grocery store, but Moms and Dads cannot spank the child– they would be reported for child abuse. They cannot walk off and leave the child on the floor–they would be reported for child abandonment. That leaves only two choices, let the child continue to scream, or give them what they want. Giving in creates a no win situation and the child learns how easy it is to get what they want….. just start a tantrum in the store or anywhere else it will inconvenience or embarrass Mom and Dad.

The only discipline allowed parents in today’s world is talking, grounding or time-outs. We should certainly not discount these disciplinary actions, but we can and should recognize their weaknesses. No child is afraid enough of a talking or a time-out to avoid throwing a fit in the store. We are solidifying their behavior. An adult in a healthcare setting who is not getting what the “want” assumes the same tactics will work. They scream and yell if they don’t get enough pain medication, the nurse doesn’t answer their call bell immediately, or if the physician dares to suggest that something in their own behavior may be part of their illness.

Somewhere in the 1990’s, there ceased to be winners and losers. The important lessons learned when you try your hardest and don’t come out on top were lost. All kids in the local soccer league get a trophy because they don’t want anyone to feel “bad.” Tests at school can be retaken several times–to give kids an opportunity to improve their grade or just make a grade. It used to be that you took a test and lived with the consequences, but that does not happen anymore. Children grow into adulthood thinking that the world will always be fair and they will be given multiple chances to succeed.

And when they don’t succeed, they are completely overwhelmed with the failure–because they have never dealt with it and learned how to cope with it. Translated to healthcare: I don’t like that diagnosis, give me another one, or I will kick and scream and throw a fit until I get what I want or I know I have cancer but you need to find a way to treat it. Don’t tell me how sick I am, “that is not fair,” just find a treatment and make me better. That is what’s fair.

Rudeness has become the norm. A teacher friend of mine was frustrated with a child in her Junior High School class. He was rude and vulgar and used the most offensive language. After a week of this behavior, she sent the young man to the principal’s office. As per policy, a meeting was set up between the teacher, the student, the principal and the parents. The teacher describes walking into the meeting where the father of the student was already loudly protesting the conference, and using the same vulgar phrases and inappropriate language as his son. The teacher knew that the battle was lost before it even started. Instead of making our children face the consequences of their bad behavior, we jump in and defend them. The lesson they learn is that they can say, do and be anything they want. They now use social media to post their post-medical care opinions knowing that no one will know who they are and there will be no repercussions. Trashing people and ruining reputations is the norm. Healthcare workers cannot defend themselves because of privacy rules. So social media pundits can say anything. There are no consequences to disrespectful and uncivil behavior.

This is not meant to be an all-inclusive list of items, but just a few of the things that have changed in our society and created the environment for a cultural change. Those young kids who grew up without proper rules and discipline assume that same type of behavior as an adult. Scream and yell and get your way. Call people names and get what you want, and healthcare is paying the consequences.

• A recent sign inside a hospital stated:

• Attention Patients and Visitors

• Aggressive behavior will not be tolerated.

• Examples include:

• Physical assault

• Verbal harassment

• Abusive language

• Sexual language directed at others

• Threats

• Failure to respond to staff instructions.

We have Zero Tolerance for all forms of aggression

It’s a sad world that requires this type of sign to be posted in a healthcare setting but this is the solution that is being adopted across the United States. Once upon a time, physicians and nurses were treated with respect, but that is just a fairy tale now. What can be done? We cannot wave a magic wand and make the last 40 years of cultural changes disappear. In order to provide “ patient rights ” we have abandoned the simple societal rules of civility. There is no way back. Healthcare workers will continue to be abused in the name of “patient rights” and the professions surrounding healthcare will continue to lose their appeal to the rising generation. And healthcare, as we have come to know it, will continue to de-evolve or cease to exist.