What is not owed

The obligations of health care workers receive much attention. They have the obligation to use their expertise or to seek the help of others in diagnosing and treating. They have the obligation to do good and to do no harm, balancing benefit and risk in the favor of a vulnerable patient. They have the obligation to maintain confidentiality and to provide correct and updated information on options and progress. They have the obligation to be professional, in that work should be done efficiently and promptly. Some who write of the physician-patient relationship go even further, and aver that compassion, kindness and respect are the duty of all who would call themselves healers.

But there comes a point when service gets mistaken for servitude. In this column we have repeatedly spoken of the commodification of health care into something that is expected to be as instant, and as instantly satisfying, as fast food, and it shows. Doctor shaming is no longer in vogue this year compared to last, but what’s called an “epidemic” of violence and aggression against health care workers is on the rise. The Occupational Safety and Health Administration estimates that workers in health care settings are four times more likely to be on the receiving end of workplace violence than workers in private industry. Triggers can be as major as nonsatisfaction with decisions in medical care, and as minor as nonfunctioning room air conditioners. Is it the stress of being ill, or having one’s relatives be ill? Is it the overall inadequacy and expense of our health care system, which is not an unimportant stressor? Can it be that we’ve also just come to view those in the service industries as subhuman?

Lest some confuse the matter, these are the things that are not owed to those on the receiving end of care.

We don’t owe our patients or their relatives deference. We owe them respect and courtesy, but not the subservient, sycophantic bowing and scraping that so many have come to expect from licensed professionals. It is a painful thought that many struggle to perfect themselves in training and get licensed, only to be treated as less than dirt—and most of the time, aggressors get away with it. According to the Joint Commision, health care workers are often uncertain about what constitutes violence and aggression, because they believe assailants are not responsible for their actions while under stress. There is a 26-percent reporting rate on workplace violence for emergency department physicians, and 30 percent for nurses.

We don’t owe explanations for what we do outside of duty hours. We don’t owe patients our personal information or our private time and we are not on-call advisers for every little health concern.

We are not responsible for overcrowding, inadequate resources, or other systemic factors that are beyond the role and scope of the individual worker. Are frontliners really the ones to blame?

Health care workers are not servants, but professionals. The striking and unforgettable example of a patient ordering his nurse to purchase a Starbucks beverage, and the nurse resignedly complying, is a story I’ve written about before, but which bears repeating.

I tire of reading self-sacrificial posts about how one should give oneself in the service of the sick Filipino. The profession is a very noble one, but in neglecting to protect those at the front line from verbal abuse, aggression and humiliation, we are creating very unhappy health care workers who feel unsafe and afraid of losing security. Those on the receiving end of aggression and intimidation fail to report, out of fear of retaliation or termination. Those in training, such as nurses struggling to gain clinical experience or physicians in specialized programs, would hardly endanger their place. Service is hard enough in the context of an imperfect system. Do we really want our health care workers to struggle with low morale and burnout? Something has to change.

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