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DR. ARUNA DHARA
and DR. LEAH GENGE
A few months ago, we attended a conference and heard some sage advice: When someone is unpleasant or angry or violent, understand that this behaviour has served them at some point. Even if it’s not serving them now, they have learned that these behaviours will help them get through the world.
This gave us pause, as it should everyone. Imagine living in a world where getting by means being violent. In recent days, we have been thinking about this a lot, especially after reading the Nov. 16 opinion piece by Sydney emergency room physician Dr. Chris Milburn, who characterized some of our patient population as “the criminal element.”
We are both physicians whose primary work is with those who live on the margins, or in the shadow of centuries of oppression. It’s true that our patients are disproportionately involved with the justice system. But it’s important for us to remember that these same folks are also more likely to be involved with institutions in general — hospitals, child protection, foster care and the mental health system. Those experiences are generally not positive, and often woven with threads of judgment or systemic racism.
Authority — in the form of a health-care professional, for example — can mean loss of bodily autonomy, the withholding of needed medication as “punishment” or the traumas of losing, or being taken from, family. It is critical when we see patients that we keep in mind we don’t know what brought them to us. In fact, if we are really interested in patient-centred care, their presentation to a physician ought to be viewed as an opportunity to show the care and compassion they may desperately need.
Referring to people as “criminals” perpetuates the negative experiences and deepens the mistrust and fear that keep so many of our patients from seeking health care. Person-first language is as important here as it is anywhere else in medicine — perhaps even more so. We don’t refer to people with cancer as “cancers,” so why should this be any different?
The truth is that we, as physicians, have the privilege of being present during some of the most trying and difficult times in people’s lives. When patients are “civil” — grieving quietly, or stoically accepting bad news, grateful for our care — we often say they are “coping well.” But that’s only the kind of coping that suits the medical establishment. For our patients, coping might be loud or involve the community of people who have stood by them through rough times.
In these scenarios, people are not always grateful for our care, and the hard truth is that they don’t have to be. Indeed, their emotional responses to stressful events don’t always make a whole lot of sense to us. And that’s the key.
Until we have all walked a mile in the shoes of our patients — or at least made time and emotional space to really hear their stories — we won’t ever see beyond someone yelling or screaming at us, and we won’t get past our defensive reactions. That doesn’t mean that health-care providers should be subject to violence or abuse, or that we always accept those behaviours when we are confronted with them. We advocate only for looking at people first, and thinking about behaviours as something they do, rather than as some marker of who they are. It is a difficult thing to detach personal bias, but that is the very thing that years of training in medicine and experience is meant to teach us.
People make choices that don’t always make sense to us, or indeed, that contravene the law, and they show up in front of doctors afterwards — in ERs, in the hospital, at the office. Sometimes, they show up with police. But people are still people and our job is to serve them.
Dr. Aruna Dhara works at Sipekne'katik Health Centre in Indian Brook and at Dartmouth General Hospital. Dr. Leah Genge practises at Mobile Outreach Street Health (MOSH), Direction 180, and a family clinic in Spryfield.
- DR. CHRIS MILBURN: 'Criminal element' sent to ER puts docs in dicey spot
- CHRISTINE COOPER: Memo to Dr. Milburn — people in crisis no less worthy
- LETTERS: 'Criminal element' in ER — readers react to Sydney doctor
- MARYN MARSLAND & ALEX STRANG: Blaming patients unseemly — criminal behaviour often a byproduct of social ills