Shaming Your Doctor on Facebook

My wife was upset and angry when she called me. She had been scrolling through a community Facebook page for Huntington Beach and come across a scathing post against me and my office. An angry and upset patient had written multiple paragraphs, accusing me of billing for services I did not provide, of being rude, arrogant and mean, and saying my staff reflected the same attitude. The page has over 20,000 followers and many of them, some of whom had no personal experience with my office, had joined the mob of commenters,  supporting the patient and her opinions. Many of the negative comments were personal.

I was at breakfast with a friend when she called. I excused myself and hurried home to deal with the online damage. My wife had gallantly tried to defend my honor only to see some of the attackers turn on her as well. I stared at the screen for a few moments and debated how to respond. Doctors cannot respond as other businesses do as privacy laws do not allow us to reveal any personal details about patients or their conditions. I typed out a general response, trying to graciously and kindly explain that the statements did not accurately reflect my interaction with the patient or the nature of my practice. That post was criticized and attacked by strangers as well.

In the meantime a few of my patients noticed the post and came to my defense. Many shared personal stories of care they had received. Others reached out to the administrator and asked that the negative post be removed. The post was taken down within a few hours but not before hundreds of local residents had read it. I wondered if any lasting damage had been done. My wife and I were both shaken by the nature of the attack. She even said, “If I were you I would want to quit!” At that moment I did.

I thought about the patient who had written the post (which she also left in the form of a review on my office Facebook page) and wondered at the intensity of her anger. I looked back on her single visit, which had been uncomfortable from the outset. She did not like the fees that we charge and had made her feelings clear to the receptionist on her arrival. It seemed her unhappiness carried over into the exam room. I nevertheless spent a great deal of time with her and did the best that I could to meet her needs. I failed. A few weeks later she went to another doctor and first made her accusations of false billing. When that office called me and questioned the billing I waived all charges and asked that she not return. I hoped that waiving charges would calm her anger. I was wrong.

My wife and I spend much of the morning talking about the incident. As we reflected on what had happened we kept returning to the meanness of it all. While we could understand someone being unhappy with their care we could not understand the intent to harm and destroy. When posts are shared with thousands of people the harm is real. (The following day a new patient told me she had read the post and nearly cancelled her visit! It was only when she read my reply that she decided to give me a chance.)

We wondered, “What has happened in our society that people so easily attack one another?” In the old days patients could file a private grievance with their health plan or medical group and have the incident investigated. Because the matter wasn't public doctors could openly share their side of the story. In the vast majority of cases all would see that the doctor had been misunderstood or that the patient did not understand what was going on and the problem would simply go away. The patient would move on.

Things are different today. One slight misstep, one mistake, one bad day or simple miscommunication can result in anger raining down. This is not unique to doctors. Everyone is under the microscope. Just a few months ago on the same community Facebook page someone posted about children playing roughly with baby ducks at a public fountain while their mother did nothing to intervene. At least one of the ducks was seriously injured. The poster, furious with the seemingly uninvolved mother, attacked her on the community page. People searched Facebook, found the mother’s profile page and publicly outed her. She was viciously attacked and publicly shamed.

The mother’s story, and mine, are important reminders that social media attacks hurt people. People who may be doing the best they can, people who may just be having a bad day. The patient who attacked me had no knowledge of how hard I have worked over the years to be a kinder and more compassionate physician. She had no knowledge of the free care given, the house calls made, the hands held, the tearful hugs shared or the prayers offered. All she knew was her single experience, and even then she only knew her side. For her that was enough to pass judgment.

If we are to be kind and generous we need to be more cautious in our judgments. We need to give people the benefit of the doubt, to assume the best and not the worst in others. All people have bad days and bad moments. We need to be understanding forgive and when we can’t we should strive to keep our anger private. No one wants to live in a world where every mistake is public record. Life is hard enough.

I need to change my attitude as well. I need to extend more grace to others. There are times I have left a negative review of a restaurant based on single bad meal or rude server. This recent experience reminds me of how wrong that is. What right do I have to judge someone’s business based on a single interaction? This is someone’s livelihood, something into which they may have invested their life’s savings. Negative reviews can do real harm not just to a business, but to a person. They hurt. I need to be less critical.

I intend to intentionally look for ways I can be more gracious. It may seem silly, but after this experience I went on my Yelp account and deleted negative reviews. It was a small step but it is a step.

As for my professional life, I will continue to do what I have always done. I will try to be better each day, to communicate kindness and compassion as best as I can. When I fail, as I did with this patient, I will do my best to learn what I can and apply the lessons to my practice. Not just because the world is watching, but because it is the right thing to do.

- Bart

PS: I called the patient later that day. The conversation wasn't wonderful but I was able to hear her concerns and why she was angry, and was able to show her that I wasn't the man she had accused me of being. "If it is possible, as far as it depends on you, live at peace with everyone." Romans 12:18

Thanks for reading and sharing and commenting. Comments are welcomed.

Violent Words in a Parking Lot

“You’re an F-ing idiot,” he screamed at the woman, who was obviously frightened at the explosiveness of his outburst. Concerned with neither the woman nor how he appeared to others he screamed the words at her over and over again, gesturing fiercely and menacing in his posture.

The scene played out in the parking lot of a nearby supermarket in plain view of others. The man did not care. It was clear that he wanted everyone around to know that the object of his anger was an “F-ing idiot.” My wife Lisa was witness to the outburst, the man’s words impacting her as she exited her car. She was stunned to see that the recipient of the man’s wrath was an elderly woman who was fearfully standing next to her parked car. Shocked at the intensity of his rage, Lisa waited before going into the store, fearful that the man might do something rash.

As the man continued his repetitive insults Lisa was unable to remain silent. Hoping that the awareness that others were listening would give him pause, and to let the woman know she was not alone, she said, “Excuse me?”

The man turned to her but his anger did not diminish. My wife became a secondary target. He had F-bombs to spare and was apparently willing to hurl them at anyone who did not agree with him. Lisa found herself plotting escape routes if he approached and pondering whether to dial 911.

In the course of the man’s diatribe he revealed the terrible deed the elderly woman had done, the heinous act that caused him to respond so viciously. The woman had stopped her car and waited in the lane as another woman prepared to back out of a parking spot. Mr. Angry was one of those who had to either wait several seconds for the parked car to exit or drive around her.

That was it. A momentary delay in the parking lot. The loss of a few moments of time were enough for the man to unleash his fury, enough for an elderly woman to be publicly derided as an F-ing idiot.

When Lisa shared this story with me we both marveled at the man’s lack of decency. The elderly woman may have been overly cautious in her driving, she may have made a wrong decision and she may have caused others to waste a minute or two. None of those acts made her deserving of public scorn, none had any bearing on her value as a person. It was clear to us that the man’s problem wasn’t just that he didn’t respect the woman, it was that he didn’t respect people. That absence of baseline respect allowed him to attack others for their mistakes, to condemn them for minor slights.

As we talked I thought of how more and more people are becoming like Mr. Angry, thinking only of themselves without regard for the feelings of others. So many people have forgotten the truth that every person, even those who wrong us, is deserving of kindness and respect.

I don’t want to be like Mr. Angry. I want to be better, speak better and think better. I want to view others with respect, not just in parking lots, but even in the privacy of my mind. I intend to do this by working on avoiding derogatory labels for people, to cease with the name calling that is pervasive in our culture. From now on, if someone cuts me off on the freeway, leaves a bad Yelp review, or in any way offends me I resolve to no longer say, “Look what that idiot did!” or “What a jerk!”

I am going to try and say, “Look what that person did.” No adjective, no defamatory comments. I intend to aim my negative comments at actions, not people, to continually remind myself of the personhood of every man and woman I meet, regardless of the rightness of their actions. I want to remember that everyone is a child of God, that everyone has value. As I do my prayer is that my heart will soften, my anger will fade, and a kinder person will emerge over time.

I can’t change Mr. Angry, or the countless others like him, but I can change me, and I intend to.

- Bart

Thanks for reading and for sharing with others. I can be followed on twitter @bartbarrettmd, and those who wish to receive posts via e-mail can do so by subscribing to the blog. Comments and questions are always welcomed.

Gone in a Heartbeat

In April Paul saw the cardiologist for a check-up. He had an electrocardiogram done and for extra measure a nuclear stress test (A radioactive tracer is injected to identify areas of decreased blood flow.) Both tests were normal. His mind at ease, he looked forward to a relaxing summer.

9 weeks later he was dead from a heart attack. He grabbed his chest, told his wife he was having pain, and collapsed. He was gone before he reached the hospital.

His death is a stark reminder of both the fragility of life and the inadequacy of medical science. Death remains certain and our ability to see it coming woefully inept. People like Paul die when we think they will live while others live far longer than expected. (I currently have a patient with widespread cancer. He was told he had less than 6 months to live, so he enrolled in hospice. That was 14 months ago.)

The certainty of death and the uncertainty of its timing seem to have little impact on how many of us go about our lives. We live in denial, planning to live to be 100 and die in our sleep. We put off vacations or delay retirement, focusing on financial goals. We ignore damaged relationships, telling ourselves we will reach out to estranged family and friends “eventually.” Many spend no time at all pondering what happens in the next life presuming eternity is either non-existent or blindly hoping that if it does exist we have been good enough to qualify for a good after-life.

Paul reminds us of the foolishness of this attitude. Tomorrow may never come, the remainder of our lives may be measured in days or hours instead of years. Now is the time to pay attention to our loved ones, mend relationships, and consider eternity, for “now” may be all the time we have left.

- Bart

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Shooting Congressmen

A congressman is fighting for his life in a Washington DC hospital. He and other Republican members of congress were attacked while they practiced for a baseball game. Their attacker did not know them, had never met them, yet had concluded they needed to die. The shooter appointed himself judge, jury and executioner, imposing a death sentence on them for the crime of being conservative.

How did it come to this?

Several thoughts come to mind-

1-      Politics has become too important. When people blame all of their problems on government or look to government to provide all of the answers to their problems, those who oppose their views can be easily demonized. This is true on both sides. When we assign evil motives to our opponents we provide potential justification to harsh actions against them. Yoda said it well, “Anger leads to hate, hate leads to suffering.”

2-      Human life has lost its value. There was a time when people were valued because they were people. People were defined first and foremost by their humanity. Created in the image of God, all people deserved to be treated with dignity and respect. This was why our founding fathers embedded a prohibition against cruel and unusual punishment into our constitution. Even the worst people were thought to be deserving of some degree of dignity.

This is no longer true. We see people being beaten, bullied and attacked for what they believe. Our rhetoric has lost any semblance of dignity and respect. This week I saw a post in which someone called Jeff Sessions a “F-ing D-bag” (abbreviated for politeness.) The attorney general of the United States deserves more respect. He has served his state and the nation for 35 years. While he has been wrong at times (on many occasions I am sure) being wrong does not make you a D-bag. When we reduce people to epithets, when we ignore the good that is in them, we devalue all humanity.

3-      No one listens anymore. Everywhere I look, from the debates in congress to the comments on Facebook posts, I see put downs, insults and personal attacks. Opposing views are mocked and dismissed out of hand. No one seems interested in the truth coming out as much as they are in winning an argument. The resultant “us vs. them” posturing is damaging to our culture. It breeds anger and contempt for others.

It does not have to be this way. We can be better, we can work to focus on the good intentions of others, on their positive contributions and on common goals.

We need to assume the best in others. Both political parties want a better America for all Americans, a better healthcare system, safety for our citizens, education for our children and a thriving economy. We would all do well to remember these shared goals. We may disagree with others on how to achieve them but we need to stop assigning evil motives to those who disagree with us.

We need to remember that people are more important than politics.

- Bart

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The Doctor Won't See You Now. And That's a Good Thing

It has been 6 months since my practice fully embraced digital medicine. Whenever possible we give patients the option of being treated without coming to the office. Several times a week we review text photos of medical conditions from rashes to pink eyes and respond with treatment plans. On a daily basis we treat high blood pressure and diabetes through secure email. Patients whose blood pressure was poorly controlled due to difficulty coming to the office are now perfectly controlled. Being busy is no longer an obstacle to care and patients are responding.

Thinking I am on to something, I have been sharing our new policy with other doctors. Everyone is interested in the idea but most don't think we are charging enough for the service. Our $120 a year annual fee leads to the conclusion that they would lose money if they adopted a similar practice. My reply that patients deserve this more convenient option is not persuasive.

I expected hesitancy and reluctance from my colleagues but one doctor’s response caught me off guard. When I told him that I was only requiring compliant hypertensive patients to come to the office once every two years he replied, “Sure, but you still have them come in for their annual physicals, right?”

I replied with a puzzled expression, “No, people don’t need physicals every year.”

“I know they don’t,” he said, “but we get paid for annual physicals.”

“But why bring them into the office if they don’t need to be there?” I replied, still not following his logic. 

“Because we make money and it doesn’t cost them anything!”

“It costs them a day off of work!” I replied.

After a few more minutes of debate I gave up. We have completely different views on the business of medicine. I walked away from the conversation with a new understanding of the problems our society faces as we try to address increasing health care costs. Doctors and hospital groups talk about lowering costs but want to make as much money as they can. If they get paid to do something most of them are going to do it, even if it is useless. 

It is easy to point fingers at doctors, but they are responding to basic economic instincts. They do what they get paid to do. Which means a large part of the blame should falls on those who pay for medical care. Insurance companies and government programs are a large part of the problem. Misguided wellness programs require healthy young patients to come to the doctor once a year and pay doctors handsomely for the visits. Obamacare requires insurers to offer physicals every year at no cost to the patient. Doctors know a cash cow when they see one and willingly go along with the program.

While willing to spend millions on unnecessary visits for healthy young people, most insurers do not pay anything at all for digital care. Many patients also fail to see the value in the service. When confronted with our annual fee over half of our patients were unwilling to pay the equivalent of $10 a month for the service. Modern healthcare access is not worth as much as their monthly Netflix or latte expenditures. Physicians who want to make a good living are left forcing patients to come to the office unnecessarily, because that is what they get paid for. 

My hope is that my pilot projectwill eventually catch on. As my patients tell their friends about the benefits of digital care perhaps the demand for such services will go up. If it does, other doctors may eventually follow. Even if they don’t, I will continue to provide these services to my patients. Having seen the benefits of this care for my patients I am convinced it is the right thing to do.

- Bart

Thanks for reading and for sharing with others. To read more about our digital access plan, you can read the explanation on my office blog. Comments and questions are welcome.

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