The Dangers of Having A Bad Day

Let us do a little self-reflection: have you ever had a bad day? Did you recognize it or did a fellow professional ask you if you were having a bad day? Had your supervisor noticed it? Had your physician noticed it? Was it in surgery and did your chief of surgery comment about it? Was it in the emergency room and did your colleagues notice that you woke up on the wrong side of the bed? Regardless of what we may think about ourselves, we all have “bad days.” Whenever you think everything is just fine, just ask your life partner. They have permission to notice things: habits, triggers, which are invisible to the world in general. When a PA, NP or physician has a bad day, it can be confusing or even dangerous. You have not acted or responded appropriately to a situation, and it has just reflected on you, your talent, your self-control, your professionalism, and your reputation. Let us look at a few illustrations that are true and have happened to me, my wife, and some of my colleagues or relatives.

It was 1970 and the saphenous vein was just harvested from our cardiac surgical patient. The vein was placed in saline and a sterile emesis basin, and I was tasked to take it to the top of the table where the heart was exposed; I slipped and so did the basin in my hand and it fell to the floor. I heard some screams from the OR nurses and some loud curses and comments from the surgical team that was working on the chest. I was directed to sit on a stool and observe for the remainder of the case. Yup, I certainly was experiencing a bad day.

My wife, Celia, went to a nearby urgent care clinic for a URI and was seen by a physician who was harsh and insensitive. She did her exam quickly and without comment and ended the session by saying “Sit here and someone will give you instructions.” A few months later, my wife returned to the clinic for another respiratory issue. She hoped that she would not have this doctor again. When the physician walked into the room, Celia immediately recognized her. But, on this occasion, she was pleasant, caring, asked the appropriate questions and did an extensive exam and politely left the room in a cheery mood. Celia said it was the best exam and experience that she has had since we moved to North Carolina. This doc was giving adept and kind care, which, I assume, is her norm. On the earlier visit, this practitioner may have been hormonal or suffering

from an argument at home or having her children pushing her to the limit before she went into her vehicle and came to the clinic. We are not whom we seem to be on one specific day. I have seen some of the best professionals present at their specialty practice, suffering from loss of sleep, stress, hypoglycemia, perhaps a severe toothache. Maybe they would have made a better decision and stayed home. But you and I know how we are driven; we do not see ourselves as employees, but we are committed to our work and think that our flaws are invisible, that they will go unnoticed.

Of importance in this short essay is how our personalities and our actions reflect on ourselves and our institutions, on the unsuspecting patient, whom you have always treated so admirably. They ask themselves if it is something that they have said or done or has our work environment changed. They leave our office feeling confused, angry, doubting our clinical decisions, and our ability to be subjective, considering something has rocked our boat today. If we have made an error, they could become aggressive and report us to the administration or initiate a litigation. It is amazing how, in five minutes, we could lose five years practicing good medicine.

A breach of medical ethics or professionalism can be an abuse of our power in speaking to a patient. It can be poor interaction laced with opinionated remarks or lack of sensitivity, It can be a breach of confidentiality, which rightly creates a tsunami of anger. An emotional impairment of any kind can be a dangerous denominator. Insufficient empathy, insensitivity to the patient or their family members’ needs, feelings and wishes, or disregarding the patient by our own superiority attitude interferes with a patient presenting an honest HPI. When we took our oath, part of “Do No Harm” touches on all of these and require us to be honest, sincere, empathetic with our words, facial expressions, and gestures. We also have a commitment to have the same respect when dealing with electronic medical records and communication.

What can we remember that will prevent or heal these violations of trust and professional care? Maggie Smith asserted, “Trust that your best tomorrow will be even better than today’s. That is healing. Keep moving.” Maya Angelou said, “You may not control all of the events that happen to you, but you can decide not to be reduced by them.” This too, is healing.

Remember that malpractice events are often initiated because of our poor attitudes, lack of asking for forgiveness if we realize from the patient’s facial gesture that we have just erred. If they have already left your office, a telephone call apologizing for your attitude, mistake or

behavior stating the causative factor goes a long way to disarm a poor patient encounter. Patient satisfaction is more than a comment on a sheet replete with many other comments. It demonstrates that HCP are human and suffer from the same lapses as their patients and, hopefully, that understanding will prevent a litigation. And seek to purchase an excellent personal liability insurance policy that can defend you against this type of action. When I first started practicing as a PA, I bought a personal liability insurance policy very expeditiously. I had seen errors perpetrated by my colleagues and considered that I, too, would make similar errors in judgement or technique. When I purchased my policy, I researched what was available and sought to find the best, I purchased a policy underwritten by CM&F. As a PA leader on the state and national level, I encouraged my constituents to do likewise and, as professional associations, we choose the most trusted, an AA Best Superior product, that has protected me through my entire career. Go, and do likewise. You will not regret it.

Written For CM&F?By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus CM&F Clinical Advisor