Against the expectation of patient obedience and conformity

What happened yesterday at the Dr’s office. (The draft of a letter)

The medical establishment has become more and more demanding that patients behave obediently and passively. This is no way to involve people in their own healing and health, but it does give the health care workers and providers a distorted and dangerous sense of power and entitlement.

Yesterday I went to see a my doctor. I was just reassigned to her as I had seen her once before but had tried two other doctors since and decided to come back to her (but that’s another story). I showed up with my partner, Andy, who is also her patient. He has been seen at that office by that staff for years now.

We showed up for what I had been told (at the time the appointment was set and in two telephone confirmations) was a 3 PM appointment. When we got there (I always go with a witness and support) the receptionist told me i had a 3:45 appointment, and had a series of excuses and explanations for why I had been misinformed. I complained about this totally inexcusable lack of respect for my time, energy and health. (With fibromyalgia, sitting in chairs is very painful and unhealthy.) They told me the DR would be with me soon, but actually didn’t see me until 3:50. I suggested they compensate me at doctors’ wages. No one saw the humor in that. HM.

They took me (and Andy) back to a room and told me I wouldn’t be waiting long. We had the distinct impression they were just trying to get my complaining butt OUT of the waiting area.

It didn’t help that when the medical assistant/nurse (not sure), CONNIE asked me to step on the scale, I politely refused. She was visibly and verbally annoyed at my refusal and kept arguing with me about why I had to get on the scale, and I was politely and repeatedly assertive that I indeed did not.

She was what I call “California polite.” It’s actually not polite at all. It comes from a place of deep disgust and a total refusal to meet the needs of someone one is supposed to be taking care of. Key phrases include “I can’t help you when you’re upset” “You need to calm down.” “I’m just doing my job.” It is full of false concern and visible contempt.

We met with the doctor who finally saw us an hour after we arrived, and 50 minutes after the stated but only 5 minutes after the apparently secret real time time of my appointment. The appointment went well and the basic intentions of my appointment were met. YAY! because often that’s not an easy process. The doctor was helpful, concerned and supportive.

While waiting for the doctor, we noticed a sign on the wall admonishing patients against using any equipment and that if we did, the clinic was not liable for injuries. This surprised me, that the concern was not for patient safety, but rather clinic liability.

When CONNIE came in to draw blood for tests, she brought someone with her, who we found out was her supervisor KIM. I had never had a supervisor brought in so my blood could be drawn. I’m an easy stick and it went by uneventfully, but it was evident that CONNIE had felt she needed some back up to take blood from me.

Then I was told to meet with CONNIE out by the desk and set up another appointment. When we got to the desk I asked for a chair, that standing sent shooting pains down my legs and I can’t stand long. There were several office chairs around that no one was sitting in. CONNIE refused. I suggested she just let me sit in one of the office chairs, and with the most smug and condescending tone, told me she could get me a wheelchair. It was rhetorical. Most people who “don’t need” a wheelchair, won’t sit in one. There’s a lot of power in putting someone in a wheelchair as opposed to both of us sitting in a “real chair”. I said that was fine, that she needed to get me a wheelchair. Not that one was immediately available. I remained standing and waiting, at which point I decided to sit down in one of the empty chairs, which meant going behind the nurse’s station. The other nurse/medical assistant explained to me that the office chairs were on wheels and I could fall and this was why I couldn’t sit in those chairs, and called security. There didn’t seem to be any concern that I could fall if I was standing up, having just told them that I can’t stand up for long. the other nurse/medical assistant called the supervisor. At that point the wheelchair and CONNIE showed up and I moved to my assigned seat. CONNIE was visibly smug and clearly entitled to my obedience, even at the point of my discomfort, and danger.

If the concern is of liability, certainly denying a person a chair as a reasonable accommodation would put the agency at risk. The experience I had as a disabled person requesting a simple accommodation is sufficient grounds for damages and litigation.

As it was, I did mention to the other staff as CONNIE went to fetch a wheelchair, that I had read the waiver of liability for use of equipment and was willing to take my chances. Given years of experience sitting in chairs, in retrospect, I think I was more than qualified in the use of such specialized and dangerous equipment.

Supervisor Kim showed up again, just as CONNIE was ratcheting up the conflict with very aggressive demands to silence me, and get me to point of passive obedience. This is the pathologizing of anger. I had already been given orders about where to put my body (on a scale), made to wait 50 minutes, not because the DR was behind schedule, but because I had been told to arrive 45 minutes in advance of the secret time of my appointment. At one point I was asked if I didn’t want to go into the waiting room and wait while my husband got my appointment. I said I did not, and that I wanted to participate in my own treatment and setting of my own appointment. At this point CONNIE was now speaking very loudly about me, in the open hallway, with a play by play of my disobedience. It came out that she had considered me a security threat initially when she brought in Supervisor Kim to observe the blood draw. I was angry but clear and countered CONNIE’s demands by pointing out that if I were the security risk she seemed to think I was, CONNIE’s behavior was only going to escalate the situation. If I was really a threat, CONNIE’S behavior certainly wasn’t going to diffuse the situation. In my anger, I pointed out that I was upset, but that I was clear and focused and able to articulate my concerns. Asking for A CHAIR is the most simplest form of accommodation, and if the office chairs are so dangerous, the staff shouldn’t be required to use them, either. (RIGHT?). I stated that anger itself does not make someone a security risk that it is a normal and healthy emotion when one is being mistreated and that my passivity is not assured in the face of mistreatment. Supervisor Kim listened and presented as someone who was supportive and concerned. Meanwhile CONNIE called someone and asked to speak with them and left, returning a little later with the broadest, smuggest smile on her face. She seemed very confident that her mistreatment of me was an entitlement and one that would not cause her any discomfort or reprimand from her employer, that the obedience of patients, not our own ability to advocate for ourselves at the point of medical service, was an expectation and sewn deep into her job description.

Still angry, and now having trouble walking, because that’s what happens when you mix (iatrogenic) stress and fibromyalgia, I was still talking to Supervisor Kim. I suggested, proactively, that to avoid this problem in the future, I remain seated in the exam room while the nursing staff makes my appointment. (This way I don’t interfere with their seating assignments). I also said that I did not consent to have CONNIE read my medical records and I refused to have CONNIE work with me in the future.

If patients are going to be participants in our own health care, we have to be treated with respect, which includes respect for all our health issues (including mental health diagnosis), not using those diagnosis or our status as patients as evidence against us. Our agency and bodily autonomy has to be respected and requests for simple accommodations needs to be understood as a basic human right. The medical establishment is not exempt from the requisites of reasonable accommodations (like an available chair during the intake and release stages of the appointment.)

If we have to sit in the wheelchair, which is a very powerful way of reinforcing the power dynamic, when a stationary or office chair would suffice, one should be immediately available.

Staff should be empowered to provide chairs and other accommodations to patients, should be trained in patient agency and autonomy and especially in crisis management and how to deescalate a conflict, not provoke one.

If my very simple assertions of body autonomy are rare in a medical office, then along with your diabetes, nutrition, yoga classes and other classes offered to patients, your clientele needs support in how to assert themselves with medical personnel and such assertions need to be respected, not seen as a threat.

When a patient cannot ask for a chair or refuse to stand on a scale, they will certainly not be comfortable with asserting their needs in more pressing matters against even more entitled personnel, like doctors and hospital administrators. This makes patient participation in our own healthcare, including raising issues of concern, voicing a difference of opinion, providing essential medical or personal history (especially if that history will be used as justification for abuse by medical personnel) even more difficult and unlikely. Staff should be encouraging patient and customer input and requests to make our visit healthier and more comfortable, not ratcheting up our marginalization and passivity as a point of entitlement and staff comfort.

I left the office devastated and exhausted. Having lost almost an hour of my time due to the miscommunication of my appointment time, and another hour asserting my right to be a dissatisfied customer against the expectations of patient obedience and conformity, I cancelled the other events I had scheduled that evening. I have only so much energy for these sorts of indignities and have learned to budget my outrage by limiting my exposure to the CONNIEs of the world and the institutions that empower that total lack of empathy and compassion.

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