Amy’s Life in Brief

So, in my job I do a lot of social worker intervention for patients. I would go so far as to say that the majority of my interventions are aimed at the patients and/or their families. But, occasionally I have to intervene for co-workers (ie nurses, CNA’s, various other staff). I don’t mind and realize that they all have difficult job and absolutely need support.

Unfortunately, sometimes I think, I’m not as helpful as I would like to be. Recently, we had a patient who obviously had a personality disorder. It’s actually pretty likely this patient had a certain type of personality disorder with the features of at least one other. Because of this, this patient simply can’t be nice. As a result of this personality disorder, this patient is unlikely to ever by nice to anyone, empathetic to anyone, respectful to anyone.

Everyone seemed to think I had some special rapport or ability to deal with this patient. I could take that and build my ego as an excellent clinician. However, I see it more of having reasonable expectations of what my interaction with the patient would be like. Our interactions involved a lot of complaining on the patient’s part, lots and lots of cursing on the patient’s part, and not a single thank you for anything. Based on what I knew of the patient’s diagnosis, I was fully prepared for this type of behavior.

So, I was asked to go speak to this patient and request that they not speak to staff in the manner that they had been. I tried to explain that it would do very little good for me to go in and essentially tell the patient to behave. I suggested that the nurses and other staff be prepared for the patient’s behavior and to limit their interactions, that long explanations of why they found the patient’s behavior offensive would only escalate the behavior.

The staff member’s response to me was “Well, I don’t care what their excuse is. They can’t talk to staff like that.” So, two thoughts ran through my head after that comment.

The first thought was, “Am I excusing their behavior?” I don’t know that I was. Maybe I wasn’t explaining how to interact with them well enough. I had hoped to explain that maybe some lower expectations for the patient’s behavior would help the staff cope with having to care for this person. We certainly had no hopes of changing this person’s personality while they are here. Telling them the rules in great detail would only escalate them. And, it was just as likely that they would get a “Fuck you!” as a “Thank you.” when helping the patient with their personal needs.

The second thought that I had to the comment of “They can’t talk to staff like that.” was actually rather snarky. My thought was, “Well, of course they can.” It’s not like we can throw people out of the hospital because they are being difficult. The hospitals would empty out fast if this was a possibility. Certainly, if a patient is interfering in their needed care, there are steps we can take, to a certain degree. But, really, if cursing and being rude is the extent of a person’s bad behavior, there isn’t a lot to be done about it.

And, I totally understand how awful it would be to deal with a person who greets you with four letter words and other rudeness. Unfortunately, I don’t think I was able to encourage staff to try and not take it personally.