Bit of an arse.

I don’t want to analyse the etymology of this phrase, yet, it is something that I have noticed cropping-up over the years.

I suspect people say this outside of medicine, but in the context of a doctor taking to a nurse, ‘he’s a bit of an arse,’ tends to suggest the person has behaved in a stupid, arrogant and condescending manner.

A Why did you call me at three in the morning to see an old man who is asleep?

B Sorry…

We can all picture the situation; patient is upset, perhaps anxious or in pain, calls nurse, nurse is concerned for patient’s wellbeing therefore calls doctor; doctor is busy, it takes them a while to arrive.

By the time they get to the ward patient has drifted-off to sleep. The doctor is left with the dilemma – is the patient ill? Are they still in pain? If they are ill, should I wake them? If they are in pain, it can’t be that bad as they are asleep… A more circumspect analysis might lead to the consideration, ‘Oh, they are not conscious, their level of alertness is reduced,’ and, so on.

This is a situation where doctors can become arses.

Taking the stance that the nurse is unintelligent or not adequately resourceful, berating them for calling for help or whatever, if this then proceeds, you can create a situation where the ‘arse’ deteriorates to worse.

This in essence is a patient safety issue. Something I have not written about for a while, although key to the successful running of a hospital, clinic or care setting. This also relates to an interpretation of hierarchy – the doctor treating the nurse without respect, with disdain. More than this however, it creates a potential state of fear for the nurse who called for help. In many respects, this is bullying.

What does the nurse do the next time she is concerned about that same patient – will she risk calling the grouchy doctor? Will she hang-on until she is sure the patient is sick?

You can almost perceive the sense of anxiety within the nurse, determining what to do.

Many people will not even think this an issue – if the nurse is concerned she should call for support regardless of how she feels or the butterflies in her stomach. This is missing the point of individuals being humans with real-time feelings and emotions.

Usually these considerations will happen in the blink of an eye – within moments.

And this I believe is why we need to review the situation of arses in healthcare.

They are a menace.

They cause offence, they hark back to a time of paternalism and deference, they are an abuse of authority and, they can risk lives.

What is the solution?

Most likely, it is to call out the arses.

Certainly, try to reason, explain your motivation:

B: I called you to see Henry* because I was worried about his breathing, he said he was in pain, I wasn’t sure…

A: He appears perfectly fine. Do you know how many times I have been paged in the past hour? I haven’t stopped since…

B: Doctor, I am sorry, I am just trying to care for the patient. I feel you are behaving like an arse.

This might not be the most diplomatic way to resolve the situation and perhaps in the middle-of the night is not the best time, although, it is likely that the nurse, if sensitive – which is what nurses (and doctors) are supposed to be, will go home and worry about the interaction.

Do the arses realise they are being arses at the time?

I believe, for all my human frailties and flaws, I am not often an arse, and on the times when this might have happened, I am usually assailed by overwhelming feelings of guilt, remorse or regret immediately afterwards (indeed, I have discussed this previously).

Do all arses feel remorse? Are some even aware of their actions?

Perhaps, if we develop a screening tool this could be a useful way to determine who we should allow to enter into doctor, nurse, therapy or pharmacy training. It is central to team working, safety and wellbeing after all.

Only an idea.

 

*Henry is fictional