Home Forums Discussions General Discussion Attitudes

We had a staff meeting last week and started discussing the issue of parents (in our case since this a Pediatric office) coming with a chip on their shoulder even for the first visit. It seems that people have more of an attitude than they did 3 or 5 years ago. They come in mad and are ready to snap if anything does not go their way.

This is not just the staff venting, I have noticed this as well, but of course some of the attitudes change when they get to the back. But I have overheard the conversations and seen some of it first hand.

We discussed why attitudes have become so antagonistic but have not come with a good explanation. Is this a local phenomenon or is everyone cursed with the same change in civility

It's funny you say that, because we had the exact same discussion last week. There is something that has changed in the last three to five years.

About 2 weeks ago our staff had exactly the same observation. They also said they were getting way more flak about copays, insurance info, etc.

Gene

And, at our office, it can't be the economy. It's 65% Medicaid, and the private insured don't come in.

My office is about the same mix. It seem to be the same with private and medicaid. We discussed whether the fact that they are always connected with facebook, ect makes them more prone to just blurting out their feelings. No solution was reached.

The attitude of people, I agree has changed not only in the office setting but also in society in general. And it seems to me the younger generation tend to spend more time on the gaming devices, fiddling with their smart phone, and connected to facebook, etc... I hate to admit this but I have an Xbox and have found that a lot of the games that are the most challenging and fun to play are the call of duty series and black ops. However, I found a subculture on the Xbox that has been quite fascinating to observe, and I think the rules of engaging one another, has everything to do with out mastering\out maneuvering your opponent, and has everything to do with imposing your will over your opponent.
If you take a snapshot into anyone of our local communities, I think the ability to carry on a conversation or just being civil with one another is dying off with our older generation, and the influence of the technological gadgets, games and devices has created a buffer, and often times we may not see the end result of communication over devices, including the computer. The younger generation who have been born into this technological soup of gadgetry tend to respond as if their actions have no consequences,(as if playing a match on call of duty 3--the match ends and you go on to your next match and no one ever really dies) but the cold hard reality, is that every action has a reaction.
I realize this statement is an overgeneralization but the basic fundamentals of opening a door for a lady, saying please and thank you, respecting your elders has been replaced with a different mode of interaction. Its a bit harsher and a less receptive way of communicating that I am trying to adapt to in the office setting and life in general.

It is not an overgeneralization. It is likely true, and I often say in the office that the advent of the surge popularity of the video game, texting and other smart phone activities is leading to the downfall of the social fabric of America. Overdramatization, perhaps. But, consider that many of my patients can't look up from the DS, a parent was snacking on popcorn while on the phone and parents discipline their children by taking away the very thing that has caused them to have disciplinary products.

I don't have children, so it probably isn't fair to say this, but I don't think I would allow them to play them until a certain age. Same thing with cell phones or at least until they could pay for them. Personally, and I could be wrong, I don't think they make kids safer.

See jimmie's post.

I had to buy special software (incredible software) to stop my staff from going on the Internet. They are now allowed to go on Facebook at lunch and, trust me, lunch starts, the microwave dings and they are on Facebook the entire lunch break.

Jimmie's post is excellent. I also think that the newer generations have no Earthly idea what a service industry is...what having someone to help you find something or to wash your car windows or give you a peppermint stick while Mom fills a script are like. I think they are spoiled and have a sense of entitlement that pervades everything they do. They demand those things we considered "extra courtesies" in everything they do and in every place they go. It is not only the gadgets that have turned the upcoming generations into demanding and rude people but also our government that has enabled them to believe that they should expect someone else to take care of them

And then they anonymously state how incompetent you and your staff are on the internet.

Make that just I.

And, then your attorney tells you, "If you fight it, they will just make it worse.

@Bert--What software did you get?

@Jimmie--no consequences FOR THEM!

OOps!
I never could make an A in English!!

Wait....are we still doing the grammar correction thing or not?

Not to hijack a great thread started by Wendell, I will respond and, if anyone is interested, we can take it offline.

I spent a lot of money on crappy software until I found CurrentWare www.currentware.com.

It is amazing. I only use the Internet blocking although it offers more. It is very simple and rock solid and it is easy to set up schedules to block sites.

You can give permission for all sites and then block the ones you don't want -- I did this at first but spent 30 minutes each not adding the sites they went to. Would work well if you just wanted to block Facebook.

I changed to blocking ALL sites and then opening those as I needed them. This works best.

The nice thing about Currentware is the support. I use Sai and he works with me exclusively. So, he knows me by name and is extremely good.

End of hijack. Let Attitudes continue.

No today is spelling, tomorrow is syntax.

I'd rather stop the attitudes, not let them continue.....

Gene

I have to apologize--i did not initially understand what Wayne meant, and while exercising on the elliptical it came to me what he was saying-just reaffirming that actions do have consequences--

Great example. Well kinda. Couple comes to our practice. Baby fails newborn screen on MCAD, but given another baby on the same day also fails, it is assumed that an error has been made.

So, I have to explain their baby may have MCAD plus explain they may not and somehow give the news that the hospital probably made a mistake. Had to repeat newborn screen, do all sorts of DNA testing. I chose to do plasma acylcarnitines and urine acyclglycines. I spoke with state geneticist several times. I spoke with state newborn screening several times. I also went out of my way to talk to the leading metabolicist.

Spoke with parents many times over the phone at length deciding when with each spit up should the baby go to the ED for IV fluids and dextrose. Spoke at office multiple times to explain disease if present.

Turns out both babies did have it and both babies were carriers. Not affected.

So, I got them through the initial scary event, and today they tell me they are transferring to another office, because it is 15 minutes closer.

That's the weird thing. Wendell can tell you that in Chicago driving 45 minutes means nothing whereas in Bangor, 15 minutes seem like an eternity.

But, they did say thank you, so all is OK.

In my practice, we are beginning to see 3rd generation patients. Although civility is not a major problem in my small corner of the world, I do notice an increase in distractedness. The younger generation of parents will, at times conduct conversations on their cell phones while in the exam rooms, and their children are often jacked in, presumably listening to music. However, a polite, if firm request for undivided attention, usually works.

Wow, this is cool having posts every 30 minutes or so that aren't cynical, sarcastic or offensive.

Give me a few minutes, Bert, and I'll fix that problem for you.

JamesNT

Bert,

Have you ever considered using OpenDNS. It installs nothing on any computer all you need to do is setup your router with OpenDNS's ip address for DNS and then put your static (or setup a Dynamic Updater) for your IP Addresss. When a computer coming from your IP makes a DNS query for blockedsite.com it checks to see if its on the blocked site list. If it is, it redirects you to a blocked page. If not it lets you thru. Its pretty robust and I dont think anyone will catch on to the fact that is all done through DNS. Some routers (DD-WRT or Tomato based firmware) can be set to not allow or "catch" all port 53 requests(DNS) and send them to your dns servers of choice thus not allowing a end user the ability to point to another dns server. You can also do this is better routers Cisco Systems Integrated Service Routers, etc.

This solution also can block categories at a time.

Perhaps its not worth your time to reconfigure your website blocking software if you already paid for one. I just like how opendns is all managed from one website and applies to EVERYTHING connected to the network.

PremiumDNS from OpenDNS is also free, and what I love about it is there is nothing "extra" installed on the computer to take up resources and space.

I've used OpenDNS before but not for that reason.

How easy is it to open websites on the run? How easy is it to allow one user access to a site but not another? How easy is it to schedule any day of the week?

Thanks.

My favorite is when I go into a room and a patient is on their cell phone. They look at me and give me the "just a minute" sign with their hand and then continue their conversation. I just turn around and walk out if they don't hang up the phone.

So Marty-

After you walk out, what do you do?

(Serious question)

Gene

Marty, I don't know how large your office is, but in my small setup, that would tie up an exam room, leaving me no place to manage the next patient.

I go and see the next patient and then go back to the room where the patient was on the phone. If they are off the phone (which is usually the case), I politely explain to them that I have patients to see and can't wait around. I've yet to have someone get upset at me once I give them the explanation.

Nine times out of ten though the act of turning around and touching the door handle causes the "I have to go" and they hang up.

@pa-marc: We have 5 exam rooms, so it doesn't tie it up too long

Good for you, Marty. I do the exact same thing. I have a sign in my office that says "Please Turn Off Your Cell Phones. This doctor visit is at least as important as a movie". Almost never do I have to go too far before they holler "I am off!!"

My patients apologize if they have the ringer on and it goes off, they don't answer.
Average age boomers and older though.

I have actually had a patient take a cell phone call while I was trying to listen to their heart.

I agree with others, texting / social networking /smartphones are associated with people being less courteous.

On the flip size, now we have EMR's and computers in the exam rooms. The patients probably think we are rude by being fixated on the computer rather than the patient, but the payors expect this. I can maintain eye contact while typing but sometimes patients still say "I'll let you finish that and then I'll talk."

1. I agree with all of the above, and it drives me nuts when the patients use their phones in the office. On the other hand, there is something almost Pavlovian about the ring of the phone. The urge to answer it, or at least look to see who is calling can be almost overwhelming.

2. Re: Ken's point about how the patients look at us: at a "risk management" conference on EMR's put on by our malpractice carrier, they quoted a patient survey. 35% of patients felt that when their doctor was on the computer during a visit, the doctor was "conducting personal business, like banking or surfing the net". Maybe that will change as time goes on, but they suggested explicitly telling the patient that we are entering their information in the chart (at least the first time the patient comes through post-EMR implementation).

My patients (at least I think have no issues with the computers), but they can see the screens.

They apologize and turn off the phones. I actually encourage they answer it. We do it, why not them. Now, I am not talking about a long phone call or doing it while I am examining them.

Now, Angry Birds, that's a different story.

My patients never get the impression I am playing on the computer. Who in the world is going to be sitting there muttering foul oaths and obviously entering what they are saying if I was on Facebook?

As to the phones, mostly our patients know better. There have been a few who feel a nice long chat with their car mechanic is in order, but few enough that I have not really devised a plan; mostly, I just sit there in wonder at what sort of a numbskull thinks that is appropriate.

We did have one patient yesterday who told my PA to call around to the different pharmacies for who had the best price on a medication, then call it in and let him know. I sure wish I had a personal slave to do that stuff for me.

I guess you could have called around and found out who didn't have the medication, then send him there.

Actually, my two offices are 20 minutes apart and I have patients who will not want to go to the "other" office because it is "too far." And they live between the offices!

I don't consider it a hijack at all. I have about a dozen sites blocked from the router in each office. I can block by time and have opened up 12-1 and after 5 for them to be free to roam. One office uses the comcast router (by SMC) other office has a netgear router. Somewhat different interfaces, but allow the same flexibility

David, I hoped your PA laughed and told him that he would call on the second Tuesday of next week.

Bert and Christopher: Quit trying to hijack our negative thread! We need to vent.

If someone takes a call on a phone, I will sometimes just try to work on finishing their note. However, if I find myself waiting, I will just get up and leave. One time I came back much later and they were still sitting there waiting.

I am sure the technology has something to do with the aforementioned problem. However, there is a bigger picture in the decay of our culture. There is an overall decline in MANNERS with each generation.
Remember that many of you hippie types from the 60's threw off your parents values. This was a major time of 'deconstruction' of our culture. I know my parents stepped out of their parents way of life in a big way. Now you have their children bringing in THEIR children to your office. With what values are the gen X'ers raising their kids, when their parents challenged and 'questioned' every moral value?

These values listed below come from a Jewish-Christian culture that used to be prominent in our country:

Do unto others as you would have done unto yourself
Do not steal
Do not envy
Respect your elders
Put others first
Do not be a glutton
Respect and preference for women

This doesn't have to do with the office, but it drives me crazy that at my 9 and 11 year old's sporting events there is never a winner or loser, no score is kept.
How does that prepare them for life later on?
The kids do keep score though--so there is hope.