Written by Editor   
Thursday, November 06, 2014 09:50 AM

One who does not do as the medical community desires is "crazy" and those who ask questions that the medical community does not have answers to, or that makes the medical community feel uncomfortable, are described as painful, crazy, difficult, or demanding.  

Those who have less power or authority or who unquestioningly do as the medical community tells them are considered "adorable".  Think these are just flippant observations?  A recent article titled I, Intern: Nightly Name-Calling, by Shara Yurkiewicz, LINK highlights some of the concepts that go on behind "labeling" and some of the motivations behind them. 

What kinds of terms do physicians use with each other to communicate how it feels to take care of patients, and what do they mean?  "Sometimes your co-intern tells you that a patient is 'adorable,' or their 'favorite patient,' or 'crazy,' or 'painful,' or they'll say 'don't visit their room unless there's an emergency,'"  "It made me think about physicians and their responses ... and why people are called certain things."  "It's a shorthand way of communicating complex perceptions of patients to other health providers."

"But I don't know how fair it is to the patient to use those kind of descriptors beyond just stating why they're in the hospital and what their active medical problems are." "I'm trying to decide whether to adopt this culture blindly or, if I didn't want to, how to communicate these kinds of ideas."

"it's easy to be 'adorable' if you're very young or very old .... These are groups that often don't have as much power or agency in the hospital." "Maybe the patients that we like the most as physicians are the patients who either do what we tell them to do or get better quickly, because that's very satisfying."

"I wonder if the patients that we call 'painful' or 'crazy' or 'difficult' or 'demanding' are either the patients who don't immediately say yes to everything we ask them to do or the patients who don't get better."  "There are patients who are in disagreement with the plan and are vocal about their disagreement and continue to demand something that's different .... I think sometimes that is a 'painful' patient."

Or "you go into [a patient's] room and they have a lot of questions, and you might not have all the answers."  "You might want to avoid that room because you avoid the pain of being asked the questions that you don't know the answers to."  ""Some people are more comfortable with death and dying than others, and I think taking care of dying patients is very painful for some people. So you avoid the pain by avoiding those rooms, if they're dying and you feel like you can't help them..."

"Crazy" is another term that makes its way into the lexicon during sign-out.  It can be a descriptor for either a patient or a family.  "I think sometimes we use the word 'crazy' to mean assertive. As in, they're just not cooperating with what we want them to do."  The term may describe a decision a patient or family is making with which the [medical] team disagrees.  "I think 'crazy' can also mean that people suffer in a way that we don't have a ready medical explanation for, or they're not responding to their treatments the way we expect, and we attribute it to a fault of their own."