Clinical Corner: Working in a Fishbowl – Staying Professional in a Tribal Healthcare Workplace

by Brian M. Gallagher, MSPA, PA-C

Walking out of a patient’s room, a physician visits the nursing station in the center of the ER.  “Why did the chicken go to the gym?” he asks. “To work on his pecks.”  The nursing station erupts with laughter at his witty dad joke. 

Now, put yourself into the patient’s perspective, lying on the gurney behind the curtain. What do you hear? You likely didn’t hear him telling the joke, but heard the uproar of laughter. Can you imagine how you would feel? 

I wonder why are they laughing?  the patient might think. That guy was just in my room talking to me, walks out, says something and now everyone is laughing.  It must have been about me. Why does he feel like he can disrespect me?  Obviously, he does not understand me or my culture. He shouldn’t be allowed to work here and care for my people with an attitude like that. I am filing a formal grievance against him because he is so inappropriate and lacks compassion.

When a patient perceives staff to be disrespectful or unprofessional, they may file a grievance. The patient feels the team has – with actions or words – failed to show them respect, compassion, and dignity. 

Working in a Fishbowl: Staying Professional

Healthcare teams, especially in emergency medicine, work in a fishbowl. All our actions are observed by a staff member, a patient, a visitor or an administrator. Moreover, our voices carry as if we are on a loudspeaker. Our words matter. What we say and how we say it matters.  

Consider using words like “drunks” to describe intoxicated patients. It exhibits not only a lack of professionalism but a lack of compassion for the patients’ condition. Many of those patients referred to as “drunks” have families that love and care about them. They have life experiences that may have caused them to choose the path they did.

When most individuals see their words written in black and white on the grievance form, they say, “Wow!  I never intended it that way.  My words were taken out of context.”  If your words aren’t something you would be proud of, then you might want to reconsider it.  Going through a grievance process as a professional can be eye opening, humbling, and hopefully helps us reframe our perspective. 

The Patient’s Perception is the Patient’s Reality

In the case above, the patient perceived the ED was laughing at him or her.  Perception is the lens or mindset through which we view people, events or things, or a way of regarding, understanding, or interpreting something; a mental impression.  Reality is the world or the state of things as they actually exist… existence that is absolute, self-sufficient, or objective, and not subject to human decisions or conventions. But our past experiences significantly influence the way we decode situations. Certain people, language, smells, or other environmental triggers can influence whether we see the scenario through a positive or negative lens.

According to Daniel Kahneman, the noted psychologist who received the 2002 Nobel Prize winner in economics, “Our perceptions influence how we focus on, process, remember, interpret, understand, synthesize, decide about, and act on reality. In doing so, our tendency is to assume that how we perceive reality is an accurate representation of what reality truly is.”  In other words, perception is actually an individual’s reality. 

We are guests in our patients’ facilities and we are privileged to serve our patients and the communities they live in. Tribal Health strives to create exceptional patient care with every patient experience. Knowing that the patient’s perspective is the reality, we must recognize our lack of understanding of our patients’ previous trauma. As a professional, you have not walked in the other person’s shoes.  As healthcare workers, we do not understand what a patient’s reality is or how he/she might perceive our behavior. 

Therefore, it is critical to treat others as we want to be treated: The Golden Rule.  Follow Bernard Meltzer’s advice before you speak. Ask yourself: is what you are going to say, true, kind, necessary and helpful? If the answer is no, then maybe what you are about to say should remain unsaid.

When you serve in areas with some of the highest poverty and substance abuse rates in the nation, and a lack of resources for the homeless population, many of these individuals end up in the Emergency Department. They are there sometimes for an extended period. No matter what the circumstance, they deserve respect, and they deserve to be treated with dignity. They do not deserve to be cast aside or treated as a “problem.” 

Staying Professional in Tribal Facilities

Be on Time. Show that your job and your patients matter by arriving on time. Take into account the travel time on large or remote reservations.

Keep a Good Attitude. If you’re having a bad day, leave it at the door. Never take it out on your clients. Positivity is contagious, so stay positive and professional at work to keep those around you positive, too.

Dress the Part. Make your appearance neat and clean, going above and beyond the minimum expected of you.

Be Trustworthy. If you are given a task to do, get it done. Hold yourself accountable and be receptive to feedback and constructive criticism. If you take action, be responsible for the action and its potential consequences. Be the kind of worker your team can rely on to do the job and do it well.

Seek to Improve. Make sure you are taking professional opportunities to grow. If the opportunity arises to get more education in your field, take advantage of it. Keep your skills up-to-date and your knowledge valid as you grow in your work.

Show Strong Ethics. Stay within the accepted moral code and follow the code of conduct for your organization. Never perform any questionable acts within the business. Be the kind of person people can trust to do the right thing, no questions asked.

Of course, there are some actions that can harm your reputation and your workplace culture. Avoid foul language and avoid gossip; when you hear stories about coworkers, keep them to yourself, unless the situation has a direct impact on your work. If it does, enlist the help of your supervisor. Also avoid over-sharing, as personal stories can spread like wildfire in a healthcare workplace. Own your mistakes and correct what you can. And finally, don’t talk about work on social media unless it’s a positive “great day at work” type post. We’ve all seen healthcare workers in the news who got fired for sharing company secrets or posting something inappropriate about their job.

Finally, cultural humility is key to earning patient trust and delivering exceptional care. A humble provider understands the importance of showing respect to create a positive patient experience. That respect is embedded in our words, our actions, our appearance, and our compassion – and it’s part of our commitment to showing up every day like the top-notch professionals we are.

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