In the Arena: Big Boys Don't Cry

ACEP News
September 2009

 

baehrenBy David F. Baehren, M.D.

Working in a "customer service" job is stressful. We know that more than anyone. We perform in the customer service Olympics every day. We are customer service gurus.

 

It is interesting that other customer service personnel, who work in apparently lower-stress occupations, find their work stressful as well. Waitresses, flight attendants, and receptionists complain that the customer service aspect of their job makes them weary.

 

I can relate. Give me a respiratory arrest, a patient with DKA, and a dislocated shoulder, and I'm energized. Make me deal with chronic back pain, an elderly lady who needs a social admit, and a demanding wannabe VIP, and I'm ready for a nap.

 

What is it about customer service that takes the starch out of us? In his book "Radical Honesty," Brad Blanton suggests that it has to do with lying.

 

It's not like telling your spouse that you went to a meeting when you really went to see the hot EKG tech you've been having an affair with. It's more like having to say one thing when you are really thinking another. This is not good for us. Having an affair isn't, either.

 

When the flight attendant says, "Yes, sir, that would be nice if they made these overhead bins big enough to hold that full-size suitcase; allow me to gate check that for you," he really wants to tell the guy he is a complete dolt for not checking the bag. If he said it really loudly, the rest of the passengers would cheer and everyone would feel better. Of course, the flight attendant would get fired.

 

If this kind of stress shortens lives, and there is evidence that it does, then we must be taking 10 years off the life of every triage nurse in the country. The words "I'm sure that sunburn is uncomfortable, ma'am, and we'll get you to the back as soon as we can" must take a few hours of your life right there.

 

I believe that each day, the triage nurses should get one freebie that they could not get fired over. They should be able to stand up and really lay it on some idiot: "Hey, pal. Apparently the word emergency is not in your limited vocabulary. Heart failure, level I traumas, young boys with testicular pain, and people bleeding to death get seen ahead of your chronic toothache. Sit down and shut up. We will get to you around 1 a.m."

 

Man, that would be cathartic--but it wouldn't be fair to Mr. Toothache, and no hospital would ever let you do that, even if it were good for your health.

 

Tal Ben-Shahar wrote the book "The Pursuit of Perfect." He makes a very good case that perfectionism is a bad character trait, and that being an "optimalist" is a much better way to look at the world. He also writes about taking time to restore the damage done when we hide our true feelings. Instead of taking it out on the waiting room whiner, it's better and more socially acceptable to find another outlet for these cumulative minor frustrations.

 

I write and I like to crack corny or off-color jokes. That works for me because I'm not much of a talker. Most people find it very refreshing to go to the break room and vent for 5 minutes. Others just need to be left alone with their thoughts long enough to recharge before having to put back on the smiley face. Breaks have a purpose. Take one every day.

 

We work in an imperfect environment. I tell medical students that if they like their ducks in a row all of the time, the ED is not the place for them. Our ducks usually float all over the river and some go over the dam. We, as people and as doctors, are not perfect, either. We have emotions and character issues, just like everyone else. The scripted customer service responses are nice, but the people writing the script need to understand that this goes against our nature.

 

We have to be taught to suppress our natural emotions. "Big boys don't cry." "What are you so upset about?" "Don't laugh so loud." In the ED, we see some of the saddest, funniest, and most maddening events--yet we are counseled to suppress the emotions that naturally follow these events. This can't be good for us.

 

Cardiovascular death rates in many other countries are lower than in the United States. Theories abound about diet and red wine and genetics. Maybe it has to do with holding in our emotions. Maybe if, as a culture, we laid our emotions out on the table like they do in Italy, we would all live longer.

 

How many times have you fought back tears? When people make you angry, do you let them know about their behavior, or do you just let it slide? Does your hospital have a policy about laughter at the nurses' station? I can raise my hand for all three.

 

The next time someone asks you how it's going, really tell him. "It's going like crap, man. This day is a root canal after you hear your dog died. But I'm getting through it. How about you?" Laugh so loud you get in trouble for it. Cry when people die. Hug your friends and family and tell them what they mean to you.

 

You'll live longer.

 

DR. BAEHREN lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu.

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