Richard Dean Smith, MD

In recent decades, coping with angry and difficult people produced numerous books, consultants, and seminars. Trust: A Shock to the System approaches the issue from the standpoint of developing a working, trusting relationship with patients and families, and the pitfalls that one may encounter. We discover that the individuals–patients, family members, visitors–behave in circumstance of illness in the same manner they behave in other aspects of their lives: at home, at the grocery store, at the airport, etc. While most people are reasonable, given their trying circumstances, a small number are distrustful, difficult, and consume inordinate time and energy of the staff.
The angry and distrustful individuals try to make our staff and therapists responsible for how they feel and what has happened to them. Chaos is their element, and creating chaos their specialty. From the “Angry Big Shot from Out of Town” to “Toxic HealthCare Professional from Away” to “The Sick Sybarite Syndrome” and “Virulent Visitors,” patterns of behavior evolve, making understanding and management possible with better outcomes and less stress on the staff. Everyone must help in management because splitting the staff, turning one staff member against the other, threatens our ability to care for patients and to maintain staff morale.
Most interactions with troublesome people in a medical setting are brief, but on a Rehabilitation Unit we live with and must deal with these situations for longer periods, often weeks. For the functioning of our Unit, controlling and managing these incendiary situations becomes imperative. Cost constraints by private and public agencies make it more pressing, especially in protecting our staff and maintaining our mission to provide appropriate medical services.
Theorists call it ‘reciprocal altruism,’ that is, people tend to be pleasant to people who are pleasant to us, and disagreeable with those who are disagreeable to us. Reciprocal altruism may be fine in a medical setting, reciprocal disagreeableness is not, although one’s instincts urge otherwise.
Taking control of these problematic situations may determine the success of patient management and success of a Unit of the hospital. If a troublesome situation is handled well, a distrustful, complaining individual often becomes our greatest ally. No one is all bad all of the time. Some individuals are complaining and distrustful as a matter of behavior style, or habit, and are not especially virulent; others intent on inflicting harm.
Trust: A Shock to the System outlines situations and problem individuals that we encounter and how to cope with them. Trust is not an academic study, but a practical guide. The recommendations presented developed from trial and implementation in daily practice. Trust concentrates on behavior and its management in a medical setting with no attempt at analysis.
Trust: A Shock to the System is Street Wisdom come to the bedside.