PracticalDermatology

Earlier this week I was reminded of the “Gratitude vs. Baditude” editorial I wrote last year when a few familiar situations came up. Sometimes when a door opens so does the opportunity to take advantage of it…and we witness behavior that really frustrates us. Just like my son’s favorite book If You Give a Mouse a Cookie where, of course, after getting the cookie, the mouse also wants milk, and so on and so on, so too comes the never ending struggle of the mile seeming to get longer when you give an inch. Of course Supertramp wasn’t thinking about that when they wrote “Give A Little Bit.”

Think back to the times of generosity where the chance to capitalize was more obvious than the gratitude shown. How many patients want more samples after their visits, how many employees want time away for sick leave or something disingenuous, how many colleagues ask for help or some of your work and don’t give any credit as if the work were theirs alone? Now think back to how you reacted: did it make you frustrated, or make your guard go up, or did you just dismiss it? Most would agree that some combination of all three are natural reactions, but also that most of these events don’t result in any consequences.

A colleague told me of a scenario where he was sending two research coordinators to a meeting and they had tried to get an extra afternoon off as compensation time for the travel, knowing full well that time was already documented for them on the calendar. Of course, when they were busted it sent a whole series of bad vibes among an otherwise tightly bound research team. They eventually got the message and didn’t get the extra time compensated, but they still left the office early and probably won’t get looked at the same way the next time. But that mile took away an inch that had been given to the group. Another colleague told me of a patient who left really negative reviews about the clinic online when they stopped feeding her with the free samples of topical steroids that she was used to leaving the office with, and of course was developing steroid atrophy from. The dermatologist was labeled as “greedy” when the clinic wanted her to return to the office for other options. Many of us who write our own lectures have seen our work cut and pasted into others’ talks without a reference or courtesy “Thanks,” which makes it interesting when you’re in the audience watching it unfold.

Once in a while we get burned and someone gets away with a little scheme, but those occasional events should not prevent us from being ourselves. We have to trust that for the most part, our employees work hard and respect their jobs, that most of our patients want our help and understand that samples don’t grow on trees and that dermatologists don’t control access to or costs of medicines, and that our colleagues don’t want to bite the hands that feed them. If we don’t believe these things, haven’t we lost the battle and given in? Even just a little bit?

As we enter the season of politics, both in the AAD and the Presidential races, we should be reminded of the need for civility when something does not go our way. I have found especially in California that patients will come in and inject their political views into their office visits, and saying the wrong thing to the wrong patient can result in major headaches. But what inch is to be gained when a mile of silence and restraint gets us out of the situation? And even more so when we see in print or on social media pages how easy it is to hit and run, all to gain a little jab at people who know that if they respond or stand up for their opinions they risk the piranha ambush. One of the new trends on social media is to drop some bombshell about someone or some issue…and end the post with “I’ll just leave this here!” hoping for the cascade of approval and piling on. Wouldn’t it be fun to have a real conversation with people like that rather than just run and hide like in cyberspace? Sadly, life doesn’t work that way, and as an inch is gained at another’s expense, the mile of sentiment and subsequent adversity can get shorter when being put in a position of reasonable defense is impossible. The point of the exercise is that despite what we think we know and expect of human nature, in this day and age we should never expect to avoid disappointment. And as we often see, things have a way of coming back to balance…trusted patients will post something nice about their doctors, loyal colleagues will do the same for their friends, and as a result, we restore our faith.

So my advice today is to be yourself, stand by your generosity and your merits, and make sure the reflection in your mirror and in your children’s eyes can look back at you proudly. We can sometimes only control what is on the table. How everyone eats is up to them.