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So why is it thanks was a memory? Like Carnac, most of the dermatology world is too young to remember Bob Hope’s closure song, but it sure seems like “Thanks for the memories” emphasized the memories instead of the “thanks”… during an era of manners and etiquette that has given way to entitlement, impatience, and #DYKWIA. Believe me, dermatologists are far from the offenders in this battle. Patients, the bureaucrats, and sometimes our staff are among the architects of bad behavior. We are entering the epoch where “please,” “thank you,” and simple gestures like holding the door open are endangered species.

There is no question that some patients put us on defense when we walk in, showing up with internet searches as their answers, and asking physicians, “Are you sure?” Of course, patients referring to physicians by their first names is now almost commonplace, despite our efforts to use Mr. or Ms. as well as Sir or other similar salutations.1 They loosely translate “shared decision making” to “they know better,” with their time and costs being more important. Even the AMA is addressing the rise of physician abuse by patients, especially in light of the recent murder of a physician by a patient. We are fortunate to have a dermatologist as AMA President.2

Many of us who travel see the patterns that we believe define people: the way they occupy the highway’s left lane, the inability to let people off an elevator before bulldozing in, and the simple ability to look a server in the eye as one orders food and say “thanks” rather than just treating “servers as servants.” The stereotypes that develop in our minds then translate to those with similar area codes, albeit unfairly, and, even worse, forms the fabric of our defense mechanisms for the next encounter.

On my last flight back to San Diego, one stereotypical California prima donna basically ruined the flight for many of us with his entitlement and arrogant behavior, as well as treating the flight attendants like minions. This contrasts to my last trip home to Milwaukee, where the narcissism quotient was pretty low. Should those experiences lead to profiling and stereotyping when so many variables come into play? Are we guilty as physicians of falling into that trap with patients, which could cloud our judgments for how we treat them? Human nature and our eyes deceive us more than we think, and physicians’ memories are rarely short, though in some cases they should be. Even more complicated are the times we get stuck by friends and patients’ family members looking for free medical advice; when we discuss the risks or even say no, we end up being the bad guys. And we also judge those who want something from us in a different light.

Manners are not dependent on age, geography, or any other demographic. They are fundamentally linked to integrity, to repetition, and most importantly to appreciation. One of my favorite dermatologists in Nashville made my day when he answered his son with, “Yes, Sir” when they spoke, which reminded me of trips to spots like Israel, Dubai, and South America where, “Yes, Sir,” and “Gracias, Señor” are the norm. Many of us who work with veterans and Tricare patients feel the same with their sense of appreciation and how they tell us thanks, as well as those who travel a long distance for care.

The service industry, unlike the health care industry, is obviously dependent on manners as fundamental to those in the trenches (my brother-in-law is our family’s manners coach for my sons, using his experience as a server to remind them of basics). Yet the hypocritical parallels that are being infused into health care as a customer-facing industry pair the similar basis of manners with the inability to have a level playing field. Just ask the reputation police who train us to take on the one star reviews—the dirtiest tool in the patient’s playbook.

How do we reverse the trend of the demise of manners? To use the Rodriguez method of saying, “Yes, Sir” and “Thank you, Sir,” or the Weinstein method of “Thank you for…” which both Adrian and Andy do instinctively, we can take the high ground and try to put ourselves in the patient’s shoes and be the best advocate we can be. Wisdom does not have to be portrayed as arrogance or defense; it can be the component that brings the equation together. Staying calm and being humble when we have a problem to solve will help us all stay in the game for a long time…because otherwise burnout will find us all.

In travels over the past few months I somehow got attached to the RomCom “Marry Me,” which I would never otherwise watch. Somehow the humility and depth of connection the rock star showed in their relationship was a reminder to me that none of us is above reproach. It is a hard lesson to remember, but it has to stick or we are all cooked.

Take a moment next time you go to work, and look for the manners from your staff, your patients, and yourself. Evaluate and identify the gaps, remedy the balance, and make sure you are doing your part. Then breathe and enjoy the ride, because nothing else matters.




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