“Rude people suck” was the statement, and though that’s not a particulalry gentle way to put it I agree wholeheartedly with the sentiment. That the statement is itself rude is one of the ironies of life.

By rude, I mean the following definition (via

1. Lacking the graces and refinement of civilized life; uncouth.
3. Ill-mannered; discourteous: rude behavior.

Like most people, I encounter the majority of rude behavior at work (after all, once we’re through with school we can associate with, or more precisely dissociate ourselves from, rude and obnoxious people. As I work in a ED, I expect people to be under stress, perhaps not tempering their speech in ways they might under better circumstances.

The difference between rude people and those who are rude ‘due to the moment’ is that rude people show no remorse for their behavior, while regular, decent folks will recognize a line was crossed and apologise, in one way or another.

Then we get to the heart of the matter, at least for me, which is what to do with / about the deliberately rude patient. The rude family I can deal with, usually just by exclusion (waiting room = penalty box). The rude patient is a challenge both personally and professionally, to everyone on the staff.

(An aside: if you’re rude as a family member of the patient you’re doing your loved one a disservice. We’re all pros and will do our jobs, but avoiding you, and therefore the patient is only natural. It won’t result in bad care, but it can become a vicious cycle of avoidance, ‘nobody is coming in to check on him’, etc).

I believe somewhat in Karma, more in the “what comes around goes around” sort of way, and realize life will exact a revenge on boors far exceeding my ability, but it’s hard to remember that when someone who needs your help calls you a string of four letter words.

I and some nurses were discussing this recently, and the theme of the discussion was that the rude behavior of our patients would get them denied service in pretty much any other place (merchandise return desks excluded, more’s the pity). The rest of the discussion involved why people feel free to be abusive to us, and we decided it’s because they can. They know we cannot throw them out or deny service because of rude, obnoxious behavior, we have to do our best even when they’re at their worst.

Perhaps you have another reason, or better yet a meaningful way to deal with rudeness?


  1. It’s the McDonalds generation. It’s the same people who can’t understand how they can get a burger and fries in under two minutes while sitting in their car and yet they have to wait an incredible FOUR hours just to get an X-ray!

    It’s also the younger “health care is a right” generation.

    “I’m sick! I need to be treated NOW! I shouldn’t have to wait my turn! Hurry up, I have a bus to catch! All you doctors care about is money. You don’t care about the patients! Nobody in here is as sick as I am! You won’t help me because I don’t have insurance! ”

    Did it used to be like this? I have a hunch that patients and families in ERs in the 1960s, 50s and before did not act like this. They considered themselves lucky just to be getting any care at all. Is there anyone who has had an experience from a 1960’s ER who can comment on this?

  2. There is definitely a worsening in the quality of conduct many people exhibit in public and with strangers, a much more aggressive, confrontational and unrestrained indifference to what would once have been regarded as shameful and personally embarassing behavior. These people behave as if their past bad behavior in no way attaches to them in reputation and ill regard from others,
    as if disrepute is of no consequence. And maybe this is true, which speaks more to alienation from the community and its expected standards of behavior than is comfortable to admit.

    I have worked around emergency rooms and in clinical practice long enough to see examples of this over and over again. People who have an inclination to behave badly often do what they think they can get away with, and in a care- before-all-else-mandated setting like most emergency rooms, that can be a lot. I think it is a significant stressor
    to anyone in patient contact in an ER. At least in the office, badly-behaving patients can be terminated for being disagreeable for reasons of an incompatible relationship with the practice (or for no reason, really). You can’t do that in the ER.

    There is probably some measure of over-entitlement that contributes to this, too. Some people think that having an insurance card is a license to behave rudely to office staff and to make inappropriate demands that are properly their own responsibility. I don’t mind terminating those kinds of folks. My explanation is simple: I can replace the value of their business in my next appointment slot; my office staff works hard and replacing even one of them can take weeks or months.

  3. How true. As one who constantly deals with an impulsive short fuse, I am thankfully reminded by my wife, an ER nurse, how unnecessary rudeness is. We as a profession are likely to see people at their most visceral times. I also think the thought about the seeming entitlement feelings of the modern day society is real, fostered by the creeping moves toward the centralized funding of health care, which is only likely to get more pervasive in the future. I fear we can only “suck it up”, and try to remember why most of us do this in the first place.

  4. In one of the EDs I used to work in, the ED in the 60’s required you to ring a buzzer to a locked door to summon the nurse, who would then peer out at you and ask you what you wanted. Ambulances were generally subscription services except in the city, and there was no 911….

    …. and everybody who was on MS Contin was a cancer patient (not suffering from musculoskeletal back pain).

    Hey by the way – you can boot anyone out of the ER once you’ve established that they do not have a condition requiring emergency stabilization (EMTALA stuff). My feeling – if the nurses and staff thinks the person is rude jerk and I think the patient is a rude jerk – then the patient is a rude jerk, and abusing the staff, and are disrupting the ED — and they are outta there!

  5. You ought to try being a cop. For him the only answer is to smile and take it, or smile while he’s putting on the ‘cuffs. For you and the nurses, I reckon the only answer is a dull needle.

  6. The EMTALA thing is what works for me. Once I have made the determination that no emergency exists-the rudest of the rude get discharge papers. For the rest of the rudes, I actually enjoy giving them a therapeutic trial of boredom especially on the rare nonbusy days…..

  7. Oh, this is a topic that I so struggle with! I have, on occasion, invited stable patients to leave the ED, and have even provided an escort (the police) a time or two. But what to do with those just plain rude, mean people who don’t cross that arbitrary line meriting eviction, but who are grating enough to make your night long and painful??? I have said before to one patient (who would not let me even finish a sentence before spewing his next gripe and insult) that I would return when he could treat me with some civility – I would first tend to my other patients. It surprised me that not only was he still in the ED when I got back to him (as opposed to signing out AMA then calling administration the next day), but he was almost pleasant! Hmmmm- perhaps sometimes giving a time-out to someone who is acting like a five year old works!