Some doctors may lack manners, but also gone is respect they once enjoyed

Regarding "Staff less tolerant of rude doctors" (Article, Sept. 20): Disruptive doctors are only half the problem. The other half is the emergence of a generation that is pathologically concerned with protecting its self-esteem by never having to interact with others on less than equal terms.

Since medical care necessarily has to be given at many levels, decorum and protocol are an integral part of it. The corporate culture and managed care, of course, would like for doctors to provide the highest level of care with the salary and status of a peon -- for them, only the CEOs and other high-ranking bureaucrats deserve to get the big bucks and respect.

Any fair observer will admit there is a serious erosion of work ethics among support staff in hospitals. Every request to find a missing chart, a missing patient, lab values or a patient's medical status, be it by the ward clerk, nurse or orderly (oops! mental health technician; one invites political mayhem even daring to refer to technicians as orderlies) is done with trepidation and with full expectation of getting a wise comeback, an ill-humored joke or flat-out refusal.

Gone are the days when the nurse assigned to you would rush to greet you, give a personal and emotionally rich report on each of your patients, laugh and joke with you, or even bring you a coffee, without feeling that such a conduct was an unpardonable humiliation. In fact, the doctor and nurse both would feel a sense of enhanced self-worth in this hierarchal cooperation.

Now the doctor is lucky to extract a moment's eye contact from the nurse -- busy as they are charting, having a tete-a-tete or catching up on their worldwide networking.

Surendra Kelwala, MD, Livonia, Mich.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/10/18/edlt1018.htm.