image from Wikimedia Commons

Loaded for Bear May Mean No Care

Last week, I received an email from a woman, I’ll call her Miranda, taking me to task for an article I had written that she found online. If Miranda had her way, I’d be walking the plank about now, or on my way to life in prison.

The article she found is about patient modesty and how it affects one’s ability to get medical care. It poses the problem, considers the roots of the situation, then offers ideas to help someone get beyond modesty hurdles in order to benefit from better medical care.

Oh, but Miranda was not happy about that article! She graced my email inbox with a missive (out of curiosity I pasted it into a word document to see how many printed pages it would be – about 5!), as if she was the prosecutor outlining all the reasons I should get life in prison, taking me to task because I had not taken into account survivors of sexual abuse. Further, the fact that I used a car as a metaphor offended her because people aren’t cars! (She’s right. They aren’t. I didn’t say they were. I used cars as a metaphor.) She expected me to rewrite and republish the article, and she wanted a “public apology” for being so callous and ignoring the plight of sexual abuse survivors.


A little back story: I wrote that article almost 8 years ago when I was writing patient empowerment articles for I stopped writing for them in early 2014, and I no longer have access to change or edit the 1,000+ articles I wrote for them. In the meantime they have changed the name of the site to VeryWell. They edit the articles themselves from time to time, and change the dates to be more current – all to keep Google happy, but confusing people who think I wrote them recently.

So – for Miranda – I replied – politely – that I was sorry she had suffered sexual abuse, and I was sorry she wasn’t satisfied with the article, but that the intent of the article was to help patients get care if they are modest, and not to attempt to cover all the reasons they might be modest. And, finally, that I had no access to edit the article, and I was not going to make a public apology – I didn’t feel as if I had anything to apologize for.

Turns out I had simply poked the Miranda-bear. She was even unhappier in her reply – another several pages worth… I once again replied that I was sorry that wasn’t good enough and that I would not be replying to her again. She sent her venom one more time, and I simply deleted the email.

So what does that have to do with patient advocacy and care management? Plenty.

mirandaLike Miranda, many patients, when they feel wronged by the system, are loaded for bear. Sadly, and truthfully, that frustration and anger is often understandable.

However, and unfortunately, they choose to handle any interface they have with the system by being confrontational, angry, impossible, even abusive, and that means the system will do what it can to avoid engaging with them. There are many reasons doctors refuse to work with patients, many wrong and shameful, some of them fair and understandable.

Sometimes those patients contact an advocate to help them. If an angry patient contacts you, remember: you are an independent practitioner and you have choices:

1. You can attempt to help. This requires a few things:

  • making an assessment of what help they really need (which may mean physical health help, or mental/emotional health help, or financial billing help, or all of the above)
  • making an assessment of whether they really want advocacy help, or they just need someone to be angry and confrontational alongside them
  • making an assessment of whether they are willing to pay for that help
  • making an assessment of whether you can help them keep their anger separated from their real health care or cost needs

2. You can decide against providing help. If you make those assessments in #1 above, and you realize you’ll be spinning your wheels, then this is the smarter choice.

The point to this post is this: Patients are wronged by the system every day. That is horrible and tragic, and the system should be ashamed of itself.

However! (A Big However!)

…. it is NOT up to us as patient advocates to fix those situations. It is NOT our responsibility to overcome their anger or be confrontational alongside them.

As such, if you are contacted by a patient who has been hurt by the system, do not feel an obligation to take him or her on as a client. It will be extremely difficult to focus on what is really needed medically or financially, vs the expectation that you will fix the wrongs of the system.

image: no good deed

Would it be “nice” for you to help? Maybe. But don’t forget: no good deed goes unpunished!

Spend your time with those who aren’t angry, and those who will respect your ability to help them get the real care they deserve.


4 thoughts on “Loaded for Bear May Mean No Care”

  1. Great article on an important topic.

    Someone who is angry at the system can be a good client as long as they are not angry when they talk to their patient advocate.

    Man tells therapist, “My wife and I get into these fights and I just can’t control myself. What can I do?”

    Therapist: Imagine you are in the midst of one of these fights. The doorbell rings. You open the door. It’s your boss. Are you still full of uncontrollable rage? Or do you say, “Hi Boss, how are you?”*

    People who talk to us when they are angry are using us as emotional punching bags. They CAN control their anger, as in the example above. It’s up to us to draw the line. People who get it, and respect the line, are potentially good clients. People who can’t control themselves, proceed at your own risk.

    *Example taken from Joseph Telushkin’s book, “Words That Hurt, Words That Heal: How To Choose Words Wisely And Well.”

  2. Thank you Trisha for excellent advice. I just left 45 years of working in healthcare and I have run into my share of “Miranda’s” . As I begin my new chapter of Pt. Advocacy I hope to advocate for my clients in a manner that will bypass the anger stage as we all know that anger solves nothing.

  3. Rosalie Weatherhead

    I have one such type as a client. He is ready to be angry really about anything, any time, but I luckily grew up with people who huff and puff before going into rage. The trick is catching them at the huff and puff stage and providing a neutral tone and feedback, sometimes just let them holla and scream til they wear themselves out, as long as it’s not at me..then procede with care and concern. Most of the time the rage seems to come from a feeling that they are not being heard. Being an advocate, we can be their voice, letting them know that we are working to resolve the frustrations that they are encountering. This “Miranda” seems to be looking at everything through one lens..that of hurt and abuse. Until she is able to come to grips with that and see that the whole world does not turn on that subject alone and her pain is recognized and resolved, she will unfortunately be unable to see anything clearly. Sad

  4. So sorry you had to deal with Miranda, Trisha, and I completely agree with you. You had nothing to apologize for and there are unfortunately many people who are spoiling for a fight for everything, and won’t be appeased by anything short of their very specific and usually unreasonable terms. They’re going to learn the hard way that they will alienate the vast majority of people who could help them, in not just healthcare but in all areas of their lives. Who wants to deal with someone who’s going to be so nasty> I always worry about encountering potential clients like this but I realize that I also have the right to say “Nope.”

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