The patient sat on the edge of the bed, the back of her pale gray, diamond-patterned hospital gown hanging open. During my cross-cover shift, a nurse asked me to evaluate a patient who was becoming increasingly difficult to redirect. It sounded urgent. The calm lasted only a few minutes. Shaking my head, I left the room, perspiration beading at my temples. “Thanks for coming, Doc,” the nurse said, returning to her note and typing: “MD at bedside. Attempted to discuss care. Patient continues to refuse with profanities and aggression.”
Such encounters are not the norm. Most patients are gracious, even under difficult circumstances. In fact, I sometimes wonder whether I would show the same composure if our roles were reversed. My experiences may also reflect the settings in which I practice: a county hospital, where patients arrive carrying every imaginable burden, and correctional facilities, where adverse life experiences and distrust of institutions often converge. I choose this work willingly and continue to find it deeply meaningful. None of this diminishes that. But does our oath to care for others require us to absorb any disrespect that comes our way?
Mistreatment in healthcare exists along a spectrum ranging from everyday discourtesy to violations of personal dignity and safety, including harassment and physical violence. Healthcare workers increasingly face hostility not only from patients, but also from family members and visitors. Female physicians continue to report microaggressions, patients seeking reassurance from male colleagues, or simply assuming the person in the white coat is someone else entirely. During residency, I was rounding with a cardiology attending when a patient asked whether I was his wife. Apparently, the possibility that I was the physician seemed less plausible than the idea that I had accompanied him to work for the day.
Nearly one-third of physicians report racially or ethnically offensive remarks. For international medical graduates, an accent can become its own barrier — read by some patients as lesser competence rather than evidence of the additional obstacles they have overcome. These experiences are not isolated. Over time, they can affect professional reputation, career advancement, and compensation — consequences that rarely appear in conversations about patient care.
I remember inheriting a patient who had spent weeks in the hospital awaiting placement at a skilled nursing facility. During morning rounds, I knocked on the door, introduced myself, and asked how he was doing. “Get that rag off your head,” he said. The comment was unexpected and stung more than I wanted to admit. I auscultated his heart while trying to ignore the sensation of my own pulse quickening. As I left the room, hand sanitizer foaming on my palm, I began constructing explanations. He had no visitors. He was frightened. Maybe he was delirious or simply having a bad day. The story was comforting until I watched him greet my colleague a few minutes later with effortless warmth. My colleague was not wearing a head covering.
Of course, retaliation is never appropriate. We have an obligation to care for patients regardless of how they treat us. We are trained to remain courteous and professional, advice that is often both wise and necessary. After all, there are few states more vulnerable than becoming a patient. Part of the explanation may lie in a patient's emotional experience. Studies have shown that anger is more commonly associated with profanity and verbal attacks, whereas sadness appears more closely linked to threats. Understanding the emotions that underlie these encounters may itself be an act of empathy.
We become remarkably good at moving on. Over time, the very resilience that makes us effective healers can begin to resemble self-erasure. In correctional health, patients have responded to denied requests — extra toilet paper or something else entirely — with promises of legal action or a raised middle finger. There are moments when uncharitable thoughts cross my mind — thoughts I would never voice and certainly never act upon. Yet I remember searching for the most professional way to document that a patient had flipped me off. Not simply that the patient was upset, but the exact words used or the gesture made. Why do we feel compelled to do that? The practical answer is continuity and legal protection. But perhaps the chart became a witness. We do not document kindness with the same precision — although many of us feel compelled to memorialize the moment a boundary is crossed.
The effects of incivility extend well beyond the encounter itself. Rude patient interactions have been linked to lower workplace morale and diminished confidence among healthcare workers. This can also divert cognitive resources away from the task at hand, consuming mental bandwidth that would otherwise be devoted to clinical reasoning and decision-making. In some settings, exposure to rude behavior has even been associated with poorer team performance during critical patient care scenarios, including CPR, as well as lower adherence to routine safety practices such as hand hygiene. Perhaps most telling, one study found that healthcare workers who coped by masking their genuine emotional responses were more likely to experience fatigue over time.
These findings challenge the notion that professionalism requires a reflexive “let it go.” While many clinicians view patient misbehavior as an inevitable part of the job, the evidence suggests that its effects linger. They shape how we think, how we feel, and sometimes how we work. Perhaps viewing mistreatment as part of the job serves as a necessary buffer, allowing us to continue showing up for our patients day after day. But it may also come at a cost, quietly eroding the very people we depend on to provide care. If similar behavior were directed toward our family members or even our patients by someone else, it would immediately be recognized as inappropriate. I am not suggesting that physicians have a moral duty to challenge every offensive remark or correct every act of incivility. But is what we call professionalism, at least on occasion, avoidance?
Boundaries and compassion are not opposites. Recognizing mistreatment is not the same as retaliating against it. We can continue to care for patients who mistreat us while still acknowledging the effect those interactions have. The goal is not to harden or become less empathetic. It is to remain fully human while continuing to show up for others.
What have you found to be the most helpful methods for preserving professional boundaries in clinical care? Share below.
