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Have you ever had to raise your voice in a healthcare setting?

Discussion in 'Nontraditional Students' started by Gauss44, Sep 20, 2014.

  1. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012
    Those who have had jobs outside of the medical field:

    In terms of appropriateness or inappropriateness, how does raising your voice in a doctor's office compare to raising your voice in other professions? Law, business, the corporate office, construction, customer service, etc....

    Example: I use to work in a law firm, and people would raise their voice to argue over an opponent all the time (where I worked) and no one ever raised an eyebrow. I'm not sure it's the same in say the hospital ED. (I'm not sure if raising one's voice, and NOT yelling but just talking loudly, is considered to be unprofessional, a normal part of everyday life, or something else.)

    Your insight will be appreciated.
    Last edited: Sep 20, 2014
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  3. wholeheartedly

    wholeheartedly Administrator 7+ Year Member

    Aug 8, 2009
    Beyond the Wall
    I would say it depends on the context. If you're raising your voice to communicate over noisy clatter and there aren't patients around, it's probably ok. If you're raising your voice AT someone or in frustration, not ok.
    Gauss44 likes this.
  4. puppylatte


    Sep 1, 2014
    A physician yelled at my mom in the ICU (she was a family member of a patient, my dad , and an ex-employee of that very ward 10+ years prior). So yes, it does happen. I happen to think yelling at a patient's family is worse than yelling at a coworker, although both are bad. I sided with the physician since my mom was not thinking rationally at the time. He actually stood up at the nurses station, and yelled across the thoroughfare and into the patient's room in order to be heard. My mom would not remove life support and the physician said "He is going to die, he will be in pain and it will be your fault." It was a crazy scene, but without going into my mom's personal details, I absolutely sided with the physician on this one.
  5. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012
    I would lean on the side of a man yelling at a woman is not okay. On the other hand, this may have been a situation where you had to be there to really get it, - or the physician may have been out of options and needed a way to GET THROUGH to you mom (of course, I don't actually KNOW what happened having NOT been there). I'm SURE there are better ways, but sometimes people are limited to the options they can think of in the moment.

    I personally, cannot ever picture myself "yelling." I often times "raise my voice" for all sorts of reasons (to talk across the room, to correct someone who's speaking on an inaccurate tangent by interjecting, because I'm happy and excited, etc.). If I find out that this is viewed negatively on here, I'll make a point to think of alternatives to speaking loudly.

    (I think part of the reason I do this, speak loudly from time to time, is because I have AIS and I'm a smaller guy, sometimes mistaken as female or criticized for being effeminate, and it's important for me to have characteristics that are masculine and that send non-weak, non-female signals. However, come to think of it, recently this AIS endocrine disorder has been so out of control that I might be being read as female, and those techniques of making a point to seem masculine, etc. might be backfiring.)
  6. Nasrudin

    Nasrudin Apropos of Nothing 10+ Year Member

    Jun 8, 2006
    Like most things involving the interaction with human beings, it's not possible to indicate a rule that can't be broken with positive effect.

    I was once trying to organize a few heathen wildling children in preparation for their check ups and instinctively snapped them to attention with bass heavy bark after it was apparent I would get no help from their doormat of a mother.

    They were relieved to be extracted from their own chaos. And readying them for their appointment went quickly and efficiently. On the inside I was laughing and surprised at the effect. Outside I kept glaring at them like a belligerent and vengeful demigod, for fear the effect would wear off.

    I think the mother was kind of turned on by it. Poor thing. She was a mess with those hooligans on her own.

    Humans are strange. Sometimes intellect is inappropriately slow in dealing with them. I think if you're a positive person in general you should trust your instincts for social conduct.
    Last edited: Sep 21, 2014
    jl lin and Gauss44 like this.
  7. ZX10R

    ZX10R 2+ Year Member

    May 29, 2014
    The only yelling I've seen is for patients that should probably be considered deaf and a trauma surgeon yelling at the nurse staff for being in the way or not handing him the right tool.
  8. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012
    talking loudly = raising one's voice =/= yelling

    Just to keep this on topic (hopefully), my question was about "raising one's voice" and talking loudly, NOT yelling.

  9. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting.... Administrator Physician PhD Faculty Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 12, 2004
    As if the ER weren't already loud enough without premeds wanting to shout to be heard over the general din.... :p
    sb247 and wholeheartedly like this.
  10. akinetopsia

    akinetopsia some dude 7+ Year Member

    Feb 17, 2008
    The Upside Down
    I've just raised my voice when the patient was hard of hearing and their daughter/son indicated they were hard of hearing. In anger, or because of ambient noise, not really ever.

    I run into more of a problem because I'm listening to myself when I do this thinking, "I hope I don't sound like I'm angry, because I'm not!"
    Gauss44 likes this.
  11. Nasrudin

    Nasrudin Apropos of Nothing 10+ Year Member

    Jun 8, 2006
    Seriously though...1 additional shouting lunatic is gonna make the difference. I don't think a jet engine and a marching band would.
    wholeheartedly likes this.
  12. wholeheartedly

    wholeheartedly Administrator 7+ Year Member

    Aug 8, 2009
    Beyond the Wall
    Nas, now it's not nice to refer to the EM docs as lunatics.....

    Some of them are our friends.
    Nasrudin likes this.
  13. Gauss44

    Gauss44 5+ Year Member

    Oct 28, 2012

    Yeah, and that gets into perspective.

    And of course, if you are talking loud to someone who's deaf, there's no guarantee that something will NOT happen right after that or during that loud conversation that truly does irritate you. In that case (in healthcare), I guess it's important to be careful that the loudness is attributed to the deaf person and not what happens later. (For example, if a coworker acts as if they cannot hear me, I am likely to speak louder. Then if they spit in my face or something equivalently nasty, I might not say, "cut it out" in that same loud tone, although that would probably be most people's first instinct. That would risk looking unprofessional. In business or law, I certainly would say it loudly.)

    Compare the ED/doctor's office to a court room where attorneys frequently raise their voices for dramatic effect, to make a point, to speak over someone, or to protest something. I know there's a difference here, and I'm still trying to articulate exactly what it is.

    Granted, these things don't come up everyday, it's still important to understand this fine aspect of workplace culture/professionalism IMO.
  14. kraskadva

    kraskadva ... 5+ Year Member

    Apr 27, 2011
    in a bubble
    To my mind, the difference would be that in a courtroom, the attorneys are performing in a sense. They are on a stage and speak to be heard clearly in the whole room. The volume level you need for this sort of public speaking is very similar to what a theatre actor would use.
    However, in healthcare the interactions are typically face to face in a small room. Raising one's voice to any level beyond what's necessary to be heard over ambient noise or hearing impairments tends to come across as more angry or confrontational, whatever the underlying emotion truly is, simply because you're 3 feet away from the person you're speaking to instead of 30+ feet away from the other person.
    Also, speaking over someone is generally considered rude in normal social interactions. Yes attorneys do it, but again with the stage analogy.
  15. keitaiKT

    keitaiKT Senior Member 10+ Year Member

    Aug 3, 2005
    This is terrible. Honestly. I can't imagine any physician ever acting that way in the ICU. Even though he may have been 100% right that it was wrong to keep your dad on life support, yelling like that??? Not cool.
    jl lin and puppylatte like this.
  16. Nasrudin

    Nasrudin Apropos of Nothing 10+ Year Member

    Jun 8, 2006

    I meant just any random lunatic yelling. Agree--they're so my friends. Somebody has to run than circus freak show on acid. I can't believe I thought it was awesome at one point. Everytime I go there to admit somebody....I think Jesus Jehovah jirah is this a **** show or what?!

    People just lying around on gurneys groaning everywhere. Half of them blasted or crazy or both. Some sick as [email protected] Scariness. I take a quick H&p and high tail it the F out of there like a jackrabbit.
  17. jl lin

    jl lin 7+ Year Member

    Oct 9, 2009

    Yes, I've raised my voice on some very rare occasions--sometimes out of critical necessity, and I've certainly heard many a doc and nurse raise their voices--this is in mostly ICUs, mind you. It's generally not cool, however, and escalation is not something that helps a problematic situation.

    I will say, even though you sided with the doc, I ardently disagree with his yelling and comments to your mom. Doesn't matter if he was right or not. That was beyond inappropriate and counterproductive. There are better ways to make the points, and there are support systems in place--it's the physician's responsibility to get those support systems on board rather than yelling and stating what he stated.

    Frankly, even if the poor woman was schizophrenic or bipolar, the doc's comments were beyond inappropriate and out-of-line. In short, the doc was out of control. As tough as it may be, it's the physician's job to stay in control of his/her emotions and be both empathetic and professional. Yes. Sometimes that is easier said than done; but that's the way it needs to role, period.
    Last edited: Sep 23, 2014
    puppylatte likes this.
  18. Doctor Bob

    Doctor Bob EM/CC Physician Faculty 7+ Year Member

    Feb 12, 2009
    I have walked into numerous codes, looked around at the clusterf**k going on and raised my voice in order to stop everything that was happening and be heard over the chaos. But it's a momentary thing in order to say "you, you, you, and you stay, and here are your jobs. The rest of you get out." But then after that I go back to my normal voice.

    In any crazed setting, especially a high stress healthcare setting (an ER, a trauma, a code, etc), there may be temptation to give into the stress and escalate the volume of your voice (heck, everyone else in the room is giving into it). But as the doctor you set the tone for the room. If you start getting frantic and shouty, then all it does is whip the room into a higher state of agitation. You have to be the voice of calm in the storm.
    jl lin likes this.

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