Crossing the Gap in 5 Minutes

How can a physician easily work with the poor and earn their respect, trust, and affection?  The key is feeling genuine respect.

I have worked with urban poor, working class, and underserved rural patients now for 30 years.  What jumps out at me is how everyone incorporates their place in the US class system and then acts on that.  Some, not all, of the medical personal do it.  No matter what they are taught in the lecture hall, it is the attitudes that get picked up in the informal discussions in the hallways that sometimes get most deeply ingrained.

“Treat everyone equally and with respect” is taught in the classroom.  In the hallways, at lunch, out of earshot, some patients are referred to as “dirt balls” by secretaries, nurses, physicians, dieticians, physical therapists, other patients, etc.  Informal discussions occur among the physicians in training about how it is more prestigious to have wealthy patients than poor patients.  Not everyone does this, not a majority, but far too many.  It tilts US healthcare into a class system.

And everyone incorporates their position on the class spectrum, whether they want to or not. The system is pushed in our faces every day by other people and the media, so the incorporation just happens.  And the people who are at the lower end of the class pecking order know they are there.  And they get accustomed to being disrespected by secretaries at the check in window, nurses, doctors, employees at the public assistance offices, and on and on.  They get accustomed to it, but it makes them very angry and sad.  And rightly so.  I hear at least once a week from my patients about how they get disrespected and treated as stupid.

So if you meet someone for the first time who has been stereotyped as lower class, and they see you and stereotype you as upper class, there is an instant apprehension on their part.  The minute you meet them, there is a huge perceived gap.   If you start talking and make it clear by facial expression, body language, and speech that you genuinely respect them and like them, the wall melts very fast.  Especially for people who are not used to being treated this way by someone they perceive as far above them in the class system.

In some ways it makes it easier since they are anticipating being disrespected.  If I do it right it only takes 5 minutes at the first meeting.  But if you fake it, if you are not yourself and put on an act, people will sense it and it will insult their intelligence.  Most people have a pretty high social intelligence, and that is not measured by the standard IQ tests and the SATs.  And I have met a lot of low-income people with both high social intelligence and high standard IQs.  The usual class assumption that if you are poor you are stupid just does not work in the real world.

Everything follows from there.  If you are feeling genuine respect for a person, you will make them a partner in the decision making; you will explain things to them so that they can understand.  You will realize they may have different beliefs and values than you do, but you will accept that and work with it and not put them down for it.

I believe this generalizes to all interactions in life.  Just see a person as an individual. Even if you can place them in the US class system according to income and education, put that out of your mind and talk to them one on one.  Listen to what they are concerned about and take those concerns very seriously.  Listening is key.  Listening implies great respect.   Listen to them more than you talk to them.

Is this theoretical?  No.  This has been learned by trial and error over 30 years.  And it always works.  But you can’t fake respect; you have to really feel it deep in your gut.

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Peter Daly is a general pediatrician and pediatric cancer specialist in Natrona Heights, Pa.