The incident

“I was at the hospital in Catania, carrying out my internship. I was attending the internship program together with five other doctors. Some days earlier, we had dealt with the case of an old man whose leg we had to amputated.  After a few days some complications arose and on that same day the old man died.

I was astonished by the reaction of his family members, when they showed up at the hospital, after being notified about the death of their relative, the old man:

The wife and the daughter of the old man, along with two nephews, entered the room and started to scream, exclaiming that it was our fault(the doctors’ fault) that the old man passed away.

The two nephews started to smash all the medical tools and instruments that were stored in the room.  All the doctors and I were asking the family to calm down, but without any luck.

Their violence was of a nature and extent that we had to leave the room.  I felt very uncomfortable and ill-treated. My immediate reaction was thinking that the professional doctors are always blamed when something bad happens, when the patients cannot be cured and die, or when a doctor perhaps makes a mistake. But the doctors never get credit for their successful care and for saving human lives.

I felt a strong anger grow inside of me. I wanted to react, respond and explain to the old man´s nephews, what actually happened to him. But I had to refrain from doing so, and I am not sure they would have understood anyway.”

1. Identities of the actors in the situation

The incident involves the following persons:

The narrator is an Italian male doctor at a hospital in Catania, Sicily. He recently graduated in Medicine and he cares about the fulfilment of the medical tasks and dutiesand he has great respect for the profession. At the time for the incident, the narrator is 26 years old and carrying out an internship programme at this hospital.

Apart from the narrator, five other doctors are carrying out the internship programme at the same hospital.

On the other side, there is an Italian family, who lost their relative, the old man who is the dying patient in the incident.

Apart from the old man, the family consists of:

  • The old man´s wife
  • The old man´s daughter
  • The old man´s two nephews of 20-25 years old.

The old man and his family can be described as belonging to a lower social class. In this case the patient and his family were from a social group characterised by low education and a general disrespect for institutions and authority.

2. Context of the situation

The incident takes place at a public hospital in Catania, Italy.

The situation involved actors in the typical case of meeting between the role of doctors and the anger of patient infuriated by the healthcare system.

In the situation, the wife and the daughter of the old man along with two nephews enter the room, where the old man is lying. The family enter the room after they have been notified that their relative(the old man) has died.

The narrator is in the room along with five doctors.

3. Emotional reaction

The narrator had very negative feelings towards the family:

  • Strong anger
  • The feeling of being attacked on his professionalism
  • The feeling of being treated and accused unfairly
  • Being blamed for causing another person´s death

I was astonished by the reaction of his family members, when they showed up at the hospital, after being notified about the death of their relative, the old man. My immediate reaction was thinking that the professional doctors are always blamed when something bad happens, when the patients cannot be cured and die – or when a doctor perhaps makes a mistake. I felt a strong anger grow inside of me. I wanted to react, respond and explain to the old man´s nephews, what actually happened to him”.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

1) Violence as non-justifiable reaction even when facing death

The narrator rejects physical violence and believes that it is never justifiable to act out violently, even when it is a grieving reaction and response to the loss of a close relative.

Self-control along with respect for professionals and institutions are also values that are affected in the incident. Self-control should be maintained when possible. Furthermore, common property of the society, in this case a hospital and medical tools, should be treated with respect, while all citizens are contributing to the common institutions through taxes.

2) Respect for the profession and the vital position of medical competence and treatment: Professional Identity

The doctor appreciates his own profession very highly, not just on a personal level as a doctor – but also on a societal level, where the medical profession ranks high on the professional and social ladder, seen from the doctor’s own perspective. This is not the least due to the fact that doctors through their education and profession are capable of saving people´s health and lives. Thus, the doctor strongly believes that everyone should show respect to doctors´ work and recognise the important service that doctors offer, dealing with very delicate matters like health, life and death and treating patients with the highest attention. Thus, the doctor is really concerned about the reactions of the dead man´s family, when they question the competences of himself and his colleagues.

3) Security/Safety

The conception of personal safety is also affected by this incident. The acting out and violent behaviour of the patient’s family threatened the narrator´s sense of physical integrity. It was an intense experience because the incident took place in the doctor’s own domain, the hospital, where he otherwise would be on safe ground and also belong to those who are in power of decision-making, definitions of the right way to behave etc. Suddenly, he is out of the usual comfort and safety zone.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The narrator feels strongly negative about the family and he is at the same time shocked, indignant and even disgusted by their uncontrolled, unreasonable and, in fact, primitive behaviour.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

1) Untrustworthiness of the public healthcare system

A hypothesis may be that the patient’s family acted violently because the death of the relative confirmed theirsuspiciousness and preconceptions about the public healthcare system being insufficient, unreliable and even alienating. Their main idea may be that the public healthcare, paid by their hard work and taxes, is unable to save the life of their relative and perhaps even further, to save the lives of ordinary people.

Perhaps, the family members may also be influenced by the idea that even though doctors in the public system have a high status in the societal hierarchy, they do not work as hard for their living as the working people, the working class.

Another value may be a suspicious approach to public service in general and a conviction that the public sector provides a worse service than in private healthcare.

Thus, in their grief and loss, they may be overwhelmed with the feeling that their relative might have survived if they had been able to afford private healthcare. They turn their anger and powerlessness towards the public institution and system in a society, where they do not feel recognition and have no high status – economically, socially or culturally – despite their hard work and contributions to the community. Respect for public services in general and public healthcare in particular, may lie in a small space among people on the lower socio-economical and socio-cultural levels of the society in Sicily.

2) Free expression of feelings

The family members may also be used to acting out their feelings of anger through violent behaviour, and they may be socialised and accustomed to violent behaviour in the socio-cultural environments, to which they belong. Moreover, their lack of education may be a further explanation in this respect. As they are not able to express themselves with words and through intellectual and emotionally controlled communication, they may feel even more powerless in the situation.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

In terms of professional practice, rooted problems arise concerning the understanding of roles and the respect of professionalism, as well as the respect for institutions of the society.

In this case the professional identity of a young doctor was severely affected. Perhaps, as a precaution, the young doctor could better understand that people can react violently to the death of a dear person, and could try to address one relative at a time, in a way to better manage their anger. Training about communication and empathy should perhaps be part of medical training in Italy. This would most likely contribute to overcome similar situations in the future.

The case also illustrates how insight, understanding and respect for other social strata and socio-cultural forms of expression should be a core competence for doctors as well as for other professions. In this case, it was the insight of a working-class culture that was at stake. But the case also reveals the doctor’s inability to act in an assertive way in the situation. He gets scared and angry. He reacts very emotionally while at the same time condemning the emotional reactions of other people.