Under My Skin

Rules of incivility


Some people are civil; others are not. Some patients are polite, grateful, and courteous to a fault; others are angry, truculent, and aggressive. There may be reasons why such people are uncivil. Knowing those reasons does not make them any more civil than they aren’t, or any easier to take.


Dr. Alan Rockoff, a dermatologist in Brookline, Mass.

Dr. Alan Rockoff

Charlie is 18. His mother is with him.

“I see my colleague prescribed an antibiotic for your acne.”

“No. I stopped the medicine after 2 weeks. It’s not acne.”

“Then what do you think it is?”

“Some sort of allergic reaction. I have a dog. I’ve taken two courses of prednisone.”

“Prednisone? That is not a good treatment for acne.”

“It’s not acne.”

“If that’s how you feel, then I think you will need to get another opinion.”

“My son can be difficult,” says his mother. “But just tell me – why do you think it’s acne?”

(Because I have been a skin doctor forever? Because Charlie is 18 and has pimples on his face?)

“If this were acne,” his mother goes on, “wouldn’t the pimples come in one place and go away in another?”

“Actually, no.”

“I don’t think I’ve ever been so offended,” says Charlie, who gets up and leaves.

“This is the most useless medical visit I have ever had,” says his mother. On the way out, she berates my secretary for working for such a worthless doctor.

Later that day Charlie calls back. He asks my secretary where he can post a bad review.

“Try our website,” suggests my staffer.


Gwen has many moles. Two were severely dysplastic and required re-excision.

“There is one mole on your back that I think needs to be tested.”


“Because it shows irregularity at the border.”

“I really hate surgery.”

“You may not need more surgery. We should find out, though.”

“I’m not saying you’re doing this just to get more money.”

“Well, thank you for that.”

“I’m not trying to be difficult.”

(But you are succeeding, aren’t you?)

“I also have warts on my finger.”

“I can freeze those for you.”

“Wait. Before you do, let me show you where to freeze. Put the nitrogen over here, where the wart is.”

“Thank you. I will try to do it correctly.”

“I just want to advocate for myself.”


“The emergency patient you worked in this morning is coming at 1:30,” says my secretary. “I couldn’t find his name in the system, so I called back.”

“Sorry sir, but I wanted to confirm your last name. It’s Jones, correct?”

“Are all of you incompetent there? I told you my name, didn’t I?”

“Just once more, if you wouldn’t mind.”

“It’s Jomes, J-O-M-E-S. Have you got that?”

“Why, yes, and thank you for your patience. Your appointment is at 1:30.”

“It may rain.”

“Yes, so they say.”


“I’m sorry?”

“I asked you a question.”

“What question?”

“I asked you if it is going to rain.”

“I’m sorry Mr. Jomes. I just book appointments.”

Amor Towles named his recent novel “Rules of Civility” after a note George Washington penned for his youthful self as a guide for getting along with people. Most of us intuit such rules just by noticing what works and what doesn’t, what pleases other people, or what makes them embarrassed or angry.

But there are people who don’t notice such things, or don’t care. They see nothing wrong with asking an old-time skin doctor how he knows that pimples are acne or demanding that he justify his opinion. (Or asking his staffer the best way to attack her boss.) They think it’s fine to suggest that a biopsy has been proposed for profit – after two prior biopsies arguably prevented severe disease – or making sure that a geezer with a spray can knows to put the nitrogen on the wart, not near it. Or berating a clerk for misspelling a last name of which he must have spent his life correcting other people’s misspellings.

I always taught students: “When people ask you how you know something, never invoke your experience or authority. If they don’t already think you have them, telling them you do won’t change their minds.”

Our job, often hard, is to always be civil. Society has zero tolerance for our ever being anything else. We know the rules. Uncivil people play by their own.

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at [email protected]

Next Article: