Mark Ciocca lives in Penacook.

As a retiree with chronic health issues, I have frequent appointments at outpatient clinics run by Concord Hospital. Recently, signs have been posted at these facilities saying that “physical and verbal aggression will not be tolerated.” Being concerned about this, I asked staff at my primary care office why the sign was necessary, and was told that incidents of such behavior have become quite frequent and that hospital security staff have had to intervene.

At my primary care physician’s office, I find the staff to be friendly, helpful, and hardworking, and my MD is friendly, knowledgeable, and empathic. Since long-standing psychological theory has indicated that aggression is often a product of frustration, I wonder where the frustration is occurring in people’s lives. Are people having problems getting appointments or getting health coverage? Do they believe they are not being listened to, or are they being shuffled from one specialist to another?

A trend I have noticed is reduced services in primary care offices. Laboratories are no longer in the doctors’ offices, and the number of labs has been reduced. Imaging also takes place elsewhere, potentially adding some frustration.

I have also heard several people complain about the current system of calls to clinics being answered at a central office, where the person taking calls decides what the patient needs and how urgent the need is. Adding this step is likely designed to make the actual clinic more efficient, but it creates another step wherein a patient can “fall through the cracks” and not receive requested and/or needed services. I know of some people who have walked directly into the doctor’s office, feeling as though their needs have been forgotten

As indicated in a letter published in this paper on March 4, the most challenging and potentially frustrating place to seek treatment is the emergency department. This is not a local trend, but a national one. Experts say that the reason for this is threefold. First, there is a staffing shortage, so there are fewer people to treat patients. Second, the continued prevalence of respiratory viruses in the population leaves a group of people who are discouraged from going to outpatient offices for fear of contagion, or because they lack insurance coverage. Finally, EDs remain backed up because referral places such as hospital beds, psychiatric facilities, and long-term care facilities are full and/or understaffed.

The reasons noted above are clearly valid, but as the above mentioned letter writer pointed out, the people waiting for hours at the ED were all in some sort of distress, but in spite of well-meaning staff, their distress remained and/or escalated. In my own personal case, I waited nine hours to be seen for pain due to an ulcer. The waiting area was packed, but far from this leading to anger and violence, it led to empathy and humanity. Several people helped wheelchair-bound patients use the restrooms, and others shared their personal struggles with other people having problems similar to theirs.

So, in my mind, the good news is that even people who are distressed from their problems and their wait times are willing to maintain their composure and help others. The bad news is that our healthcare system is facing real problems that need to be resolved.