A few days ago, I began seeing the same headline on social media, in slightly different forms: “Masungit / Ma-attitude na nurses, bawal na sa public hospitals”. I understood immediately why it caught people’s attention. We have all had unpleasant encounters in hospitals, both private and public. Sometimes we get a curt answer, an impatient tone, or we encounter someone who seems too busy to explain. When you are sick, frightened, in pain, or worried about someone you love, even a small act of impatience can feel much bigger than it normally would.
The headlines came from the Department of Health’s recently circulated 8-Point Patient Experience Standard, described as a “Commander’s Guidance” for government hospitals. Its first point is simple: agaran at magiliw na atensyon, which simply means prompt and courteous attention. There is nothing objectionable about that. Patients and their bantays deserve courtesy, kindness, and respect. They deserve to be spoken to as people, not as bed numbers, diagnoses, or annoyances in an already crowded day.
What made me uncomfortable was how quickly the public conversation seemed to stop at the word magiliw, and more specifically, at nurses who were supposedly not magiliw enough. There are, after all, seven other points. The same standard also speaks of a pleasant environment, clean toilets, functioning lights, reliable social support, adequate equipment, organized queues, and updated information. Read together, the eight points tell a much broader story. They are not merely telling nurses to smile. They are telling hospitals to work.
I practice in both public and private institutions, and the contrast between the two is not always as simple as people imagine. Public hospitals carry enormous patient loads with limited resources. Private hospitals may have better amenities, but they have their own frustrations as well, such as delays, unavailable tests, malfunctioning equipment, complicated processes, fragmented communication, financial concerns, and patients who are sometimes left unsure of what is happening or why.
These are systemic problems. They are not things that a nurse, physician, or any individual healthcare worker can solve alone. Yet they shape the patient experience profoundly. They also shape the working environment of healthcare workers themselves, adding to workload, frustration, and the strain of caring for people within an imperfect system.
Perhaps this is why I find the eight-point standard useful even outside government hospitals. It reminds us that patients experience healthcare not only through the treatment we prescribe, but through everything surrounding it. Was someone there when they needed help? Could they find the correct room? Did anyone explain the delay? Was the toilet clean? Was the hallway safe and well lit? Did the equipment work? Was there somebody to help when the family could no longer afford what was being asked of them? Did they know what was happening next? These things sound small until you are the patient.
At the same time, there is another part of the conversation that deserves to be said plainly: respect and courtesy should go both ways. Healthcare workers must be respectful. A stressful day does not give us permission to humiliate patients, and being overworked does not make cruelty acceptable. Professionalism still matters when we are tired. But patients and their families also have a responsibility to treat healthcare workers as human beings.
In my conversations with nurses, I have heard stories from the other side of the bedside as well. One nurse told me that a child’s bantay punched him after he was unable to insert an intravenous line on the first attempt. I have personally seen family members shout at nurses over matters that had little to do with nursing care, such as a leaking faucet, a television remote that would not work, an air-conditioning unit that was not cold enough. The nurses happen to be the people within reach, and so the frustrations usually land on them. Because the nurses are often the most visible people in a hospital, particularly when something goes wrong, they become the human face of problems they did not create and often have no power to solve.
This does not mean that healthcare workers should respond to frustration with equal hostility. We are professionals, and illness makes people frightened, impatient, and sometimes unreasonable. Part of our work is to understand that. But compassion cannot mean accepting verbal or physical abuse as an ordinary occupational hazard. A patient's fear deserves understanding; it does not give anyone permission to punch a nurse. A family's frustration deserves to be heard; it does not make the nearest healthcare worker responsible for everything that is wrong with the hospital.
We sometimes forget this because medicine is a caring profession. There is an assumption that because we chose to care for people, we should be endlessly patient, endlessly understanding, endlessly available. We should absorb anger because the patient is afraid, tolerate insults because the family is worried, and accept shouting because people are under stress. To a point, we do. Anyone who has spent enough time in a hospital learns to recognize that anger is often another expression of fear. But understanding why someone is angry is not the same as saying that every behavior is acceptable.
Sometimes the complaint is justified. Yes, some nurses may be rude. There are doctors who are rude, too. There are clerks, guards, technicians, administrators, patients, and relatives who can be rude. No profession has a monopoly on kindness, and none has a monopoly on bad behavior. But I worry when a systems problem is reduced to an attitude problem. A nurse cannot make up for an understaffed ward by simply being nicer. They cannot speak gently enough to make ten additional patients disappear. They cannot personally fix the broken light, buy the missing equipment, create another bed, shorten the patient queue, speed up a laboratory machine, or invent a social worker when none is available.
At some point, telling exhausted healthcare workers to “be nicer” just becomes one more burden to carry. One of my professors at the University of the Philippines, Dr. Nemuel Fajutagana, once expressed this idea in a way that has stayed with me: “If we truly value life, we cannot keep patching a broken system with the sacrifices of those who hold it together.” In the same statement came another line that may be even more important to this discussion: “The dignity of patients matters and so does the dignity of those who care for them.”
Those two ideas are not in conflict. We do not protect healthcare workers by caring less about patients, and we do not become more patient-centered by treating healthcare workers as if their own humanity is irrelevant. A good hospital should be able to hold both truths at the same time: patients should be treated with courtesy, and healthcare workers should be treated with courtesy. Patients deserve to be heard, and healthcare workers deserve to be heard. Patients should not be humiliated, and neither should the people caring for them.
That is why I hope we do not remember the DOH’s eight-point standard simply as the rule that said nurses should no longer be masungit. The real challenge is not merely to make healthcare workers kinder. It is to build hospitals, both public and private, where kindness has room to exist, where the toilets are clean and the lights work, where queues make sense, where information is available, where equipment functions, where social support is accessible, and where patients are treated with dignity.
And where the people who care for them are treated with dignity, too.
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