I was in a cab yesterday afternoon. I’m at another conference this week and as I made my way to San Diego, I had to count on many people to keep me safe. From the pilot to the air traffic controller to the cab driver. We do this all of the time, of course–step into a moving vehicle, sit down, inform another person where we’d like to go and then just trust. Trust that they know how to drive, that they’ll take care of us, that they’ll do their best to remain aware, responsive, and agile in the face of unexpected events. We trust that they’ll keep us alive and return us to our children. We do this at the clinic and at the hospital, too.

As I sat in the back of the car, I noticed a sticker on the window describing the bill of rights for passengers for San Diego Airport cabs. The list detailed things I was due: a safe car, a working seat belt, a music-free ride for example. And the kicker, a driver who doesn’t talk on the cell phone.

About 1/2 way to the hotel the driver with whom I had been chatting on and off started talking again. The windows were open and so I felt I’d missed what she said. I spoke up to clarify, “I’m sorry, what did you say?” It was then that it happened…like it often does, I realized she was talking on the phone.

So what do you do?

I mean, really, I’m asking, what do you do? Do you demand she get off the phone? Do you insist that she take care of you and provide additional safety? Do you remove a tip and silently strike? Do you wait until after you’ve arrived safely to assert your “rights” as a passenger? Does it matter if the driver is a woman, a man, is older or younger than you? Does it matter if it sounds like the driver is talking to their child like it did in my case?

I couldn’t help but start to think about the health space. The metaphor is striking. Here I am, a 37 year-old empowered, feisty, out-spoken physician who has reviewed and written about the dangers associated with distracted driving and I was intimidated by the sociology in the cab. I didn’t want to upset her, I didn’t want to rock the boat and interrupt her conversation, I didn’t want to cause tension. Something intimidated me. It sounds absolutely ridiculous as I type it this morning, but even though I believe the “inherent risk and implied immorality” of distracted driving, I didn’t speak up. On some level, I didn’t want her to drive faster or more recklessly (this has happened to me once after I asked a Philadelphia cab driver to slow down). And I wonder, if I had a difficult time speaking up in the cab, just how do we help each other as patients, as patient advocates, as caregivers, and as parents speak up in the exam room? When something isn’t going as well as planned, or when a physician or clinician isn’t really listening to what we’re asking, or when a potential medical error is about to occur, how to we learn to SPEAK UP?

Our health (care) demands that we do.

What are your ideas? What has worked for you in the exam room or in the walls of a hospital that allowed you to speak up to a clinician, or physician, or nurse, or receptionist, or technologist, or surgeon who had your life (or your child’s) life in their hands? How do you protect yourself and your family when you need something in the health space?

The end of my story goes like this: I talked with the cab driver after we stopped at the hotel. I told her how I knew that distracted drivers (on phones) were far more likely to be involved in a near-miss or true crash/accident and how I felt it was her obligation to protect her passengers. I told her I was a mother of two and that all I wanted was to return home safely to my boys. I have no idea if she will change her behavior. She did look me in the eyes and express remorse, and she did apologize.

I often say to my patients that “it’s always okay to ask” about anything in the exam room, in the hospital, or on the phone with a nurse or physician or technologist. Yet, my ride in the cab reminds me again, it is certainly more complex than that.