I work in an environment of total inappropriateness, mostly just staff-staff. But sometimes I think we have to engage in some code-switching to communicate effectively with some patients. Case in point:
Medic: "Dude, you really hurt yourself this time. You made a bad mistake."
Medic: "You really messed up."
Medic: "You fucked up, man!"
Pt: "Oh, I did? What did I do?"
It's not necessarily disrespect. Food for thought.