- Email: [email protected]
The Disgruntled Colleague
OPINION
The Disgruntled Colleague Spencer B. Gay, MD Go man, go, but not like a yo-yo schoolboy. Just play it cool, boy, real cool! —Stephen Sondheim West Side Story
The source of our livelihood as physicians is the professional fee, for which we give a service—an opinion or a procedure performed in a professional way. How to keep it professional is sometimes more difficult than it would seem. An unfortunate incident recently occurred between one of our residents and a referring surgery resident. When the radiology resident called to get more clinical information to correctly protocol a computed tomography scan for a trauma patient, the surgery chief gave a curt response, and the radiology resident hung up abruptly. Both physicians felt that they had not been afforded the respect due them. When I investigated further, I found that the same surgery resident had several other poor interactions with some of our calmest residents. I was concerned that patient care might ultimately suffer, and I informed the surgery program director of this incident. After I heard the other side of the story (there is always another side, I have learned), he said that this particular surgery chief resident may occasionally react inappropriately, but there also were transgressions on the part of the radiology resident, some of which were selectively omitted from the version that I had heard. What has this small vignette to do with me personally or with us as physicians? Both the surgery program director and I agreed that communication was poor. I
felt that there would be no real benefit in continuing the discussion of the other small transgressions that the resident surgeon had made over the last year. I instead spent a lot of time thinking about how I could really improve communication skills in my own practice and in our residency program. It is in the interest of the patient, as well as in our own interest, to have smooth physicianto-physician interactions. Many medical malpractice lawsuits have poor communication as the root cause. I can think of no instance in which poor communication could improve patient care. We as radiologists have an asymmetric relationship with referring physicians. They “request” or “order” examinations, and we perform or interpret these. When we call the referring physician with a question, we may only want more information but may seem to be refusing to do the study. They may see us as being part of the problem for the physician rather than part of the solution for the patient. It could really come down to whether you choose agreeable first words, such as “How can I help you?” and then “Let’s see what would be the best for your patient.” But what if things turn sour? What will you do the next time you are faced with a really unhappy fellow physician? What would really be the best way to conduct yourself? In such a difficult situation, you may not even be able to control yourself; you will likely not be able to control the other person, particularly if he or she is already feeling slighted or threatened in some way. We are more likely to
© 2008 American College of Radiology 0091-2182/08/$34.00 ● DOI 10.1016/j.jacr.2008.01.008
succeed if we focus on controlling ourselves. We should indeed always show respect to others (physicians included) and ourselves. After all, respect is truly something that is given, not taken or demanded. I believe that most of us have a built-in thought editor that sits somewhere behind the prefrontal cortex and “reads” what we think before we open our mouths to help prevent us from blurting out the first thing that comes to mind unless it fits the situation. Some of us have a more powerful editor who never lets much out, and others seem to grant the mind an open access to the mouth. Stress or alcohol may put the editor on vacation, and we may regret and end up paying for what was said or done. Medicine is too important to our patients to let reckless words compromise the result. Imagine what it would be like if patients were also included in such a suboptimal medical discussion— what would they say or think? Or, imagine what a completely selfish jerk would say in your place (hopefully you have not yet opened your mouth). You do have the choice to say nothing. This indeed may be the best response if the other party is being abusive and unreasonable. Silence is sometimes the best answer. You could choose to show compassion and patience instead of joining in the fight. The other person may lack sleep or personal satisfaction in their life. Instead of confronting the anger directly, try to deflect it and step out of the way. “Remember the mantra: This is not about me, this is not about me, this is not about me . . .” Staying above 791
792 Opinion
the fray leaves you in a position of strength—you remain blameless. I had the good fortune to work with K. K. Wallace for several years and observed him sitting in a meeting, listening to a fellow faculty member rant on about some small annoyance, and instead of getting in on an argument, he said “I can see how you could feel that way”—always the consummate gentleman. The telephone gives us another opportunity to practice communication skills, but it has its own unique pitfalls. If someone is yelling at you through the phone, though it might seem like an easy out, it is really best not to hang up on anyone. Hanging up on someone then qualifies you as a participant in the “fight” and also part of the problem. Otherwise, if they are misbehaving, it is still their problem. If the other person is truly out of control, an appropriate response could be “Sorry, I need to get back to my work now,” or “I need to get
back with you on that one, goodbye” and then hang up. This does not, I believe, constitute a transgression. Just think of all the clever things you could have said but didn’t. An even stickier issue arises if there is profane language involved. This is just not an appropriate way to communicate in a hospital. Even if you might just be showing your level of frustration with a situation, cursing is an infraction that can put you in the wrong in a heartbeat, even if previously you were blameless. Traditionally, profanity was considered an effective way when coaching college basketball players. Beginning this year, basketball coaches, even revered ones whose name starts with K, can be penalized for foul language. Apparently, cursing is now not even appropriate for the hardwood. The primary goal of all of our medical endeavors is to take care of the patient. These 2 little words,
“patient care,” provide a simple way to remember what it is all about. It is certainly not about getting this other person to respect me by belittling him or her. So, if the sum of our communication does not seem to be leading to optimal patient care, I need to look at and perhaps change the interaction so that it will be a positive one. I need to rise above the first inclination to join in the mental sparring match to see who is more powerful or intelligent. That is not at issue. The bottom line is surely only the patient’s best interest. The little spat one night deep in the bowels of our hospital helped me to consider how we see our referring colleagues and to consider what other options are available when faced with a suboptimal physician-to-physician professional interaction. I just hope I will think before opening my mouth when faced with an angry doctor.
Spencer B. Gay, MD, University of Virginia Health Sciences Center, Department of Radiology, Box 800170, Charlottesville, VA 22908-0001; e-mail: [email protected].
The Disgruntled Colleague Spencer B. Gay, MD Go man, go, but not like a yo-yo schoolboy. Just play it cool, boy, real cool! —Stephen Sondheim West Side Story
The source of our livelihood as physicians is the professional fee, for which we give a service—an opinion or a procedure performed in a professional way. How to keep it professional is sometimes more difficult than it would seem. An unfortunate incident recently occurred between one of our residents and a referring surgery resident. When the radiology resident called to get more clinical information to correctly protocol a computed tomography scan for a trauma patient, the surgery chief gave a curt response, and the radiology resident hung up abruptly. Both physicians felt that they had not been afforded the respect due them. When I investigated further, I found that the same surgery resident had several other poor interactions with some of our calmest residents. I was concerned that patient care might ultimately suffer, and I informed the surgery program director of this incident. After I heard the other side of the story (there is always another side, I have learned), he said that this particular surgery chief resident may occasionally react inappropriately, but there also were transgressions on the part of the radiology resident, some of which were selectively omitted from the version that I had heard. What has this small vignette to do with me personally or with us as physicians? Both the surgery program director and I agreed that communication was poor. I
felt that there would be no real benefit in continuing the discussion of the other small transgressions that the resident surgeon had made over the last year. I instead spent a lot of time thinking about how I could really improve communication skills in my own practice and in our residency program. It is in the interest of the patient, as well as in our own interest, to have smooth physicianto-physician interactions. Many medical malpractice lawsuits have poor communication as the root cause. I can think of no instance in which poor communication could improve patient care. We as radiologists have an asymmetric relationship with referring physicians. They “request” or “order” examinations, and we perform or interpret these. When we call the referring physician with a question, we may only want more information but may seem to be refusing to do the study. They may see us as being part of the problem for the physician rather than part of the solution for the patient. It could really come down to whether you choose agreeable first words, such as “How can I help you?” and then “Let’s see what would be the best for your patient.” But what if things turn sour? What will you do the next time you are faced with a really unhappy fellow physician? What would really be the best way to conduct yourself? In such a difficult situation, you may not even be able to control yourself; you will likely not be able to control the other person, particularly if he or she is already feeling slighted or threatened in some way. We are more likely to
© 2008 American College of Radiology 0091-2182/08/$34.00 ● DOI 10.1016/j.jacr.2008.01.008
succeed if we focus on controlling ourselves. We should indeed always show respect to others (physicians included) and ourselves. After all, respect is truly something that is given, not taken or demanded. I believe that most of us have a built-in thought editor that sits somewhere behind the prefrontal cortex and “reads” what we think before we open our mouths to help prevent us from blurting out the first thing that comes to mind unless it fits the situation. Some of us have a more powerful editor who never lets much out, and others seem to grant the mind an open access to the mouth. Stress or alcohol may put the editor on vacation, and we may regret and end up paying for what was said or done. Medicine is too important to our patients to let reckless words compromise the result. Imagine what it would be like if patients were also included in such a suboptimal medical discussion— what would they say or think? Or, imagine what a completely selfish jerk would say in your place (hopefully you have not yet opened your mouth). You do have the choice to say nothing. This indeed may be the best response if the other party is being abusive and unreasonable. Silence is sometimes the best answer. You could choose to show compassion and patience instead of joining in the fight. The other person may lack sleep or personal satisfaction in their life. Instead of confronting the anger directly, try to deflect it and step out of the way. “Remember the mantra: This is not about me, this is not about me, this is not about me . . .” Staying above 791
792 Opinion
the fray leaves you in a position of strength—you remain blameless. I had the good fortune to work with K. K. Wallace for several years and observed him sitting in a meeting, listening to a fellow faculty member rant on about some small annoyance, and instead of getting in on an argument, he said “I can see how you could feel that way”—always the consummate gentleman. The telephone gives us another opportunity to practice communication skills, but it has its own unique pitfalls. If someone is yelling at you through the phone, though it might seem like an easy out, it is really best not to hang up on anyone. Hanging up on someone then qualifies you as a participant in the “fight” and also part of the problem. Otherwise, if they are misbehaving, it is still their problem. If the other person is truly out of control, an appropriate response could be “Sorry, I need to get back to my work now,” or “I need to get
back with you on that one, goodbye” and then hang up. This does not, I believe, constitute a transgression. Just think of all the clever things you could have said but didn’t. An even stickier issue arises if there is profane language involved. This is just not an appropriate way to communicate in a hospital. Even if you might just be showing your level of frustration with a situation, cursing is an infraction that can put you in the wrong in a heartbeat, even if previously you were blameless. Traditionally, profanity was considered an effective way when coaching college basketball players. Beginning this year, basketball coaches, even revered ones whose name starts with K, can be penalized for foul language. Apparently, cursing is now not even appropriate for the hardwood. The primary goal of all of our medical endeavors is to take care of the patient. These 2 little words,
“patient care,” provide a simple way to remember what it is all about. It is certainly not about getting this other person to respect me by belittling him or her. So, if the sum of our communication does not seem to be leading to optimal patient care, I need to look at and perhaps change the interaction so that it will be a positive one. I need to rise above the first inclination to join in the mental sparring match to see who is more powerful or intelligent. That is not at issue. The bottom line is surely only the patient’s best interest. The little spat one night deep in the bowels of our hospital helped me to consider how we see our referring colleagues and to consider what other options are available when faced with a suboptimal physician-to-physician professional interaction. I just hope I will think before opening my mouth when faced with an angry doctor.
Spencer B. Gay, MD, University of Virginia Health Sciences Center, Department of Radiology, Box 800170, Charlottesville, VA 22908-0001; e-mail: [email protected].