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Don't Be a Jerk

Colinson72x721Colin Son -- I’ll let you in on a little secret: providers in hospital settings can be really antagonistic towards each other at times. The same as any workplace, I suspect. Only in the hospital you’re sometimes dealing with life and death, not who ate your sandwich out of the break room refrigerator.

Here the surgery chief resident argues with the medicine attending whether this or that patient on the medicine service should get surgery. Here the ENT resident argues with the surgery critical care fellow whether the patient should be admitted on the ENT service or the trauma service. Here interventional radiology argues with medicine whether attempting a percutaneous mass biopsy is appropriate.

In the academic public hospital setting, the ones doing the arguing are often the residents since they’re the ones who essentially run the various services. As I get closer to residency, I’ve started to wonder how I’ll handle such situations.

Let me say that these heated debates over patient care aren’t necessarily a bad thing. You would hope that everyone involved would be advocating for what they truly believe is in the patient’s best interest. When that is the case, then arguing things out can be a good thing. The point is, there are truly times as a resident when you (or your staff) feels strongly about something and you need to hold your ground.

Such can be tough. I am not a Type A personality. I imagine myself a year from now, in a situation I’ve seen my residents in more than once:

I’m a month in and on call and some shunt kid who is cranky or not feeding well comes into the emergency room. Before the overworked and tired emergency medicine doc even gets the head CT he gives me a call. Down in the ER the conversation comes to a head with something like this from the EM attending, “You’re going to admit this patient.”

Well maybe, but it isn’t exactly his place to be saying something like that at this stage of the work up and it certainly isn’t his decision to make. No one in such a situation wants to be a pushover and nod their head, so that their chief has to call or come in and fight the battle.

At the same time, residency is a grueling ordeal and tends to "harden" more than a few people who journey through it. You don’t want to be a jerk and then suddenly the EM doc is waking up your attending at home.

I’ve got a chief right now that no matter where I end up I’d like to imitate in such encounters. I don’t think we’re merely talking about basic social skills here either. I’ve witnessed too many residents stumble when navigating antagonistic situations in the hospital. Playing the middle ground -– being an advocate for your patients and your service, while also not getting heated -– is a skill. Maybe being aware of that fact is the first step in mastering it.

July 29, 2008 in Colin Son | Permalink


ahh, ver-ee ver-ee gooh, collin-san

Posted by: mr. miyagi | Aug 5, 2008 12:34:39 PM

Very well said. As an antique RN, whenever I run into this sort of impasse, I request that each one sketch out his/her reasoning. As they listen to each other and to my questions, their thoughts clear and, thus far, the one with the weaker case has conceeded--- and I've agreed! I've learned that I have to be my own advocate.

Posted by: witchcat | Aug 5, 2008 5:33:28 PM

as long as ur basic standpoint is that the patient will benefit the most, then no matter what u say or do will come short when anybody examines the situation at hand

Posted by: kj | Aug 6, 2008 9:28:31 AM

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