I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the clinical dilemma, and mentioned that I would speak to the kidney specialist before making the decision — and would perhaps order an additional medication if appropriate. I went back to my desk, entered a note onto the computer, spoke with the nephrologist, and we decided to go ahead and order the medication. A few minutes later, the nurse came back to me and asked: “Dr. Dhand, I saw your order and just wanted to double-check that you spoke with the nephrologist before I give that medication?”
The way the question was asked, may have come across to some as slightly condescending. I could tell some of the other doctors in the room were surprised with such a direct question. After all, I’m a reasonably experienced physician — why would I order a medicine I didn’t want to give? And how dare I be asked so bluntly if I’ve double-checked with another colleague, after I’ve already said that was part of the plan? Did this nurse not trust me?! It wasn’t even a particularly strong or toxic medicine, but one that we use every day on the medical floors.
I paused for a bit, and said: “Yes, I’ve double checked, and it’s fine to give, no problem.” The nurse, sensing this question may have come across in the wrong way, then said: “Oh, I just wanted to check because you said you were going to speak with the nephrologist … and I looked at your note, and you didn’t even mention the medication.”
Indeed, that was correct — I wrote my note just before I had the conversation. The nurse was spot on. Whether or not the question could have been phrased differently is irrelevant, and I actually found the fact that this nurse sought to clarify the issue with me, highly impressive. I passed on that compliment. Not to mention the fact that the question was based on the conscientious act of actually reading the physician’s note! A more junior doctor colleague in the room afterwards commented on how what was asked to me sounded like a bit of an affront. Actually, I said it was the opposite, and explained why. There’s no room for ego in health care, and that’s frequently how mistakes happen, and what the nurse did was outstanding.
That interaction interested me, because as someone who teaches communication, I know I myself would have handled that situation very differently ten years ago. Indeed, many doctors would have snapped right back at the nurse or taken offense that they were being so directly questioned. Perhaps even with a sarcastic response.
“Of course I have, do you think I would have ordered the medication if I didn’t want it?!”
“Yes, I’m a doctor too, and wouldn’t order a medicine for no reason. (You dare question me like that!)”
Imagine if that had happened, what the effect would have been on the nurse of being chewed out, possibly leading to not double-checking an important clinical issue in the future if they felt like something wasn’t right. A bad thing to happen to a well-meaning professional! Many doctors I’m afraid to say would have responded very differently to how I did, and chosen the latter approach during a hectic day when they already felt overloaded with questions and issues. I’m sure if you ask almost any nurse, they will tell you about countless times when they’ve been needlessly talked to in a terse manner by doctors. That’s not to say these don’t represent a small minority of interactions, but certainly enough to remember.
The one thing I feel most proud of as I’ve (hopefully) matured over the years, is how I handle situations like that. I may have always had a relatively calm demeanor, but I was definitely much more of a hot-head around the time when I finished medical school. Not confrontational, but definitely more somebody who could get into needless conflict over things like this. For anybody not working in the high-paced and frequently emotionally charged health care arena, you may not realize that run-ins, disagreements, and personality clashes are part and parcel of the job (frequently between physicians too). They happen every day, everywhere. I remember after one negative interaction I had with a colleague many years ago, I was talking to another group member, and was given some great advice. She said: “You know what Suneel, always remember the saying: Great Minds, Don’t Mind.” That saying, Great Minds, Don’t Mind, has always stuck with me. It’s so very true, in all aspects of our lives, and something I strive for every day. The very best of us don’t take offense, become hyperreactive, or needlessly be petty and escalate situations, when we could easily interpret something as a personal insult. Especially when we are all doing our best for our patients at the frontlines of health care.
Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.
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