Everything we do in medicine is (or should be) for the good of the patient. The physician crafts a diagnosis and treatment plan so that the patient can get better. The nurse administers medications to improve the patient’s symptoms. The ancillary staff responds to patient requests, and keep the rooms tidy, all for patient well-being. “For the benefit of the patient” is the ethos that drives everything we are doing.
Yet sometimes things we do are not in the patient’s best interest, nor in the interest of each other. In fact, they can have a negative impact on patient care. I found myself in one of these scenarios while rotating through an offsite operating room.
I’d been given the simple task of drawing a couple tubes-worth of blood from my anesthetized patient for the purpose of a research study. We had dependable arterial access, so obtaining blood would be a piece of cake. The more difficult part is delivering it in such a way that pleases the lab in order to get the test run expeditiously. I’ve learned (the hard way) that if a specimen tube gets sent up with an extra 0.2 cc of blood, the lab might reject it. This inevitably leads to a 15 minute delay as we find out the sample has been rejected.
I politely ask the nurse in the room, who has been working here for roughly 30 years, how much blood is needed, to which she yells, “Your attending is supposed to tell you that! You know he’s absolutely the worst attending.”
Okay then. I can let one outburst slip without taking too much issue with it; we all have bad days and sometimes tempers are shorter than we’d like them to be.
I call the attending and ask him how much blood we need for the samples. He has only been working here for a few months, is not well-acquainted with this particular research study, and rather than give me the wrong information, tells me that the circulating nurse probably knows.
When I go back to her and let her know that my attending is uncertain, and that he has directed me to her for an answer, it’s as though we’ve committed an unforgivable sin. “You know? Get him in here! What is his problem? He’s the worst. That guy is the worst attending here. Does he know anything?” She continues to express her extreme frustrations to me, leaving me in a bit of a pickle. I feel compelled to say something now.
“What would you like me to do? I’m not going to jump on the bandwagon and denigrate him with you. I’m not going to pick a fight with you in his honor. I’m not a punching bag for your frustrations, and you are putting me in a very difficult position here. What can I do?”
“Just listen,” another nurse in the room instructs me.
All I really care about is getting this sick patient through their spine surgery safely. I haven’t the desire nor energy to get involved in whatever pre-existing conflict exists, but despite any level of focus I try to maintain, it is impossible for me not to devote some of my mindspace to this tension between colleagues.
Questions run through my mind: Why is she being a curmudgeon? Is my attending less than stellar? I don’t think so; he’s been helpful and given me good guidance and teaching throughout the day. Do I tell someone about this? Should I have dug my heels in harder and fought? Or said nothing at all? I still don’t even know how much blood I need to put in these specimen tubes!
When my attending arrives, the angry nurse tells us, “4 cc’s total, 2 cc’s in 2 tubes.” That was it. That could have been said to begin with, but now there’s anger and frustration and bovie smoke in the air.
This behavior has no place in the hospital. It doesn’t matter if you have worked at the institution for 3 decades and have climbed the ranks, or if it is your first day in the hospital as a medical student. Everyone deserves to be treated respectfully, and by employing these ideals, our patients will do better.
So why are we still gossiping? What’s to be gained from picking fights and calling the clinical acumen of others into question?
Perhaps it’s the desire to form some level of connection, no matter the cost. If our shared interests and mutual respect aren’t enough to bring us together, maybe our shared frustrations with Dr. X will forge the bond. Others might talk trash to make themselves feel better about their own insecurities. Maybe it’s an attempt to push the blame on someone else for a negative outcome, whether or not it’s happened yet. Dr. Y is a terrible surgeon, so of course the case is dragging; his patients never do well.
Among the most innocuous reasons that we lash out at each other, whether directly or behind closed doors, is as a crooked sublimation of the heavy toll of this line of work. People are often trying to die before our eyes, so pleasantries and smiles can fall to the wayside as stress and fear cloud our judgements. Not that it serves as an excuse, but critical situations can be hard to navigate eloquently.
What, then, can we do with our interpersonal frustrations? If you absolutely believe that a coworker is the worst at his role, don’t plead your case to his subordinate. If it’s putting patients at risk or is a legitimate professionalism issue, tell the powers that be. Every hospital will have a dedicated outlet for such transgressions. If it’s your own personal qualm because you don’t like the cut of someone’s jib, if you must, keep it between you and your friends at the lunch table. Or better yet, keep it to yourself, and we'll all have a better day. Most importantly, we can put our combined focus on taking care of the patient in front of us. Isn’t that why we all showed up today anyway?
Brian Radvansky, MD is an anesthesiology and critical care resident and blogs at the Med School Tutors’ blog. He is also a 2018–2019 Doximity Author.
