Director’s Corner: Slow boil

Late arrivers and power politics, all in a day’s work

 

When colleagues or medical staff are rude or even conniving, what is the best approach for conflict resolution?  

Boss:
I always try to show up to work a few minutes early. Just common courtesy. But I have one partner who consistently shows up 15 minutes late. I end up taking extra patients and having to stay over to finish them up. When I asked him about it, he said I can go home any time. Am I being too picky?
-Dr Slow Boil

Dear Dr. Slow Boil,
First, let’s make one thing clear: never leave a shift before your relief arrives. And that doesn’t mean passing in the parking lot. To do so could be construed as patient abandonment and could result in the loss of your medical license. Almost as bad is the 30 second sign-out that leaves questions, and patients, hanging in the air.
Now, that said, having colleagues consistently show up late is certainly one of the most frustrating things we face. When you decide to enter into shift work as an emergency physician, you automatically agree to a life where you punch a time clock. I’ve worked with people who believe arriving late to work is not being there 15 minutes before the shift starts. At the very least, on time arrival means being ready to see patients at the start of your shift—not arriving a few minutes after shift change and then needing to get a white coat and a cup of coffee and socializing with staff. Coming late to a shift is disrespectful to your colleagues, delays patient care, and contributes to ED clogging.

I do appreciate your willingness to pick up extra patients but perhaps only the most critical should be started and the rest can either wait (not ideal) or you can see briefly enough to allow a work up to ensue and then have your colleague take over. Although I think individual physicians should be able to discuss their feelings and frustrations with their colleagues when they show up late, ultimately it’s up to your medical director to reign in your colleague and get him to show up on time. I’ve heard of some emergency departments getting creative with their sign-out problem, such as levying a fine to late comers. Some departments have the late comer pay the person their relieving out of their pocket twice as much as the hourly rate for each fraction of the hour that doctor must cover. Other departments go as far as firing doctors for showing up late too many times. Ultimately, you’re not being too picky as we should all expect our relief to show up and be ready to work on time.

Boss:
I’m the medical director of a mid-size ER and I have an intensivist who frequently complains to our hospital CEO about the ED. These are vague complaints but somehow it seems that I end up reporting medical care to the CEO. When I’ve reviewed cases, I usually feel our care has been appropriate. Please help me to sort this out.
-Under Attack

Dear Under Attack,
I call this the Dr. H (as in hemorrhoid) maneuver, named after a surgical subspecialist I used to work with at a previous hospital who was a real ‘pain-in-the-arse’. By going to the CEO, the specialist, in your case, the intensivist, gets to complain about the ED but never really has to discuss the specifics. By complaining to the CEO he’s trying to undermine your CEO’s confidence in you. It’s a not-so-subtle tactic to make you afraid of upsetting the intensivist. It’s pure power politics. Don’t start a war if you can’t win it. Rather, you must take an aggressive approach to heal this relationship. First, respond directly to the intensivist and send a copy of the email to the CEO. Be professional, even kind, but not apologetic. Stick to the facts. Forget the feelings. Next, contact the intensivist directly to discuss the cases. Ask for specifics and get details. Afterwards, make it clear to this doctor that you are always available and it’s best to discuss his issues in as close to real time as possible to allow you to make appropriate interventions. Moreover, you can remind the intensivist that the CEO may not appreciate being placed in the middle of a clinical issue. Afterwards, report back to your CEO that you and the intensivist are dealing directly with the issues. In most cases, he will appreciate your inititative and having one less problem. Finally, any problem that the intensivist gives you, you must deliver an answer. Sometimes he may be right. And if you handle it correctly, you might even earn his respect. Relationships like this can be mended but it takes time, communication, and the willingness to put personal agendas aside and work towards better patient care. Good luck as we’ve all been there.