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“Doctor, I am just double-checking … “

Learning to not take offense

November 2018

Published in the November 2018 issue of Today’s Hospitalist

I WAS RECENTLY seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, trying to balance hydration with the need to get rid of excess fluid, and things were not going so well.

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 a decision—and that I would perhaps order an additional medication, if appropriate. I went back to my desk in the workroom area, entered a note in the computer and spoke with the nephrologist. We decided to go ahead and order the medication.

A few minutes later, the nurse came back and said: “Dr. Dhand, I saw your order and just wanted to double-check that you spoke with the nephrologist before I give that medication.”

An impressive need to clarify
The way the statement was phrased may have come across to some as slightly condescending, and I could tell that some of the other doctors in the room were surprised.

There shouldn’t be any room for ego in health care because that’s frequently how mistakes happen.

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 already said that was part of the plan? Did this nurse not trust me?! After all, it wasn’t even a particularly strong or toxic medicine, but one we use every day on the medical floors.

I paused, then said, “Yes, I’ve double-checked, and it’s fine to give, no problem.” Sensing that the statement may have come across the wrong way, the nurse then said, “I just wanted to check. You said you were going to speak with the nephrologist and when I looked at your note, I saw that you didn’t mention the medication.”

That was indeed correct; I wrote my note just before I spoke to the nephrologist. The nurse was spot on, and whether or not the interaction could have been posed differently is irrelevant. I actually was highly impressed that this nurse had sought to clarify the issue with me, and I passed on that compliment. Not to mention the fact that our brief conversation was based on the conscientious act of actually reading a physician’s note!

A more junior doctor in the room afterwards commented that the double-check sounded like a bit of an affront. Actually, I said, it was the opposite, and I explained why: There shouldn’t be any room for ego in health care because that’s frequently how mistakes happen. What the nurse did was outstanding.

The ripple effect of taking offense
As someone who teaches health care communication, I have to admit I would have handled that situation myself very differently 10 years ago. Indeed, many doctors would have snapped right back or taken offense that they were being directly questioned.

But if that had happened, imagine what the effect would have been on the nurse from being chewed out—possibly never double-checking an important clinical issue again, even when something in the future doesn’t seem right.

I’m afraid that many doctors may have responded differently, going for pushback or sarcasm during a hectic day when they already felt overloaded. I’m sure most nurses can tell you about the times they’ve been needlessly talked down to by doctors. I’d like to believe those represent only a small minority of our interactions, but I’m sure they’re certainly enough to remember.

“Great minds don’t mind”
The one thing I feel most proud of as I’ve (hopefully) matured over the years is how I handle just such situations. I have always been relatively calm, but I was definitely much more of a hothead around the time I finished medical school. Not confrontational, but more of someone who could get into needless conflict over things just like this.

Anyone who doesn’t work in this kind of fast-paced, frequently emotionally charged arena may not realize all the run-ins, disagreements and personality clashes that are part and parcel of the job—frequently between physicians as well. They happen every day, everywhere.

After I had one negative interaction with a colleague many years ago, another group member gave me some great advice. She said, “Remember, Suneel: Great minds don’t mind.” That saying has stuck with me, and it’s something I strive for every day.

The very best of us don’t take offense, over-react, or opt to be needlessly petty or escalate situations because we’re too quick to interpret something as a personal insult. Especially when we are all doing our best for our patients.

Suneel Dhand, MD, is a physician, author, speaker and co-founder of DocsDox, a company that matches physicians looking for moonlighting and per diem work with hospitals. A hospitalist, Dr. Dhand is also the founder of DocSpeak, a health care communication coaching company. This commentary was reprinted from his DocThinx blog.

 

 

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Tom Doyle MD
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Nice piece – and I like the observation that you were impressed that the nurse had actually read your note! In my own experience I get a fair number of pages with questions that conversely could have been answered if the nurse had looked at my note in the first place…