contemporary professionals
If a professional says ...
"I got you."
Beware: they rarely do.
The order is wrong.
Items are missing.
The task is incomplete.
The work isn't done.
The product is unusable.
"Get over it."
Notice that the first person itching to move on from a conflict is the very person who started it.
"... I swear!"
There is a
99.999% chance
he is lying.
beware of the spewer of superlatives
Case:
A formal meeting for allied providers to discuss provider performance to better communication and execution during codes is underway.
-
A provider fires, "That was the worst communication I've ever experienced!"
-
Another provider roars that in all her "30 years of working," regardless of whatever sign-out she receives, she always makes sure to cross-check all the equipment herself at the start of her shift.
If bombarded with such claims as “always” and “(n)ever,” be comforted that it is indeed a lie.
Caution: Refrain from minding embellished insults.
charged phrases
Contemporary culture thrives on charged phrases to subjugate others.
Whether these detonated locutions fail to be substantiated arguments are of no importance.
Only the subsequent hush over all others and the seizure of attention matters.
Case:
- Post resuscitation efforts, the medical team huddles for debriefing to better their logistics during a code.
- An allied provider fires, “I don’t feel like I was heard.”
- Having secured the expected hush among the team, the provider volubly contends that his directions were not followed.
Rather than consider that those directions were indeed heard and possibly considered ineffectual, the provider instantly launched a charged phrase to win whatever war the provider’s ego had waged against the others.
DEI - the umbrella shelters all ...?
In this season of inclusivity, ponder this:
Why must a self-contented introvert be taken out of its peaceful shell while an exacting extrovert is emboldened to remain in its gregarious one?
(hmm … guessing personality nuances are out of season …)
today's positivity
Positivity pearls from a redundantly self-proclaimed ‘most positive person in the world’:
“I feel it’s healthy to have a little bit of hate or dislike for people …”
(yep, not an ounce of negativity in that one)
"no offense." "none taken."
What ever happened to that?
Even if offense is intended, why take it?
is this okay?
5 minutes prior to the 7 am shift, the hospitalist coordinator frantically texts:
Hey all, Dr. Slack Kerr just called in sick. The jeopardy person is already covering. Can anyone come in?
team abuse
The “Team”
Boss | Senior – Sam | member A – Art | member B – Brett | member C – Chris
The Case
Boss assembled Sam and Chris to create a comprehensive summary for clients. Sam was tasked to act as a guide for Chris. Chris was solely responsible for the presentation.
FOUR WEEKS LATER during the team meeting, Boss huffs, “This is taking waaay too long. Where are we with this presentation?”
Sam waits for Chris’s report.
Chris charges, ”I’ve done everything I, I could. I, uh, tried to uh, do what you told me to do. I hope it’s what you want. Heh, uh, yeah.”
Boss peers at the document. Boss huffs, “OKAY, we need to get this together today. I have to present this afternoon. The 3 of you or the 4 of you need to address this. Whether it be you, Sam and Brett or you, Sam and Art, we need to get this together in a way that –“
Chris charges, “I tried to do everything you told me, but you kept saying it wasn’t right. So, I’ve done all that I could. I did my best, but it’s just not good enough for you. So, I can email you guys the pdfs, and you can figure it out. Yeah, I can email Art the files. But I can’t do anymore. I’ve done all that I can do. I have to work with my mom today. So yeah, uh, yeah.”
Art asserts, “If Chris doesn’t feel the need to do his work, I certainly do not feel the need to do his work. If Chris doesn’t feel responsible for cleaning up his mess, I certainly do not feel responsible for cleaning up his mess.”
Sam and Brett hurriedly assure Boss that they will complete Chris’s work right after the team meeting. Boss proceeds with the rest of the agenda then pronounces the meeting a great success.
The Conclusion
The two willing team members must scramble to complete 4 WEEKS of work IN 2 HOURS.
The Question
Was Art wrong?
(… was anyone else? … leadership … maybe? …)
personal day
You drank too much the night before after breaking up with a 3-year companion who cheated.
You are scheduled to work the next admitting shift and must relieve the current admitting hospitalist.
You are nearly forty-five minutes late already and are no where near car-ready.
There is a jeopardy, back-up call person.
Your head and heart are in tatters.
Should you call in sick?
the privilege, the surgeon
Plastics' assessment and plan:
"Sleeping quietly, not disturbed."
the quarterback
Every hospitalist team has a quarterback. You know, that one hospitalist who, no matter how few in number, accepts then passes nearly half the incoming admissions from his shift.
Consider this scenario: A quarterback accepted 9 admissions. Having failed to enter a single order or type a portion of even one H&P, he passes 3 admissions. One of the 3 passes is vertigo. Before you, the wide receiver, can finish reading the chart, you spy the ER nurse’s note: “Patient ambulated to bathroom with steady gait.” (Then there was the comfort care admission.) Before you end your shift that day, you discharge all three passes.
Like professional quarterbacks, the hospitalists’ quarterback has his unique style of passing:
You have the Star Quarterback, who can get away with a 5-cap admitting shift. The Star can make the play on any and every pending admission. … But why should he?
There is the Nonchalant Quarterback, who knows how desperately the hospital needs each pair of hands it employs. So, the Nonchalant does just enough till his shift ends. Job security is no threat to him.
Finally, up next is The Usual Suspect.
This one parades a stress, frazzled, frenzied state to Oscar award levels – every shift. Thus, he’s earned the sympathy of the entire team. In fact, the team runs more, even accepts sloppy handoffs with few grumbles.
This quarterback blames overwhelming cross-cover nurse calls for his inability to admit comparable numbers of patients like his peers. After Administration shifts the burden of nurse calls to an ancillary service, this quarterback continues his usual performance.
One night, a fellow hospitalist hands off 5 (of 16) incoming admissions to the frazzled quarterback. Finally leaving two hours past his shift, the fellow hospitalist retrieves his belongings. He passes the call room then takes four steps backward and squints through the door window. The quarterback is sacked, cozying up in sheets, blankets and a comedy. 5 admissions are pending.
Should the fellow hospitalist tally and tattle? Snap a pic and post it as a “joke”? Or, grumble and gossip about it?
artful versus absolute confusion
The legendary bewildered and befuddled weekend nocturnist unfailingly passes 5-8 accepted admissions onto the morning admittist.
With every bounteous pass-offs, the illustrious disheveled and discombobulated nocturnist would blame ceaseless cross-cover pages.
Recently, cross-cover pages were eliminated.
Still, as if never liberated from the disordering pages, the nocturnist unfailingly passes 5-8 accepted admissions onto the morning admittist.
Keep in mind that he personally caps at 5 admissions no matter the night, no matter the number.
Either way,
beware of the Confusion-ist.
pants on fire
Employer: … Did you get all of that?
Employee: Yeah, uh-huh. I got it. Yeah. … Who are we talking about?
Employer: Mr. X.
Employee: Oh, yeah, I got him right here. And why is he here again?
Employer: For x, y and z.
Employee: Yep. Right. And what did you need me to do for him?
… But you said you got it, right?
… Then why all the reiteration?
… So, why lie?
telemedicine but better!
a new take on FIFO (fly-in fly-out) medicine
Doc walks into a patient’s room.
Patient is undergoing a bedside procedure.
Doc halts at the door and waves.
“Hey, hi, how are you? Ah, yeah, you good? Yeah, you’re going to go home today.”
Patient replies, “Yeah, yeah, doctor. Thank you.”
Doc leaves.
In minutes, a full assessment and physical is uploaded into the discharge note.
Hey, who said remote medicine had to be remote?
you're not the boss of me!
… Um, but, what if he is?
Modern work culture is to foster the “friends and family” mindset. Professionals are no longer colleagues and bosses. They are dear chums and close relatives. While this creates a pleasant nest for chatter and banter, it creates an unpleasant predicament when the chum or relative neglects the whole for oneself.
Case 1: Self-Preservation
You, Dr. Site Leader, are ready to start your admitting shift. You greet your hospitalist whom you will follow then spend 20 minutes chatting and chortling about his IG story posted minutes before your arrival. Your good buddy signs out 5 admissions just as the ER pages you with more. Your hospitalist, your “work brother,” never fails to pass more admissions than he himself admits. In addition, he never manages to complete his H&Ps until after the rounders have written their notes. He’s even been cited for delayed charting by federal accrediting organizations, placing the hospital in jeopardy.
…
You may not be able to fire your brother, but you can fire the hospitalist who fails to meet the minimum expectations for completed admissions and timely documentation.
Case 2: Self-Indulgence
You and the new hospitalist hit it off like a “house on fire.” In fact, you feel as if you have known each other forever. He’s hilarious and great fun at work. That is, when he reports to work. He fancies his time and, in an instant, perhaps the very morning of his shift, he may decide to honor his personal time. Ironically, you tend to honor his personal time too because you are the back-up hospitalist.
…
You may not be able to speak against the actions from your bestie of 3 weeks, but you can diplomatically address the tendency to leave the rest of team in a lurch for the 3rd personal day taken that month.
Blurring the lines between work and friendship can lead to angst and unnecessary conflicts when discipline is required. Leaving relatives and friends unbridled primes their colleagues and bosses for burn-out, resentment, rage.
Fostering a comfortable, friendly workplace does not require fragile intimates that prevent correction, growth or advancement. Everyone will have a moment (or few) in which defiance, offense and anger will arise, requiring correction that can result in growth and advancement.
The catch is this: the workplace must level its emphasis on family ties and friendships with its emphasis on professional requirements and respect.
fake it until you make it, but ...
what if you don't make it
A Child Abuse Nurse Practitioner performed 14 out of 72 physical exams. The remaining 58 patients, per NP, denied exams. In addition, the NP perfected a convention of calling off work whenever it suited him.
The NP’s lead investigated further and implemented a corrective action plan in which the lead would directly shadow the NP’s patient encounters. The lead discovered that the whenever the NP decided to work, he frequently failed to offer a physical exam. If offered, the NP completed a deficient exam.
Naturally, the NP was peeved about the corrective action plan and threatened to leave.
NP: My official leave is in two months, but this is last day I’m coming into work.
Lead: Oh no, no, no. Your official leave is now.
titles, slurs, pronouns - a matter of if
If I know who I am, what does it matter what others say otherwise?
If others don't matter then it doesn't matter.
If it matters, I ask myself why.
new triggers
You’re Chief of Staff tasked with hiring a new doc. A paper-stellar doc presents for an interview. While conversing, you learn that 4 of 5 primary tasks for the job are triggers for the prospective hire.
You have 3 options: (a) acceptance; (b) rejection, (c) avoidance.
Opt A: Acceptance
You hire the doc and ultimately set the new doc up for failure. (For which you will be branded a sadistic punisher).
Opt B: Rejection
You don’t hire the doc to avoid Opt A’s repercussions. (For which you will be criticized a disgusting discriminator.)
Opt C: Avoidance
You politely close the interview then never communicate with the doc, pretending as if the application and interview never happened. (For which you will be resented as a dismissive coward.)
So … what to do?
self-care or self-ish
Back to Dr. Skip, the habitual paid sick leave caller:
Reference: Beyond the Body - Burn Out the Whole Just for the One
“Dr. Skip is a habitual paid sick-leave caller. Skip skipped out of shifts for common colds, minor headaches, tummy aches, mild UTIs (treated with cranberry juice and rest) and inundation.”
If Skip is not able to work in a field that requires him to work where other people’s lives depend on him, then he may require a job in which he is not responsible for other people’s lives.
Perhaps Skip could consider a less responsible occupation that still imparts a sense of usefulness.
Perhaps Skip could sell shoes. Everyone needs shoes. Fortunately, other people’s lives will not hinge on whether Skip feels like selling that day.
One caveat, Skip:
Yep, you have to dump the title – no more Lifesaving, Frontline Hero. (But hey, you can call off anytime you’re not in the mood to work.)
title. paycheck. work? for what??
Since 2016, no one has seen a certain ortho doc.
The ortho doc fashioned remote medicine fashionable before it became fashionable.
Doc simply phones the patient, conducts an assessment, and concludes the consultation with patient refusal of surgery.
Coincidentally, all the ortho’s cases refuse surgery.
follow's thumper's* lead
*Bambi, 1942
A text thread among the hospitalist site leader, the hospitalist coordinator and the hospitalist is underway:
The hospitalist is enraged by the fouls habitually committed by the notorious nocturnist, who almost never seems to be able to complete his assessments and plans.
The hospitalist waxes bluntly about the moronic magnitude of the moron to both his site leader and coordinator.
Inarguable Truths:
~ We have opinions about our colleagues.
~ We don’t like some of our colleagues.
~ We disagree with a good number of their assessments and plans.
Still, our colleagues are not our underlings.
Arguable Assertions:
~ Even if they have earned their scorn, as a lateral professional, shouldn’t we fight the desire to belittle them, particularly before our leaders and impartial administrators?
~ The reading of that person may be absolutely, inarguably right. However, as a professional, is it absolutely right to make everyone else feel uncomfortable with your personal grievances?
Lingering Arguments:
~ Is the hospitalist willing to confront the target of his ridicule?
If so, will he turn confrontation into a destructive or constructive opportunity?
~ Is there anything leadership needs to do?