When did people’s feelings start mattering more than patient safety?

www.kevinmd.com/blog/2019/04/when-did-peoples-feelings-start-mattering-more-than-patient-safety.html

As an elder millennial physician, I’ve been straddling two worlds, that of the “old-school” mentality of training and this newer one of “wellness.” I’ve become disheartened with new physicians being increasingly unable to tolerate any criticism by teaching faculty, even when patient harm is at risk. However, it wasn’t until I was accused of bullying and bullying exclusionary by a group of colleagues — not trainees — that I grew completely fed up.

Merriam Webster defines bullying as the abuse and mistreatment of someone vulnerable by someone more powerful. By definition, there is no power differential between my colleagues and myself. I am in no position of power — purely clinical physician at a community-based teaching program. I have been told that while there is no “factual evidence” to base these claims off of that it is, perhaps, the “perception of my tone” and my “intimidating nature” that are to blame.

It is known to most of my colleagues that I have exceptionally high standards when it comes to patient care, my signouts are very detailed, I pose lots of questions and ask about exam findings, etc. This style of signout is not only targeted at those who have been known to miss things or have cases go before our performance-improvement committee but extends to my close friends and physicians I would trust with my family’s lives. Patient handoff is the most dangerous time for the patients, and I take it seriously. My intent is not to intimidate others, and there is no subtext of criticism. At what point am I in control of the perceptions of others and at what point are others projecting their own insecurities onto my clinical questions? I welcome all clinical questions about my patients as I want to ensure the same focused care for them after I leave. If residents ask about changes I suggest to their management, I let them know if things they were doing could or did cause patient harm — because that is a paramount part of their education.

When did people’s feelings start mattering more than patient safety? If the goal is to create a work environment where everyone feels safe, including patients, where does that leave me?

I have been told many that I am intimidating, but never before in a negative light. I have exemplary blinded resident evaluations. I have been told that my high expectations push residents to be better, more thorough and efficient clinicians. Many a female resident has told me what an inspiration I have been to them as a strong female role model. Many a colleague, as well as nursing and support staff, have told me they would entrust or have entrusted me with the care of their loved ones to me, so I have to assume I’m not that intimidating — right?

People would also not describe me as a social butterfly. I have a small group of friends at work I socialize with outside the hospital. I have courteous professional relationships with the other faculty. I work similar shifts as these close friends, does that mean we exclude others? I would argue that by a group of us working a similar typically undesirable shift, we have developed excellent teamwork and ways to support each other as we work with limited resources. When people who do not typically work these shifts join us occasionally, they are welcomed and sit with us and enjoy this same support. Does my special bond with a few attendings really cause distress for others?

Does being demanding now equate with me being a bully? I would argue not. Does that give the others I work with the right to associate this HR terminable phrase with my name without any evidence — definitely not. The same people claiming I am contributing to their “toxic work environment” are essentially creating that for me. What recourse do I have? It seems that everyone’s feelings about this matter except mine. I have asked for ways to improve perceptions of others and my superiors had nothing to offer.

Interestingly, now I am the one who feels targeted, under a microscope and unsure how to proceed. If I were in extremis, I’d hope the doctors taking care of me cared more about my care and less about their feelings towards each other.

Filed under: General Problems