Messy moments: Clash with a colleague

Two attending physicians – one a millennial, the other older - want different things for their patient. The former wants to discharge. The latter wants to admit.

The younger MD asks why. The older one says: “I told you we’re going to admit because [she restates her reason].”

The younger MD feels snubbed. You’ve seen similar situations before, and discharge was appropriate. This other MD disrespects because you’re younger. You really don't like being ignored. You’re tired of this. You say:

“I think a discharge is reasonable from my experience. I’d like to tell you what I’m thinking.”

But the other MD is already out the door going to her next patient…

She stops to chat with a colleague in the hallway and says, “What’s wrong with [that millenial MD]?! I asked him to discharge the patient. He argues and complains right in front of the patient!”

The two MDs are frosty when they next meet.

What would you like to happen here?

• To know that MD colleagues will listen to you and discuss patient treatment. That’s how you’ll learn more. And you may have critical information!
• To create a better relationship with this MD.
  • You want a peer’s respect and to feel you belong here too.

Create a future for the relationship

1. Arrange a conversation later with the older MD.

2. Focus on enlarging your common interests – especially valuable in common situations.

• “I had talked to the family. They were comfortable dealing with this at home. So it would be helpful for them to understand more about your concerns with any options.
• “What was your intention and your thinking about risks and priorities here?”
• [After listening] “We both care a lot about X and Z. Now I see your saw a risk of B. I was concerned with H and J.”
• Restate commonalities – said and implied, like candor, family participation in decisions, other values …
  • Commonalities usually far outnumber differences! If that’s not true in your list, dig deeper to find commonalities.
  • They powerfully remind everyone of shared values and interests.

3. Forward focus

• “How can we better serve our patients (or other shared value) the next time? I think agreeing on a few things would help us communicate information to one another better.
• “Would you agree to step away from the patient to discuss next steps?
• “Can we make room to ask each other: what else do we know? What else do we need to know? That will give us a moment to exchange available information.
• “If speed is critical, can we make sure each of us says one or two sentences we think critical for any decision?”
• “What will we do if you don’t agree on treatment?”
  • We can list together additional information or resources that will improve a decision.
  • We can decide who will do what to pursue these.
  • We can then agree on a time and place to reconvene to discuss what we learned and decide.

You turn discord into dialog.

What does this do for you and your colleague?

1. You’re listening. You show respect. You’re discussing.

• She sees you. You have valuable information, reasonable thinking and investment in the best care.
• She realizes her dismissal of millenials’ skills and knowledge belittled you.
• You soften the threat she may feel from you.
• These make the next conversation easier. Probably deeper.
• You likely create options together neither had considered.

2. Managing your own emotions and listening to the other’s perspective reduce friction.

3. Future focusing powerfully shifts you to your common intentions without criticizing or blaming.

4. You bring your voice in. This tests your psychological safety in this relationship. This is easier to try privately, away from the situation. Without determining your relative safety, the older MD’s behavior may silence you. Because that’s how the medical culture works. That’s bad for patient care. And for you.

5. Improving the comfort of this relationship increases the chances you’ll find a productive place for yourself in the practice. The quality of clinical relationships is the top predictor for clinicians leaving.

Being ignored or excluded because of stereotypes is corrosive. This kind of discomfort makes people want to leave. If you’ve experienced this, what did you do? What would have helped you resolve it well? I’d like to know. nance.goldstein@post.harvard.edu

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.