Messy moments: Physicians productively address relational problems so that it’s better for everyone

MESSY MOMENT: What would make your GenY/millennial happier at work?

Millenials flaunting rules because they see a better/easier way

A junior MD enters the room of a patient who may have COVID. The MD has no PPE.

When asked about this, he says that the (experienced) overnight physician had probably ordered testing as a knee-jerk reaction. He says, based on his information, "all this stuff is really a waste of resources."

You must talk with this MD. What do you do?

What would you like to happen here?

You decide your own intention. Useful directions here include:

1. To understand others’ perspectives and to express that you value others’ Points-of-view
2. To find a way to speak meaningfully and supportively with the young MD to draw him into the care group and at same time to reduce his assumptions and ‘othering’ the older, overnight MD
3. To create a safe container for candid conversation, reprimand-free. So each feels heard and understood and can see The Other’s perspective
4. To promote a culture of learning where everyone learns from each other

Use multi-generation discussions to reveal assumptions and preferences for more productive relationships

1. Make every conversation multi-generational if at all possible so together you reveal and understand differences and identify commonalities – because both are critical
2. Ask everyone to re-consider their assumptions and judgments about others’ motivations. Ask: ‘What was the context last night?’
3. Ask ‘What could [each of you] have said or done differently so the hand-off fostered understanding?’
4. The younger MD may prefer an electronic note that includes the Why. The senior MD may prefer talking directly with the MD. Create a plan for next time. Together they may agree
   1. That the probability of COVID was low, yet
   2. It’s critical to follow precautions strictly until test results are known because everyone’s safety is vital. And discuss where they have choices.
   3. In future they’ll meet in-person for 2 minutes to handover all patients or…
   4. Each feels heard and validated. They have a real conversation, so it's easier next time. They build a foundation for collaboration.

What does this do for you and your practice?

• Millenials (born between 1981 and 1996) are now half of all US nurses and a third of our MDs.
• Young generations have a much higher share of people of color than each older generation. Most millennial physicians are women. That means that attitudes, assumptions and misunderstandings may be complex. Feeling safe and belonging to the care group become even more crucial when multiple sources of bias and exclusion are present.
• Unsuccessful communication among generations is understandable. The generations were raised with differing values, priorities, cultures. Expectations of the job, the care group and themselves differ. Without exploring assumptions and communications styles, some in the practice will feel excluded and ignored. That is unacceptably costly. It triggers misunderstanding and mistakes that jeopardize patient outcomes safety. And younger people will leave – which takes a toll on everyone who remains.
• Millenials want to be told the information they need candidly. They want to know what is expected of them. This critically helps them deal with medicine’s highly uncertain, complex and high stakes moments.
• They want to be respected and to be listened to. This starts give-and-take relationships and dialogue that enable them to ask and learn while on the job.
• This softens frictions and conflict so it’s a calmer place to work.
• Respecting varied PoVs reduce burnout – theirs and yours. It replaces a harsh hierarchy telling them what to do.
• Engaging everyone in the common mission unleashes their contributions and energy for patient care.
• This can be done anywhere (though it helps if it’s quiet and focused) in a short time – rounding or after-shift huddles.

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