‘Sorry’ she said with a half-smile. ‘He speaks to everybody like that,’ and then ‘but, I just wanted you to know, I thought he was rude’
I said thank you to the nurse for telling me and I was grateful to her, because I didn’t know anyone there really yet and I thought maybe it was just me.
It had been a long time I thought since I had felt that sort of incivility from a member of my own team, a long time since I had felt vulnerable. We get used to the sort of occasional friction between different teams and the different priorities we all push, within the overarching shared goal of patient centred care.
I think it just feels worse when it’s your own team.
Incivility made me unproductive that night. It made us a less functional team. When I offered suggestions, I found myself looking at the floor. If you know me, you would know that isn’t like me; I am not the sort that is afraid to use their voice. Faced with a situation where I was also less confident clinically, I found it harder to speak out.
Obviously, there was a patient between us, so I persisted. When I suggested something that was actually an OK idea, as it turned out, the nurse in charge beside exclaimed in an over-animated way, ‘that is an excellent idea!’ and I wondered if she did that mainly because she also thought ‘he speaks to everyone like that’.
A consultant I have learned a lot from has often told me that it takes two people always, to have a productive exchange. So, I look for my own part. I know that when I arrive at an emergency I will think out loud. I verbalise differentials, I often verbalise them as undirected questions
Could this be a pneumothorax?
What are we missing?
Metformin could cause that sort of lactic acidosis.
Once I said that last exact sentence beside a renal registrar when we were trying to puzzle out a particularly confusing case in resus and he snapped back at me: ‘I’m aware what metformin can do’
I told him; I’m not trying to teach you anything, I’m just thinking about differentials out loud.
The nurse had told me that the other registrar who had appeared to me so uncivil that night was more likely to speak like that when he was ‘stressed and didn’t really know what was going on’
And I think you know, not knowing is OK; we often don’t know exactly what’s going on in an emergency, but we work through it. That’s what a team is for.
And I also think that if you can’t control the way you speak to people in an emergency then maybe you should pick a speciality within our profession that has fewer emergencies.
You’re going to ask me what ‘I’m doing about it’. Have I given them a chance to know how they made me feel? The answer is, I don’t know. I move around so much these days, perhaps I just have to pick my battles.
By the Secret Doctor
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That's appalling! They must have learnt that behaviour from someone else in their training, I don't know. It's very difficult to deal with. Bullies are essentially cowards and back down when confronted (not always). I was spoken to a few short years ago by a young consultant in an emergency situation. I beconned them away from the scene and explained (somewhat forcefully I regret to say) but away from others, that they should never talk to me like that again (or words to that effect). They never did. Subsequent to that encounters were very civil.
Can be very distracting when you are systematically assessing and thinking through, to have someone else blurt out random differentials and ideas. That's when it's time to take a step back and discuss logically as a team, starting right from the patient's first presenting symptoms.
Interesting (I find) - your assumption (in comment below) that there was "blurting" of "random differentials" ....and that it would not be logically ordered....or start from the beginning
The Secret Dr
Don't be so quick to judge, we are all human, one day that might be you.
It's a shame that you have taken anon's comments as a personal attack. In your piece, I see that you have not taken the opportunity to reflect back on how you could have modified your own actions & communication in what was obviously a stressful circumstance for your registrar.
Sorry, I do sympathise with your distress but I was waiting for the punchline. I gather it was his statement that he knew the side effects of metformin?
In my first pre-reg (paediatric} job, the senior reg took every opportunity to belittle and mock me. E.g. "You're just a joke!)" "You want to be as clever as these hosp porters - all as bright as buttons!"( Maybe he fancied them?) All I know, is that those were the longest 6 months of my life - I had no "buddy", being the only junior on the team - same applied to ENT so we covered one another during time-off. I was so frankly scared of taking blood from newborn babes and little children that I used to hide when supposed to take these samples. When Dr L and the equally snotty staff nurse went off for coffee, I would tremble my pathetic way to the Sister;s Office. Tiny, 60-ish, very blunt and very heavy smoking including in her room on the ward, she was always most kind to me. For instance, she showed me by example how to wrap up a baby, hold its head slanted downwards and take a jugular vein sample. The babies always cried a bit, which made the blood-taking easier. I became quite adept it, and that sister will always be someone for whose friendship and understanding I remain highly grateful.
No offence taken. For clarity he wasn't my registrar. we are both registrars.
It difficult to reply consistently with the anonymous comment set up here. To clarify no it wasn't about the metformin, that was just an example from a different time.
The secret Dr
if you cannot take the heat......
For what it's worth (and I'm mainly commenting because I'm feeling pretty angry at the comments that appear to have fingers pointed at the secret Dr suggesting it was their fault) I'm going to put my tuppence worth in. It's shit when you feel belittled, it's been shown to be less beneficial on outcomes if seniors (and I appreciate you mentioned that you are at the same level but i would imagine it applies) are dismissive & rude, and bullying is absolutely not okay. Good on the nurse for having your back, particularly in a place where you're clearly new, but really she shouldn't have to, because that kind of behaviour is not okay. Wherever he learnt that behaviour, and for whatever reason it is, it's his responsibility to sort it out. But also sort of somebody's responsibility to call him on it at some point because sometimes these people just don't get it....
To whomever made that heat comment:
I think you must have mixed up your copy of grey's anatomy with Delia smith's latest cookbook. You are looking at the cooking instructions for a turkey escalope.
Whereas displacement and acting out are immature ego defence mechanisms, humour is a mature tool to diffuse tense situations.
This is unfortunately the case in many NHS hospitals. Bullying should be stamped out and the senior leaders (sadly some of them are the culprits too) need to improve the culture within the NHS.
Try renaming your blog The Secret Snowflake.
It shouldn't be distracting to hear people "blurt out differentials" - it's a team approach and not a time for thinking within - if you don't vocalise your thoughts to the team how will you ever know if one of them had a better idea? We educate all our medical students to think out loud - if you need time to think then you can just politely say I'm just going to think this through for a second - no matter what level you are you should always (in an ideal world) be able to voice your opinion in the interests of patients care - see human factors and the Elaine Bromley story. Thanks
Hey, I am sorry that someone made you feel bad just because you were doing your job. Initially when I started working in NHS almost one year ago I faced it a lot at different levels. Most of the times I felt maybe it's just me but later on I got to know that it happens even at consultant level too. If you don't answer back to bullies , they do this to you or you have to talk to them in person, but there are so many bullies supported by bullies in NHS that you can't feel better if you are a sensitive person . We as a team should be as kind to each other as we are to our patients (plus as we like to be treated).
And if you have got a good and supportive team with no politics then you are really lucky.