Systems based care

A while ago, I attended a social event with some of the support staff. I was actually quite surprised to be invited. After all, the staff and the physicians sometimes don't get along so well, and so there's can be a little tension. We talked quite a bit about the different residents and doctors, and it got me thinking about multidisciplinary care, and how sometimes we judge each other on everything but medical ability.

My mom is a nurse, so she always told me that I have to be nice to the staff, and I should always be on my best behavior, and never mean or rude. She would always remind me of my pediatrician growing up, who was a saint of a man.

So I've always tried to be on my best behavior with the nurses and staff, because they are not paid to put up with attitude from me. And I believe that people who like you will help you. Case and point, when I was rounding in the hospital as a resident, one of the interns was presenting, "The patient hasn't had a bowel movement in 2 days and—"

"Wait a minute," I broke in. "Tracy told me that he had a BM yesterday evening, and now he's got diarrhea! I asked her to send a sample." Sure enough, we walk in the room and there is that wonderful smell of melena. The intern asked me after rounds how I knew the patients so well. "The nurse spends all day with the patient. You should try talking to them."

Anyway, back to my original point, whenever I hear nurses complain about doctors, I'm always surprised, because it is often things that the doctor didn't even realize that have earned him such scorn. There's an asshole surgeon who walks around with a coffee all the time the nurses would mock him and his coffee cup behind his back. When I talked to him one day, he thought that he was beloved.

One social worker thanked me profusely for meeting with a family, because another resident was supposed to do it but was called away. Why was she glad it was me? Because the other resident comes from a culture where you don't make a lot of solid eye contact, so he doesn't look patients or family in the eye. And everyone thinks he's pathologically shy or else trying to hide something.

I have seen excellent physicians hated, and incompetent physicians loved by staff, as well as the converse: I've seen great nurses despised and horrible nurses loved by doctors. It took me a while to realize that our ability to interact productively with other health professionals is a skill in and of itself, and multidisciplinary care isn't something you can just assume (so much so that systems based care is part of all residency curricula). So for my part, I try always to be polite and cheerful, and only to be critical where it's appropriate.

And sometimes, when I'm not sure, I'll call my mom. One time, a nurse called me with a low BP of 87/53 (so obviously a machine value, since people almost always report even numbers or multiples of five), so I asked if she rechecked it. She acted like I asked her to part the Red Sea. "Why don't you get up here and recheck it?"

When I got home, I called my mom and asked her, "This nurse called me with a low BP on a patient, and so I asked her if she rechecked it but—"

"—and she didn't recheck it, right? Well, I'll bet she didn't check it the first time either. The tech probably did. She probably didn't do a manual either. That's just plain lazy." I love my mom.

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