My first consultant was a charming white haired Irish man who was one of those doctors that seemed to make patients better with his very presence. When people talk of a “good bedside manner” I think he was the kind of doctor they refer to. He was not shy in praising us, his junior doctors, usually in front of the patients. I was also terrified of him, and in retrospect he had a profound influence on my style as a doctor, although it has been difficult for me to match his charm and Irish accent (sadly, I used to have one, but try being the only Asian kid in a school in Aberdeen who said “tirty tree and a turd.”)
Over the years, magpie-like, I have observed the best and worst of consultants, registrars and other junior doctors, and borrowed the behaviours of those I liked, whilst trying to avoid the attributes of those I didn’t. The clinical lead of cardiology, who seemed to be able to chat with patients genially, in the most efficient of ward rounds, whilst helping me with the occasional discharge letters, so that I could “get on with something more important.” The medical registrar, with a black sense of humour, who seemed to know everything, and introduced me to uptodate.com. The professor who was courteous and comprehensive in his approach, yet enlivened by the “fascinating breadth of geriatric medicine” even in the months before his retirement. In addition, there have been numerous geriatric medicine consultants who have been role models, both in their diligence with their patients and their support of my career – one consultant from my previous hospital tracked me down via switchboard of my current one on a Friday evening so that he could give me last minute feedback for my CMT application, whilst another seemed more upset than me when it looked like I wouldn’t get my first choice rotation for my geriatric registrar post.
Despite the blank spaces in my eportfolio, I have reflected on my experiences and spent much of my time supervising junior doctors attempting to live by the motto “treat others as you would want to be treated.” I considered how other people had got the best out of me, and, in turn, how I might the best out of others.
So, on my ward rounds, I teach – a lot. I chat to my juniors, and try and find out what type of people they are. I think it is important that we know each others’ names (although I’m bad with remembering them, and recently introduced my FY1 to a patient as “Fattoush” – a Lebanese salad), a little about who we are as people, and find some time to have inane chat.
On night shifts, I bring lots of chocolates and sweets to the first shift, suggest that others do so for the rest of the shifts, and that we try to spend at least 15 minutes getting together where a “no-work chat” is strictly enforced – the temptation to moan about tedious events is too great. I usually find that people may be reserved on the first night shift, but by the last shift are happily swapping stories and snacks. This means that work is just a touch more enjoyable, that tedium or stress can be lubricated with banter (sorry –it’s an awful word, but you know what I mean), that people are comfortable asking for help yet are more likely to help each other out. Without quite considering the reasons why, I believed, and still do, that “social capital” is important at work.
Like that first consultant, I try and praise people where possible in public, and rebuke them in private. Being embarrassed on ward rounds by some consultants I encountered has stuck with me quite deeply. Perhaps I am overly sensitive but it’s hard to forget these occasions and I would have much preferred to be taken aside for the required feedback – which I would welcome – I want to know how to improve.
As well as teaching, giving feedback and trying to find some fun in work, I also think it’s important to stretch people. When I quiz my FY1 on their views on escalation of treatment or when a patient can go home, they may tell me “that’s not my decision to make.” I ask them to imagine that it is before talking through the rationale for these types of decisions. I used to give people homework (!) consisting usually of important journal articles that covered topics encountered at work. I think it’s very important for people to push themselves, to move outside their comfort zone.
I reconsidered some of these approaches a couple of years ago when I succeeded in making three junior doctors cry in quick succession. On one occasion, I had a particularly busy night shift and the daytime FY1 had made it much busier. I was searching for “bed 6’ with an AKI when they had moved bed, I reviewed a patient who was septic and had no cannula let alone antibiotics prescribed, and encountered several other minor omissions throughout the night. By morning I had calmed down, but took the FY1 aside to give what I thought was some measured feedback on how she could improve. She was very apologetic, genuinely so. The registrar had been off the admissions ward all day and the SHO was struggling with the volume of admissions, leaving her unable to ask for help on her very first shift on call in medicine. I could see that this was a thoughtful and conscientious doctor, who hadn’t had much support the previous day, and ended our conversation by telling her not to worry, but to reflect and improve in the future because this level of performance wasn’t acceptable.
Pleased with myself for not jumping to conclusions and not completely losing my temper, I went to get my coat from the doctors’ office where I found her sitting sat the table, inconsolable. Things had gone even worse than she had feared. She had been expecting her first on call shift to be tough but to be left alone like that had been her worst nightmare, and here I was, confirming all her fears about her substandard level of ability.
She soon proved herself to be a caring and highly competent doctor, but reflecting on this event with one of my friends later, it was pointed out how intimidating a usually friendly senior registrar giving you fiercely negative feedback could be. I had been on the receiving end of this kind of feedback, and worse, in the past. Didn’t people just need to toughen up a bit?
It’s taken me a long time to figure out, and it seems so obvious when you type it out, but what I have come to conclude is that people are different. And this means that treating everyone how I would want to be treated is only the right approach for some people, those people broadly similar to myself, who are probably a minority of the people I meet. Whilst personality typing like Myers-Briggs is rightly criticised for its lack of validity (amongst other things), where considering personality type might be useful is to introduce the concept that people prefer to work in different ways, prefer to receive information in different ways, prefer to receive feedback in different ways and have different motivations.
A simpler model to apply in everyday work and life is the social styles model. In healthcare, with our rapidly fluctuating teams it is hard to take the time to assess how best to get the best out of different individuals, but at least having an appreciation of this is important.
So some people may prefer working alone, may not like being grilled, may not want me to be their friend, may not want to go for a drink after work, may rather eat lunch alone, may find moaning about work very therapeutic, may get embarrassed if praised in public and may be very sensitive to critical feedback, even given privately – in short may have preferences exactly the opposite of mine.
The answer is clear – take some time to assess the situations and treat people how they would want to be treated, not how you would want to be treated, in order to get the best out of them. If I was to give that FY1 I mentioned earlier some feedback today, I would have asked her how she found the on call shift, realised she was trying to do a good job, sympathised with how difficult these situations can be, given her some tips on what she could do better, and avoided criticising her at all. She was already criticising herself.