Editor’s note: First of a two-part series.
Think about the last time you found yourself in the middle of a contentious conversation with another doctor about whether a patient should be admitted by you, the hospitalist, or by a doctor in another specialty. Such conversations can sometimes move quickly from respectful disagreement to posturing, drawing lines in the sand, or worse.
Respectful conversations between doctors with differing opinions about the best plan of care for patients are valuable. But disagreements that lead doctors to talk at rather than with each other risk creating quality-of-care issues for the patient, demoralize other hospital staff, and can result in lasting harm to the relationship between the doctors involved. I’d bet the frequency of such disputes could serve as a reliable predictor of overall quality of care, and might correlate with cost of care. Doctors in all specialties should work diligently to reduce the chance that such conversations lead to conflict and stress.
This conflict arises most often when an ED doctor is calling about a patient needing admission; the way communication between ED doctors and other physicians happens nearly everywhere is one reason the problem is so difficult to eradicate. (To be clear, I’m not faulting ED doctors for causing this problem; I think they usually try very hard to prevent it.)
Because the ED doctor is often in the middle of the chain of communication (disagreement), those whom the ED doctor is asking to admit the patient often are emboldened to take more unreasonable or extreme positions. It is a lot easier for Dr. Perry to make a case to the ED doctors that Dr. Mercury should admit a patient than to present the same rationale to Dr. Mercury himself. In many cases, the ED doctors can make the problem go away, or at least extricate themselves from the disagreement, by insisting that Dr. Perry and Dr. Mercury speak directly to each other.
Of course, things can sometimes go so badly that they refuse to speak directly with one another and force the ED doctor to settle the dispute a power given to the ED doctor by the medical staff bylaws at nearly every hospital. Or maybe they do speak directly and that leads to greater conflict (i.e. shouting or an abrupt hang-up).
Improved Social Connections
Most hospitals I’ve worked with seem to feature harmonious and collegial relationships between the ED doctors, hospitalists, and other specialties. But for some, divisive conflict crops up frequently. A first step for those hospitals laden with conflict could be to deliberately work to improve the social connections between the physician groups that often disagree. I’m not Pollyannaish; sometimes relationships are beyond repair, or one of the doctors involved might have a character disorder that requires more significant interventions.
A few years ago, I visited a place where years of conflict between ED doctors and hospitalists had led to remarkably adversarial relationships. Both of the lead physicians for the ED doctors and hospitalists were pleasant, professional, and highly regarded by others. Nonetheless, they both were fed up with the ongoing conflict and found themselves in such an adversarial relationship that I worried the next nighttime dispute could come to blows (literally). With a combination of support and pressure from hospital leaders and physician peers, they committed to a series of dinner meetings, just the two of them. They agreed to meet monthly, away from the hospital, and for the first few meetings avoid any conversation about work-related issues. The point was for them to build social connections so that they could find new ways of communicating, thus regain respect for the character of the other.