black and brown wooden signage



I’m going to work this morning. As such, I have been wondering who is on call today. Since I work in the emergency department, a lot of my day is spent calling consultants (for the non-medical that means other specialists) either to admit patients or to manage complicated issues like stroke, heart attack or trauma.

A quick glance at the call schedule sometimes gives me a little anxiety. Because certain names can mean almost certain conflict.

I learned about this in medical school and residency. I remember that a few residents or staff above me could make life exceedingly difficult.

As a staff physician, in practice now for 29 years, I still feel this sense of dread.

The conversations are like this, culled from decades of experience: “What do you want me to do?” “It’s not my problem.” “I don’t understand why you keep calling me.” “Did even you examine the patient?” “You better watch your mouth.” “Why don’t you call me back when you’ve finished the workup?”

At one point in my career I worked in a location without a neurosurgeon. One neurosurgeon who took call in our nearby referral center would routinely call back…collect. (For those of you of the smart-phone era, it meant that the receiver of the call had to pay the…oh never mind.)

All of this has consequences. First, it often effectively creates a barrier. The difficult physician sets up this verbal and emotional hedge which others learn not to cross. Or maybe it’s more like the stripes of skunk or rattle of a Diamondback. You learn pretty quickly that it’s often not worth the trouble. But that leads to the second consequence:

Consequence two is that it impedes patient care. Physicians like me are the classic, ‘Jack of all trades, master of none.’ I have a case that makes me uncertain, if I’m not quite sure but need the guidance of a specialist, then I might just do my best, look some things up online or in a textbook (you know, ancient scrolls bound and printed on paper…). I might do almost anything to avoid ‘poking the bear.’

This is how bad things happen. But for the difficult physician, it’s no big deal. When negative consequences occur, all they need to say is ‘I was available, why didn’t you call?’

In medicine as in so many professions, personality conflicts are problematic. But sadly, it can be especially dangerous in a field where the right information and the right experience can be life-saving.

(And I’d be remiss if I didn’t say that this is a huge problem for nurses as well, who are far too often subjected to loud rants or profanity when they call physicians.)

I understand that some specialists are very stressed, or very unhappy or wildly burnt out. I get it. But that doesn’t make it any easier for the rest of us who have to interact with them.

Not long ago I called a cardiologist for a patient with an MI (heart attack). He was kind on the phone. He said, ‘I had better come on in…see you in a bit.’ He decided to take the patient to the cardiac cath lab. While things were getting prepared he sat down and chatted with me about medicine and life.

What a delight.

Pity all of our interactions in healthcare can’t be the same. Physicians and nurses would be happier. And ultimately patients would be safer.


PS Tell me about similar situations in your own career in the health professions or in other career fields! I’d love to see discussions in the comments.


5 1 vote
Article Rating