Are We Obligated to be Cordial in Medicine?
- Jul 19, 2022
It was a day like any other in “the heart room.” I was a relatively newly minted attending anesthesiologist, inducing a patient with some level of mitral stenosis. The echo read “atrial mass causing pseudo-mitral stenosis.” Sounded innocuous. Rather than exercise a “trust by verify” mindset by double checking the echo images with my own eyes, I thought to myself, “I know how to induce a mitral stenosis patient,” and did what I usually do. I watched the A-line tracing intently as I gave a cc of drug at a time.
We were about to code. I was pushing epi, pushing epi, and doing my best to play it cool. Without missing a beat, the RN in the room said nothing, and started giving chest compression to circulate the epi that I was pushing into the patient’s antecubital IV. The pressure climbed back up, and we were out of the woods. I thanked her, collected myself, and we went on with the case uneventfully.
Through my eyes, it was a surgery like any other. Looking to decompress, I figured i would chat with the rest of the team on the trip to the ICU. While in the elevator, I asked the chest compressing nurse, “Was that a fun case?”
“Does it matter?” she retorted.
“Oh.” I was a bit taken aback. “I was just making conversation.”
“I don’t really do that, and I’m not here to be your friend.” Talk about a way to end a conversation.
While the honesty was perhaps, refreshing, I felt kicked while down. Was this permissible? Could a coworker, especially someone from my team with whom I’m going to work with frequently, shoot down my earnest attempts of casual conversation?
Neutral cordiality, please.
It doesn’t feel great for someone to say “Don’t talk to me,” in not so many words. But the negative downstream effect of this is that I will be less likely to communicate with this person, even if it’s in the interest of patient care. There exists an obligation to be, at the very least, neutrally cordial, to keep the lines of communication open.
During my fellowship in the heart room, I remember a seemingly inconsequential finding. There was mild-moderate mitral regurgitation, something that surely the surgeon wouldn’t go after in this octogenarian. I told my attending, he internalized the results. After we are on cardiac bypass, the surgeon asked “How did the mitral look?” When we conveyed the results, he became furious, literally berating us for the lack of communication.
A different approach?
Should the objective information have been communicated to him sooner? Sure. My attending, who was called to another room to come off bypass, should have looped back to have a formal discussion of the echo.
But could this situation have been approached in a different way? Could the surgeon have let us know that the communication was subpar, without actively yelling at the two of us in a room full of people? Of course they could have!
Think about the last time you were yelled at during medical training. Not quietly reprimanded, but yelled at such that the decibel level makes your ears hurt a little bit. What happens? You close up. You fall silent, afraid to say anything at all to anyone. There’s that visceral sinking feeling, and you see yourself as small and unworthy.
Now what would happen if something important came up during this personal recovery time? While the lesson was to communicate more, I felt so intimidated by the cardiac surgeon that I felt like I couldn’t say anything. His behavior was totally counter to his goal.
So, what does it all mean?
How could these two have behaved differently to foster a congenial workspace, conducive to speaking up when something has to be said?
Positions of authority are not an excuse to exercise overpowering, domineering behavior. An authoritative message can be delivered tactfully, with authority, and without anger behind it. Regardless of the hierarchy of the medical system, we should all be treating each other respectfully, and not use untoward language and tones with one another.
Also, think about the common goal that brings us all together: superb care for our patients. Taking great care of our patients depends on having open lines of communication that aren’t hampered by intimidation. If you are an attending surgeon, you want that junior anesthesia resident to err on the side of over-communicating information to you, not being terrified of you. Puffing up your chest and yelling will not accomplish that goal. The friendly and more approachable you are, the better the communication will be, and the better your patients will do. You don’t need to be saintly, just get over the bar of being marginally friendly. It is not too much to ask of one another.