Leadership Thingz: Wishing For A Happy Medium

So maybe I just like having things my way.

But as much as I complain about how often my senior leaves me alone to do the work of the entire team, I gotta say it’s really refreshing to be in charge.

I was alone (again) today. But really, REALLY alone this time. My senior had given both herself and my co-intern the day off. (To punish me for refusing to give her the Nephrology exam answers?) It was just me, with my two illustrious and eager but rather inexperienced students (who really impressed me today).

And you know what? It was nice. I didn’t have to deal with the screaming or the miscommunications or the working at cross-purposes. My students helped me to the best of their abilities, and then I sent them home. And you know what? Stuff got done.

As much as it helps to have more people on your team and more hands and minds working together, a non-functional team can be less effective than doing things on your own.

But given my preference, I like working with a functional team. Sometimes you can have the best of both worlds.

This month was unfortunately not one of those times.

Not much longer.

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Published in: on May 27, 2011 at 6:32 pm  Comments (5)  

Leadership Thingz: Actually Good Ones, This Time.

Well, I feel a little better about life. Because even though my senior resident is a…..shall we say….inadequate leader, the Chief Resident is not.

There’s a reason he was voted-and-appointed chief.

So you may have noticed I’ve been having difficulties with my senior resident. Well, the other day I confronted her, hoping to have an honest conversation about what exactly was going on with the team, including how inappropriate it was for her to leave me in charge of some pretty advanced and dangerous situations without backup. I tried to phrase it as appropriately I could. It didn’t work the way I wanted it to:

Me: I’m surprised you left immediately after we diagnosed our patient with a pulmonary embolism. I’ve never worked with a senior who just left the hospital in that kind of situation, leaving a first-year to manage it.

Senior Resident: That’s probably because the seniors you’ve worked with before saw how completely incompetent you are, and didn’t trust you enough to manage anything on your own.

Well. Enough said, I think.

It was time to take this a level up. I dropped by the Chief Resident’s office, whose door is always literally open.

The first thing the chief said that impressed me was this:

Chief: I think I know what this is about.

Me: (Surprised) Oh, really? What is it?

Chief: Oh, no. I’ve been bitten enough times by assumptions before. Why don’t you tell me what’s going on?

So I told him. And he listened. And when I expressed concern that I was coming across poorly this month because of the situation, he gracefully applied one of my favorite leadership techniques: reframing.

Me: This team is a combustible combination of personalities. Each call day ends with at least a half-hour shouting match between my senior and my co-intern. My tactless co-intern pokes the senior with a stick, and then the senior turns around and lashes out at him. Then he responds in kind. Then she does. Then he does. And it’s an upward spiral of vitriol, and neither one of them has the grace or self-awareness to de-escalate so we can get our !@%$ work done and go home. And when I try to intervene, both of them turn on me. (And I also delineated the number of times my senior had let me hang for errors that had occurred when I wasn’t even in the hospital, how she took every opportunity to undermine me with my colleagues, with the nurses, with the attending, etc.)

Chief: To be honest, I knew this would happen. The thing is, the way the clinic schedule was set up, those two had to be on the team together. There was no other way to arrange it. But you might not have noticed that we put you on that team for a reason. There had to be SOME stabilizing force.

So we went on to have a big, long conversation about team dynamics and leadership. And then somehow he turned the conversation into a series of reassurances about what I had done well that year, and positive things about my performance that had been noticed by my bosses over the past year.

I told him I felt like I was a mediocre intern, and he told me that he thought that he had been one, too. He said that even a mediocre intern can be a fantastic resident, because the skill sets are different. He asked about my writing and whether everything was okay in my life outside of work. He encouraged me to keep working hard, and he told me that he’d speak to my attending to get an assessment about whether or not I was actually taking blame for things I hadn’t done, and set him straight if that was the case.

Then he told me he was glad I had come to see him, because what he had initially thought was a different problem than the ones I was talking about. And he said that he was going to keep an eye on things. He pointed out a few things that I could probably improve on. He told me not to worry.

And now I feel a lot better.

Go, Chief Resident, go.

It’s nice to have positive examples as well as negative ones this month.

Published in: on May 21, 2011 at 4:22 pm  Comments (6)  

Is May Over Yet?

Far be it from me to wish a week and a half of my life away, but this month is really wearing me down.

Besides the senior-resident-from-hell and the attending-from-hell and the co-intern-from-hell being exactly who they are with absolutely no variation…..

…….you know it’s going to be a bad day when you have to throw your shoes away before lunch.

Published in: on May 19, 2011 at 10:52 pm  Comments (7)  

Leadership Thingz: Excruciatingly Bad Form

Senior Resident: I’m leaving at noon today. Tell the attending I’m going to a class!

Me: Are you?

Senior Resident: Of course not. But you’re covering for me!

Me: ………………Sure. Of course.

And I manage the team. Alone. For seven more hours.

Published in: on May 18, 2011 at 10:14 pm  Comments (4)  

Whoa! Holy Cow!

Did YOU know they were making a Tintin movie?

Whoa!

Why didn’t you tell me?

Published in: on May 17, 2011 at 9:46 pm  Comments (2)  

Tell It Like It Is.

One of the things I dislike the most about my job is expectation management. You know, making sure people don’t expect miracles and get depressed when they don’t happen, because that could make things even worse than they already are.

For example, today I had my first follow-up with a patient that we diagnosed with a progressive interstitial lung disease…basically, his lung tissue is slowly turning into scar tissue. (Scar tissue does not pass oxygen the way lung tissue does, and while functional lung tissue can turn into scar tissue, scar tissue can’t turn into functional lung tissue….so I guess you can see where that’s going.) We did a couple of things at his initial appointment that got him feeling a lot better: he’s now on portable oxygen, so he can walk upstairs to his apartment without having to stop on each floor, etc. Which is awesome.

But what kills me is that then he turned to me and said, “Doc, I feel like my body is breaking down the disease in my lungs, and it’ll just keep getting better.”

And my heart sank. Because then I had to bring out my ugly, ugly truth-needle and pop that poor, hopeful bubble. Because he’s not going to get better. This thing will kill him far earlier than he should have died. Of course, I didn’t say that in as many words. But I did have to tell him that his lung disease wasn’t going to go away, that we can manage things and try to keep them the way they are now, but that this is probably the best it’s going to get.

I. Hate. Killing. Hope.

But it’s better to trim it down a little to a more of a realistic view now that he can grow to accept, than to let his expectations eat him alive and make him end his life with anger, confusion, depression, and betrayal.

Honesty is still the best policy. Even when the truth is ugly. Because people deserve to know what’s going on.

I can only hope that they understand.

(And once again, it’s always the nice people that have the worst diseases.)

(Today was not a very good day.)

(I feel like there are probably a lot of other viewpoints about this issue; what do you think?)

Published in: on May 17, 2011 at 5:35 am  Comments (8)  

Leadership Thingz: Because SOME Good Has To Come Of This.

I’m having a difficult floor month. It’s not the patients who are the problem. For once, it’s not even the hospital staff.

It’s my colleagues.

I’m on a team with two extremely unprofessional people who also hate each other’s guts. And they don’t have the interpersonal skills to keep it to their own damned selves.

One of these people is my senior. And she’s no good at team management. Which means this month is a lot rockier than it has to be.

So.

I’ve decided to inexpertly blab a little about leadership. A bit at a time.

Hopefully I’ll learn some good lessons on how NOT to treat my subordinates next year.

Lesson 1: If something goes wrong, do NOT dress down your subordinate in front of his or her peers. That’s just rude. If you really want something to improve for next time, take him or her aside and have a quick, private conversation about what went wrong and how to fix any problems that arose. Humiliation is a tool used by incompetent leaders.

Published in: on May 14, 2011 at 12:43 am  Comments (7)  

More Problems With CPR: The Doctor Edition!

***SPOILER ALERT FOR THE RECENT PIRATE EPISODE OF DOCTOR WHO***

Oh, Doctor Who. Why you do me wrong?

Yes, Amy is only doing CPR by rote description, under stress, and she has to do it so the camera can see her panicked face past her swinging hair, so we can forgive her improper technique and improper timing.

Things we can’t really forgive:

-Rory: Amy, you have to be the one who does CPR on me, because you’ll never give up!
Amy: ::Does X number of cycles of not-enough-chest-compressions-with-not-enough-rescue-breaths (I didn’t go back to count, but it was only a few)….then gives up immediately.::

-The Doctor sits idly by looking very concerned, even though 2-person CPR is much more effective (as chest compressions are really, truly exhausting, and you can do CPR longer if you switch out with a buddy). The Doctor has to know this, as he knows all kinds of other things. He could kinda lift a finger or something. Unless he has some sort of ulterior motive other than to demonstrate to the audience exactly how dire the circumstances are. Let’s take bets on that one, shall we? (Hint: It’s usually a bad idea to bet against writerly laziness and shortcut-taking, especially when it comes to pseudo-medical circumstances. Remember that the last time he did something doctorly, he sprayed some goop on some people and thusly cured “every disease in the world.”)

-There’s a pause between cessation of effort and recovery. Rescuer gives up, exhausted and distraught, and then there’s a pregnant pause….followed by a huge gasp, and inevitable spontaneous recovery by the victim.

Please, someone pay me a nickel every time an author uses this obnoxious pattern to create a contrived and formulaic emotional rollercoaster:

Author: He’s dead! Audience: ::Sob!:: (or, so hopes the author.) Author: Oh, just kidding! Audience: Oh, hooray! (or, so hopes the author.)

Come. On.

-Even improperly-executed CPR works. Victim pops up, smiling, with no ill effects whatsoever. Because CPR is magical. It’s the medical deus-ex-machina. And it’s complete crap. I’ll get into why in a future post. But for now….Gah! Stop treating CPR like a magic wand! Please, oh please, oh PLEASE!

(I still want to beat writers with wet chickens when they pull this stuff.)

Oh, Doctor Who. You broke my heart this week.

Published in: on May 10, 2011 at 6:00 am  Comments (32)  

It’s The Little Things

My recent discovery/acquisition of the one-person teapot has resulted in a noticeable increase in the time I spend studying without jumping up every five minutes to distract myself with something non-medicine-related.

Weird.

I’ll keep this in mind for when I have the opportunity to get back to writing. It might up my wordcount.

Published in: on May 6, 2011 at 7:55 pm  Comments (1)  

How Fortunate That We Have Mark Twain In Our Lives

He really has captured the essence of the human condition; he gives us an applicable quote for pretty much any occasion.

Today’s example:

“I’ve never wished a man dead, but I’ve read some obituaries with great pleasure.” –Mark Twain

Lon Prater also has some pretty wise things to say.

Published in: on May 2, 2011 at 10:34 am  Comments (2)