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)  

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6 CommentsLeave a comment

  1. But now aren’t you worried and wondering about whatever it was that he had initially thought you were coming to see him about? πŸ˜‰

    • No, I’m not terribly worried. I’m pretty sure I know what it was about. My co-intern is a loose cannon, and the chief probably thought I was coming to report another one of his many, many inadequacies.

      Which is certainly part of the problem, but not the whole one.

  2. That’s what I was gonna say!

  3. Yay πŸ™‚


  4. Just found your blog the other day, and have been tracking back. I apologize that this comment is coming late, but I had to say:
    As someone who was, once upon a time, diagnosed with a pulmonary embolism, and who, during that hospital stay (a month in all) saw a great many interns and residents, both good and bad, I find the notion of your senior leaving you with that inexcusable. The fact that you were concerned about it tells me you probably would have handled things, but you shouldn’t have had too. You would have been fully within your rights to say no, I’m not covering for you, and report her immediately. I suppose that wouldn’t do anything good for the interpersonal problems, but your patients would have been grateful.

    • Thanks, Carolyn. I handled it okay, and rest assured that this girl was reported. Plus, there were plenty of seniors in the hospital working on other teams who were all willing to step in and help me out, once they heard about what happened. So I definitely had appropriate backup at all times.

      Thanks for reading, and thanks for writing!

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