Wellness and Resiliency During Residency: Interprofessional Conflict

2016-12-23T19:45:24+00:00

“It’s rarely the patients that hurt me. It’s my colleagues in the hospital.”

cartoon conflict pointing finger 3d

“[Interprofessional conflict] is so underappreciated as a source of stress and misery in our job. And so often in the hospital, horrible behavior is swept underneath the rug because a) there is no pathway to address this stuff and b) it’s almost seen as de rigor for certain services to act this way. “Oh it’s the surgical service, what do you expect, that’s just the way they are.” That is what ruins me … I think that is the biggest threat to wellness in my world.”

–Scott Weingart, MD

Burnout in Emergency Medicine

We get it. Emergency Medicine (EM) is tough. Depending on who you ask, EM tops the charts for burnout.1 Long nights, short holidays, critical patients, and jam-packed waiting rooms are just the beginning. Poorly handled arguments, rudeness, and lack of respect between physicians, nurses, and other hospital staff also contribute their own fair share to the burnout epidemic. EM is particularly vulnerable to this type of interprofessional conflict for at least three reasons:

  1. The “fishbowl” effect
  2. A heavy dependence on consultants for definitive care
  3. Necessary interactions with a wide range of specialties and services within the hospital.

Not only does almost every other service have the benefit of hindsight when criticizing patient care in the emergency department, our inpatient colleagues are also often in positions of power to refuse our requests for their expertise, admitting privileges, or operating rooms. Even though as professionals, we are all expected to rise above the level of our own petty emotions. On a busy night at 2 AM, it is easy to see why emergency physicians can often bear the brunt of the distinctly unprofessional wrath of consultants, nurses, techs, and other staff in the hospital.

Disrespectful Behavior and Downstream Effects

Disrespectful behavior may be one of the major contributors to the dysfunctional culture and hidden curriculum of our healthcare system.2 We see it all the time—loud and inappropriate arguments between residents and consultants, demeaning comments to nurses and prehospital providers, and the humiliation of medical students through open censure or criticism in front of others. Not only does all of this contribute to a hostile work environment, interprofessional conflict can be bad for patients too. Rudeness and incivility impairs effective communication between team members, which can then lead to patient safety issues and medical errors.2,3

So what can you do?

The best way to stop an argument is to be the voice of reason. Take a moment to breathe and step back from the situation. Be a professional and encourage your colleagues all over the hospital to do the same.

Want an even better solution?

If you are an EM resident, join us on May 15, 2017 at the 16th annual Essentials of Emergency Medicine (EEM) Course where residents from all over the country will be coming together for the first-ever Resident Wellness Consensus Summit (RWCS) in order to innovate real-world solutions to resident-physician wellness issues just like this one. This Consensus Summit is jointly sponsored by EEM, Emergency Medicine Residents’ Association (EMRA), and ALiEM.

Also if your residency program has not yet sent 2 resident representatives to the Wellness Think Tank, that would be a good start because work for the RWCS will be starting soon there.

Featured podcast with Dr. Scott Weingart

Listen to Dr. Scott Weingart as he shares his own story of a central line gone horribly wrong. He reflects on the damaging nature of disruptive behavior and proposes ways that each of us can manage interprofessional conflict during our next shift.

What is coming up in the Wellness Think Tank?

On December 5, 2016 at 4 pm PST (7 pm EST) , we will be hosting a Google Hangout on Air videochat with the famous ZDoggMD, a featured strategist for the Think Tank. Hear him share his stories about why this is such a passionate issue for him. Here’s a creatively insightful video he did on physician mindfulness.

1.
Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. [PubMed]
2.
Leape L, Shore M, Dienstag J, et al. Perspective:  a culture of respect, part 1:  the nature and causes of disrespectful behavior by physicians. Acad Med. 2012;87(7):845-852. [PubMed]
3.
Riskin A, Erez A, Foulk T, et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015;136(3):487-495. [PubMed]
Arlene Chung, MD

Arlene Chung, MD

Chief Strategy Officer,
2016-17 ALiEM Wellness Think Tank
Assistant Professor of Emergency Medicine
Assistant Program Director
Mount Sinai Emergency Medicine Residency
Editor, AKOSMED (EM wellness blog)
  • Pik Mukherji

    Zdogg lyrics on point! Except should have been “attn to the flow.’ Minor quibble.