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How to deal with subordinates when you're new (doctor & nurses)?

Something happened the other day.

When we enter the room where the patient is, the nurse is supposed to do her/his short evaluation and report back for any red flag or something we should be aware of.

The new protocols (which people don't follow) is to go together when the patient enters the room with the patient in order not to have the nurse repeat again the patient's story to me as the story could be heard by both of us. So we go inside together but the nurses are not used to work as a team with a doctor. I know it's sad but it's the truth where I work. Now, I know that they need a certain degree of autonomy and I respect it.

So because of certain criticisms towards my approach. This is what I do now:

I enter with them and the patients and I let them do their thing without speaking. Because the moment I introduce myself, the attention gets shifted on me and now the nurse cannot ask their question as I'm taking the lead.

But in many cases, the opposite happens: I enter the room with them without speaking as I wait for the nurse to do their job. Depending on the nurse and the case they will either ask a few questions or just weigh the patient.

This case was an insect sting on the foot and treatment is anti-histamines by cream or orally. I asked the nurse (in an effort of good will): what do you propose?

And the nurse said: this and this and I said ok, I'll prescribe it to you. But then the patient's father was confused as to who was the doctor. He almost did not believed me as he thought I was a student learning from the doctor. It's true that the nurse knew by heart the dosage and I had to look it up as I don't know it by heart.

I know this is the weakness of servant leadership. How would you deal with the situation to achieve the following objectives:

  1. Give the nurse the autonomy he/she needs
  2. Clarify the roles for the patient and the parents
  3. Save time (by going together at the same time)
  4. Work as a team

My idea is that I should take the lead in this way: "My name is John Freeman, I'm the resident in pediatrics and I will let my colleague do his/her evaluation/weigh the child/ask you a couple questions and then I will ask you some of mine"

What do you think?

As you know they don't like that we are too dominant but then it gets confusing. If the context is not clear enough, I can clarify.

Hey John,

Yeah, I can see how that was confusing for the father.

Maybe you can mix that servant leadership with a bit more of an active role.
Think of yourself like the conductor/leader who takes care of bringing up the sounds and voices (expertise) of the people around him to reach the best possible melody (the final diagnosis).

For example, say something like this:

You: OK, the cure in these cases is usually anti-histamines, either in cream, or orally.
(turning to the nurse)
You know the dosages in these cases, right? What's your opinion on this?

Such as, you still go for servant leadership and you still get the inputs from those who know best, which helps reach the goal faster, and more efficiently.
But you do it more actively, more from a leader's position.

Your new approach: sounds very good

I very like your idea of the new approach.

You enter the room and introduce yourself. That will bring a lot of clarity on the roles, and will take out a lot of guesswork when it comes to statuses and power dynamics. People feel more at ease when they know who's who and who belongs in what hierarchical spot.

I also like that you say "my colleague will ask you a few questions", which avoids pushing the nurse too low down and which does increase collaboration.
Furthermore, if you later ask the nurse what they think, it will not seem weird to the patient.

Society holds doctors in super high regard, while having a rather low opinion of nurses. Most people don't think that nurses can do anything and if you introduce them as "nurse", most patients will likely feel that something is wrong if the nurse is even being asked anything.
So yes, you need to take that into account, which you are doing with your new plan for introductions.

Otherwise, an alternative is to introduce the nurse with name and surname, say they have been working here as nurses for X years, and have lots of experience.
That should build their credibility and authority high enough as to remove any patient's surprise when you two triangulate opinions.

One further authority-building device you can use to bring up the nurse's opinion could be to add:

You: I see. It seems to me this might be XYZ.
(turning to the nurse)
You have probably seen similar cases very often before, right? What's your opinion on this.

Great mindset to adopt

A great mindset to adopt in these cases would be:

My goal is to reach the best possible diagnosis and prescribe the best possible course of action. That's what a great doctor does, and I will do anything to reach that goal.

If you internalize that, you will naturally come across like that orchestra leader we talked about, and retain power and authority even while you let others take the center stage.

One more tip: explain why you're introducing new orchestra players

Just make sure that before you let others take the stage, you communicate why you are doing so, which reminds everyone of your role as orchestra leader.

For example:

  • name/surname has been here long years, she has probably seen lots of similar cases. What do you think of it?
  • name/surname has been prescribing dosages here many times. What posology do you think is right?


Have you read the forum guidelines for effective communication already?

Thank you very much!

I talked about this situation with a friend yesterday and he also advised me not to let them too much space. Would you agree?

Quote from John Freeman on July 25, 2020, 9:45 am

Thank you very much!

I talked about this situation with a friend yesterday and he also advised me not to let them too much space. Would you agree?

In your first example, I did feel like you stepped back too much, yes.
In that sense, you could say that "they had too much space", yes.

On the other hand, swinging in the opposite direction and making nurses -and their expertise- disappear would also be poor leadership. And you already know that.
So, yeah, it's to find that balance.

John Freeman has reacted to this post.
John Freeman
Have you read the forum guidelines for effective communication already?

Thanks, this is helpful. I'll find that balance on my journey to become a great leader.