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How to deal with superiors? In a hospital setting

#1 · July 13, 2020, 12:01 pm

Quote from John Freeman on July 13, 2020, 12:01 pm
Hello,
For info:
Resident = junior doctor, subordinated to attending and chief doctor (level 1)
Attending = supervisor of junior doctor, subordinated to chief doctor (level 2)
Chief doctor = level 3
2 days ago, there was a suspicion of an appendicitis. I was asked to call the surgeon V. (attending) by my supervisor A. (attending) to ask for a consult. I explained to her the case and she was with her kids at home and told me "I just arrived at home, I'll be there soon", she took some time to eat and arrived 1 hour later. She sees the patient and tells my supervisor A. and the head doctor R. (higher up two levels from me): "if I knew it was you who was suspecting I would have send the child directly to the operating room and not even come". This means: you don't need a surgeon for people as experienced as you to make this diagnosis. Of course as usual, zero teaching for me at this point.
Then it was a perforated appendicitis which is a complication of an appendicitis. So far so good.
Yesterday, I talk to the surgeon and ask her: "we did not talk about the case of the other day, could you please let me know about the clinics", trying to learn something from the case. She was busy and obviously did not want to talk to me.
Then my supervisor (attending A.) took me on the side before leaving the hospital to give me some "feed-back" (they only give negative feed-back), so when they want to talk to you it means you fucked up.
She told me: "the surgeon V. (attending) told me that it was not clear on the phone that we thought it was an appendicitis, was it clear to you?" I said: "of course". She said: "so you should communicate better what the problem we think it is". I said: "ok but why did not she tell me herself directly?" and she said: "because you were not there". I was dumbfounded as I was trying to figure out this "not being there" (remember it's in the middle of the emergencies, I'm taking care of two patients as she interrupts me to tell me this). Unable to answer anything, I told her: "Ok thanks"
Of course, I do think I must better my communication and I will. This is not the point. The point was the tone was derogatory as usual from this supervisor and that basically the surgeon was blaming me, not telling me directly and my supervisor thought I was the one to blame.
In their mind, it's the lesser-up hierarchal who's to blame and the higher-up hierarchical who's to get the credit (Swiss culture). So in this case: it's my fault.
So for me it was totally a power move.
Any opinion on this power dynamics?

Hello,

For info:

Resident = junior doctor, subordinated to attending and chief doctor (level 1)
Attending = supervisor of junior doctor, subordinated to chief doctor (level 2)
Chief doctor = level 3

2 days ago, there was a suspicion of an appendicitis. I was asked to call the surgeon V. (attending) by my supervisor A. (attending) to ask for a consult. I explained to her the case and she was with her kids at home and told me "I just arrived at home, I'll be there soon", she took some time to eat and arrived 1 hour later. She sees the patient and tells my supervisor A. and the head doctor R. (higher up two levels from me): "if I knew it was you who was suspecting I would have send the child directly to the operating room and not even come". This means: you don't need a surgeon for people as experienced as you to make this diagnosis. Of course as usual, zero teaching for me at this point.

Then it was a perforated appendicitis which is a complication of an appendicitis. So far so good.

Yesterday, I talk to the surgeon and ask her: "we did not talk about the case of the other day, could you please let me know about the clinics", trying to learn something from the case. She was busy and obviously did not want to talk to me.

Then my supervisor (attending A.) took me on the side before leaving the hospital to give me some "feed-back" (they only give negative feed-back), so when they want to talk to you it means you fucked up.

She told me: "the surgeon V. (attending) told me that it was not clear on the phone that we thought it was an appendicitis, was it clear to you?" I said: "of course". She said: "so you should communicate better what the problem we think it is". I said: "ok but why did not she tell me herself directly?" and she said: "because you were not there". I was dumbfounded as I was trying to figure out this "not being there" (remember it's in the middle of the emergencies, I'm taking care of two patients as she interrupts me to tell me this). Unable to answer anything, I told her: "Ok thanks"

Of course, I do think I must better my communication and I will. This is not the point. The point was the tone was derogatory as usual from this supervisor and that basically the surgeon was blaming me, not telling me directly and my supervisor thought I was the one to blame.

In their mind, it's the lesser-up hierarchal who's to blame and the higher-up hierarchical who's to get the credit (Swiss culture). So in this case: it's my fault.

So for me it was totally a power move.

Any opinion on this power dynamics?

#2 · July 13, 2020, 1:17 pm

Also, generally, how would you deal with a culture where you cannot openly talk about problems and issues to your superiors and you have to censor yourself?

Like I don't get enough teaching by my supervisors, but talking about that would be a critic and it could reflect bad on my evaluation and on how I'm being treated. Like we do not get a lot of respect from nurses but talking about that could reflect bad on my evaluation and on how I'm being treated, etc.

#3 · July 20, 2020, 7:12 am

Hello John,

Yeah, there are plenty of business and organizational cultures around the world that focus more on power and heirarchies than on learning and teaching.
Needless to say, these organizations don't perform nearly as well as they could.

In this specific case, I would have probably avoided of handing them on a silver platter the opportunity to frame you.

For example:

Supervisor: the surgeon V. (attending) told me that it was not clear on the phone that we thought it was an appendicitis, was it clear to you?
You: of course. And it's funny she said that, becuase I thought I made it plenty clear to her

Now you blocked your supervisor's self-righteous "feedback" and "passing the buck attitude".

You could end it there.
But two more options on where to take it:

Double down on the offensive

By the way, I asked V. for some feedback to learn more, but she was busy.
I'd be happy to talk ot her on how we can work better together.

You indirectly say "she is being uncooperative... Plus, I'd appreciate a direct conversation with her instead that this indirect power game".

This is riskier and I wouldn't recommend doing it so early when you're still finding your onw place in a new organization. You'd risk getting branded as too rebellious and troublemaking.

Soften the blow

But I understand now that it was still unclear to her, am I right?
If so, I will be even clearer next time to avoid confusion. I learned my lesson from that experience, boss.

Make him feel good, make him feel like you respect his autohrity over you.
This way, you defend yourself against V. trying to frame you, but you don't compromise your relationsihp with your supervisor.

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#4 · July 24, 2020, 10:51 am

Thanks a lot! Makes sense.