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My Journey to Power

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Hi John,

Quote from John Freeman on April 19, 2022, 8:32 pm

Do you think I went overboard in my reaction?

I am aware that I must increase warmth with the nurses. This is a challenge as I think many of them are dicks. I understand that by not being warm enough I am taking a risk of being perceived as an asshole.

I’m aware I have to improve my relationship with them in a 1-to-1 basis.

However, witnessing the disrespect they have (among each others as well: the new one is being given the worst tasks and must show deference to “older” nurses, they have a bullying culture, they think they are doctors themselves) it is challenging for me.

I know they are going out together sometimes for drinks with some doctors and I’m not invited. However I would not like to go so I’m fine with it. I think they are low quality people.

I think your reaction was "rapport breaking", direct and irritated. Did you go overboard? I think this is a question of perspective. So only you can answer this question according to your goals and standards.

That being said, I can understand your reaction as you seem to be working a lot and to have a lot of responsibilities. I guess you have to deal with higher levels of stress than most people.
I used to be in a situation similar to yours as I'm also working a lot, and I was surrounded by people that I didn't really appreciate (a lot of small talk, low value, hypocrisy, power games / manipulation, irrationality, entitlement and gossiping). I also have a high work ethics and standards so I am very easily irritated when I see mediocre people in the same working environment. And the more I become power aware and competent in my work, the least I accepted to be disrespected.

I also have a similar character where I tend to be too direct or impulsive which then creates resentment in people (I have disagreeable traits). Despite knowing that sometimes it's not optimal, it's difficult for me not to act like that in the heat of the moment, but I will tell you how I found ways to help.

So back to your situation, on one hand, you seem to have accepted the fact that they are low quality people and that you don't want to invest too much effort into them, but on the other hand you also seem to feel a bit guilty about it and also probably afraid that your behavior might create negative and unwanted consequences. That's probably why you feel stuck and frustrated about the situation.

If I analyze things objectively, I think that probably your locus of control is too external. If you switch your locus of control to an internal one, you will realize that you choose to do this job where it is normal to be surrounded by low quality people, so it was your choice to be in this situation in the first place. Especially because you also don't want to make an effort with these people.

Now that I said this, these are the solutions I found to handle my choleric temperament and this kind of situation:

  • I try to use the principles of non-violent communication if I still want to give a chance to the people (1. surface the problem in a non-aggressive way by asking a question, for example "why do you talk about me like that when I am in your presence?". 2. explain how you felt about it. 3. ask if the person can change it in the future). This usually works in 50% of the cases. If this doesn't work in other cases, I either attack the person until I win in the very rare cases where it's really important that I don't loose face, or ignore the person.
  • I try to accept that some people will never want to respect me no matter how well-intentioned I am. This kind of person doesn't have to do anything in my life.
  • I am not affected when a child is disrespectful, so why would I be when a stupid or low quality person is disrespectful?
  • I try to avoid low quality people in the first place. I still respect them and I am polite, but I don't talk to them. I keep in mind that I am the sum of the 5 people I spend the most time with, so I don't want to have these people in my mind more than necessary. A simple principle to find high quality people: Great minds discuss ideas. Average minds discuss events. Small minds discuss people. Plus all the criteria that Lucio discussed about about high value people.
  • I only interact with lower quality people when I am at the top of the food chain (in a position of formal power). This way, I avoid a lot of problem, frustration and drama.
  • I don't accept any job or situation that put me in unfavorable contact with this kind of people, unless the outcome is worth it (not for too long though, I can tolerate 1 or 2 months maximum).
  • I do a lot of activities that can improve the function of my prefrontal cortex (meditation, relaxation and massage, exercise, sleep enough, good diet, increase my HRV, nootropics and adaptogens, spend good time with friends/family/lover, etc). This is probably what helped me the most.

Anyways good luck with this situation, I know how annoying this can be.

Lucio Buffalmano, John Freeman and 2 other users have reacted to this post.
Lucio BuffalmanoJohn FreemanAnonIllystorm

Hello Alex,

thank you very much for your elaborate answer. Based on it, I think in this case I was better off to ignore them. As when I did that, I did surface the issue intentionnally. This sub-communicated: you guys are not respectful. So it was confrontational in a way.

I would have been better off ignoring it as it was not really important. I made enemies with my reaction so my reaction was not socially effective.

Saying: "I would prefer if you talk to me as if I'm present" would have seemed thin-skinned or too emotional.

So, in this case I was better of ignoring I think.

Thanks also for sharing your own journey and frustration with these situations. I agree with you, it's better to accept that they are low-quality people, take responsibility for my own behavior and move on.

This was a yellow power move in this situation.

So in this case, I was 1. Not affected emotionnally. 2. It was not so disempowering. 3. It was not so important.

This would have justifying ignoring it.


Lucio Buffalmano and Alex have reacted to this post.
Lucio BuffalmanoAlex

Today, my boss pulled a power move on me:

I was seeing a 2 year old patient (just started the consult) and he calls me:

Him: There's this patient who's supposed to come at 11:30am.

Me: Yes I started to see her

Him: I'm supposed to see her. Tell her I'll be a little late as I'm stuck at the MRI with a patient

So I tell the mother and leave the room as he'll be the one seeing the patient.

30 min later I get a call from the nurse that he wants to see me. I don't understand why. I go and check

Him: did you see the patient? (in front of the mother)

Me (suprised): No (and give him the file which was on the nurses' desk and that he could have gotten himself)

I think about it and realize he played a power move on me: he blamed me for the lateness. If I would have seen the patient, it would have saved time but he explicitly told me he was going to see her. Also, the mother wanted to see him.

What choice do I have?

  1. To ask him (in private: face-saving) : "I did not understand earlier as ..." and explain the situation.
  2. Ignore

I was going to ask him to get some respect back but I realized this would leave him with 2 options:

  1. Deny: "yes but you know you're supposed to see patients" or "yes, but you know it would have saved us time". Leaving me with the only option to escalate (frame impose) or submit. I would have lost. I could have said: "it was a misunderstanding" but I would still have been blamed. I would have shift the problem from: "You did not understand how we work/you were not proactive enough" to "a communication error".
  2. Ignore: I have a performance review in about a month, so it's more effective to have a better relationship with him. So I took the blame.

There is a last option:

To clarify AND take the blame: "I did not understood earlier as you told me that you were going to see the patient. Did you want me to see the patient finally?"

This let me be assertive, confirm me being subordinate to him and framing this as a misunderstanding, with me wanting to better know his expectations. So it would be empowering for him.

However, next time I'll ask: do you want me to do the consult or shall she wait?

Quote from John Freeman on April 19, 2022, 8:32 pm

Then other nurses said multiples times ”he” like I was not around. The frame was “when is he going to see the patient?”.

I answered “he’s going to see the patient now. But you can talk to me as I’m here” in a calm voice, addressing the whole group.

One option was to say:

Hey, are you talking about me?

Such as, less imposing, and more recruiting her to surface her own game.

That being said, I don't think your more assertive reaction was "bad".
As a matter of fact, I think it's potentially great (potentially because, as Alex says, depends on the situation and general relationships and I wasn't there).

Now they'll lick their wounds.

But that allows you to re-negotiate win-win while coming from above -from a higher power position- rather than below -always difficult-.

The only "issue" with this is that it was a group. Now they have an easy way served on a silver platter to find emotional and social strength in the group to push back against the overly-dominant doctor who disempowered them.

What I'd focus the most is to avoid them forming a group where everyone agrees you're an ashole -and keep on reinforcing that narrative, as people always gain points in hate groups by spreading even more hate-.
That's the biggest risk.
You want to start being kinder now, especially to the good ones, so that you avoid that group dynamic of "all VS one" and that narrative of "he's so bad".
(and while I often start typing answers as I read, I notice that you correctly identified the strategy: nice).

Great answer by Alex, that's an even more root-cause approach to the situation.

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Ali ScarlettJohn FreemanAlexIllystorm
Have you read the forum guidelines for effective communication already?
Quote from John Freeman on April 20, 2022, 1:36 pm


30 min later I get a call from the nurse that he wants to see me. I don't understand why. I go and check

Him: did you see the patient? (in front of the mother)

Me (suprised): No (and give him the file which was on the nurses' desk and that he could have gotten himself)

I think about it and realize he played a power move on me: he blamed me for the lateness.

Yeah, sneaky shit.

What I'd have said:

Him: did you see the patient? (in front of the mother)
You: yeah, I was just starting, then left it to you as it seemed the best thing to do

Feel free to drop the "yeah" if it's more of a formal question and situation.

The idea is to do both:

  1. not take the blame or make it seem you didn't do something you had to do
  2. while also not blaming him

You also don't mention the call of course, but he knows the told you so, so he can't push it much further. And he also knows you're not throwing him back under the bus by directly mentioning the call, which might even give you some points actually.

Some good Machiavellian socialization, if I may so of something I said myself 😀

Ali Scarlett, John Freeman and 2 other users have reacted to this post.
Ali ScarlettJohn FreemanMats GBel
Have you read the forum guidelines for effective communication already?
Quote from Lucio Buffalmano on April 20, 2022, 1:47 pm

Him: did you see the patient? (in front of the mother)
You: yeah, I was just starting, then left it to you as it seemed the best thing to do

Another non-confrontational but high-power power move option:

You: yeah, I was just starting, then left it to you as.... Yeah, you know... Anyway, they're here now (I'm happy to help if you need anything else from me)

The last part is if you want to end with a collaborative frame.

Basically you're saying:

You know the reason, asshole: you called me and told me not to and I'm not throwing you under the bus, but we both know

Both options also show you're aware of the game and while you're respecting the power positions and not throwing him under the buss, you also don't appreciate and are not going to roll over.

John Freeman, Anon and Bel have reacted to this post.
John FreemanAnonBel
Have you read the forum guidelines for effective communication already?

Thank you very much Lucio, this is advanced stuff!

Hello guys,

I have a question for you and need your help. I feel like I'm kind of stuck now in my career. Here are the facts:

I did two degrees in engineering (computer science and life sciences) then went to medicine. I was supposed to become a physician-scientist. However, I see that:

  1. Academic medicine is quite toxic: dysfunctional workaholic people, all about power, etc.
  2. If I do research, I won't have enough free time to be happy: I'll become another workaholic at the hospital.

My hospital is dysfunctional and so is our department. There is a current crisis where many attending physicians left and 3 executive physicians (cream of the crop, gave everything to their career) are in sick leave due to burnout. There has been the politically correct article (organised leak) from the management to say that it is temporary, that it's due to people going into retirement, sick people and pregnant women. It's a lie. It's very poorly managed with very little respect and overwork for interns (junior docs). Like in many university hospitals. Plain and simple: we are being exploited.

We had 2 meeting with the top boss who told the attending physicians that if they were not happy, they could leave. Which two of them did. How is that for good management?

So I definitely know I want to leave this hospital. The problem is that most of the knowledge is in university hospital and cases are interesting. I'm thinking to go to another university which is close to learn more as I feel I'm not competent enough yet to practice medicine on my own because of lack of autonomy and training.

In 1 year, I'll be done with the training. I have 3 options:

  1. Going to the other university hospital (emergency medicine): but they have to hire me and the schedule will be bad. I will also have to commute or get a flat in this new city (1 hour door-to-door from where I live)
  2. Going to a community hospital: but most of them are toxic because they were trained in my university hospital. There are a couple with normal people only.
  3. Going to a private office: but I feel that I'm not good enough yet. Also, it's not as stimulating as the hospital. I will be self-employed but tied to the office.

I'm thinking about changing my priorities as I'm still single at 41 years old. I feel like medicine will consume my life as I already let it in the past.

I want to be a good doctor and it is such a challenge in these environments.

I want more free time and a healthier work environment. I want to be happy to go to work and be respected.

So I feel that by going to medicine I find my calling. I love to work with children. I want to continue doing that. However, I also want to be happy.

I'm thinking that I made a mistake by going in this field and now I'm stuck. I don't want to change field as I already did it twice. I know there is bullshit everywhere. However, I think I can find a better work environment. That is why I considered changing country.

I'm aware I'm not really stuck but this is how I feel. I opened my eyes to the opportunities above so I can have more free time.

Last point: in this rotation I've seen my superiors and they're working all the time. I don't see the point. I like to work but I'm interested in other things outside of work as well. This is why I don't see myself doing research: it's very time consuming.

What do you think of my situation? What would you do?

Would it be possible for you to open a private practice?

While from outside it may seem that it is impossible to grow clients by working alone, it is something that happens naturally the more you grow and learn.

And the cases you will see will probably be different from what you see now, but always stimulating, in a different way.

And in 5, 10 or more years you will become an expert, and even famous, if you dedicate yourself to your practice. Being able to command high fees and respect in the field is a real thing, if you devote time to your learning and working.

Liking work is also something that grows with you the more you work and learn. There comes a time when you find you are suddenly on the other side of complexity, so to speak. What you did so far may have been difficult and stressful, but it's not going to stay that way.

And you will be free to decide what time and effort to dedicate to your practice, without having to subscribe to someone else's rules.

John Freeman has reacted to this post.
John Freeman

Thank you very much, Bel for your answer!

It is great advice.

On a side note: our department released a statement about the problems. It was a PR stunt of course. Today the truth came out through the testimonies of attending physicians in a newspaper. The hospital director had to answer in the media.

It’s actually a big crisis due to very poor management .

It was the usual hypocrisy. It was geared towards the public. “Children are safe at the hospital” and did not address the journalist’s questions about the personnel’s suffering.

It’s all about money and image. We are expandable and he implicitly acknowledged it by not caring about the personnel.

Only the public image. I would love to write a post about it but it’s too long of a story. When the conclusion will be drawn I might write about it.

For the moment: I will run for my life!

For those interested:

The head of the pediatricians in a private practice (office paediatricians with their own practice) said that it was necessary to increase the personnel and budget. So everybody knows the truth.

Bel has reacted to this post.
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