By Tracy Adesuyi
How does one muster the courage to speak up against a senior colleague? How do you call someone out for their actions? Taking a tough stance might seem like a Herculean task especially when you are meek or shy and are up against someone who has been in the profession for longer than you have. Doctors at all stages of their training and after, grapple with the mental struggle of - to speak up or to stay mum.
As medical students and future doctors, we are encouraged to stand up for ourselves in the workplace. But we are often faced with work environments that are not conducive to walking the talk. Lack of support from senior colleagues and not having your opinions valued can be significant barriers in exercising this right.
I would like to reflect upon a personal experience of mine where I found the courage to question a consultant’s chosen approach to breaking bad news. I, a 3rd year medical student at the time, had just met this Consultant on my placement and felt that their conversation with the patient lacked empathy and care. It got me questioning the value of all the rigorous communication skills training we receive in medical school and the usage of protocols such as SPIKES (Setting, Perception, Invitation, Knowledge, Empathy and Summary) while breaking bad news. I felt strongly about this but wondered, what do I do?
I have a vivid recollection of the fear of challenging the consultant compounded by them being angry and stressed out throughout the consultation. In the end my beliefs and principles motivated me to action. I initially gave the consultant enough time to recover from the interaction. I then chose an appropriate setting and time to broach this subject in a respectful manner. I politely explained to the doctor why I felt the way I did. I expressed how I would have broken the bad news and why I perceived their style of communication as cold.
I would credit the consultant for taking this conversation well and appreciating my courage in speaking up. They admitted that they were having a bad day and knew that their communication had been sub-optimal . This made me feel at ease immediately. It also reminded me that doctors are humans too, sometimes struggling to keep their personal and professional lives separate. And while there is no avoiding adversities in life, acknowledging that it’s hard to wear a smile on our faces every day to work makes us more human and relatable.
This experience shall stay with me on my onward journey to becoming a doctor and remind me to be kind to patients and colleagues. I hope you can use this as a lesson in embracing your/others’ vulnerabilities and being open to constantly improve and do better for your team and patients.
This blog would be incomplete without touching upon the human factors that can be detrimental to communication:
Emotional state of the parties interacting – stress, anger, anxiety
Perception and bias - stereotyping, preconceptions, personal bias
Reading/using non-verbal cues – gestures contradicting verbal communication
Power dynamic
Inattention to and lack of focus on your environment
Here are some ways to navigate challenging situations:
Ask clarifying questions in a respectful manner instead of confrontational – you are there to learn but also to pick up on good skills. It is okay to question things sometimes. Use a calm and respectful tone when explaining yourself.
Choose the right time and place – avoid trying to challenge peers in front of patients /other peers. This will only lead to a loss of trust in the team.
Focus on patient well-being – put yourself in the patient’s shoes. Practise empathy.
Acknowledge the consultant’ expertise – balance confidence and humility. Understand that you don’t know everything or see the full picture of what influences behaviours.
Use emotional intelligence – read the room. Gauge their emotional state. Pick your moments carefully to ensure your concerns are received well.
Be open to constructive criticism too – if the doctor disagrees with your perspective, be open to feedback and ask questions to further understand their rationale.
Reflection – reflect on the outcome. What could you have done differently? How could you have varied your approach?
Here are some resources to work upon one’s communication skills:
BMJ – The British Medical journal have informative articles giving directions and tips on how to improve one’s communication skills.
Alongside this, the BMA (British Medical Association) speak about the importance of good communication skills as a medical student. (2)
Discussions surrounding Cancer can be sensitive. If you know anyone with a cancer diagnosis who could do with an advocate of their wishes, there are people you can speak to. Clinical nurse specialists & Palliative care nurses are highly skilled in advocating for patients during difficult times, to ensure their treatment is a reflection of what they want.
To conclude, reflections on patient safety incidents have shown that in a critical situation, team members offer unique perspectives and solutions which they may not always feel empowered to express due to the fear of challenging a “superior.” By viewing this through the lens of a team, working towards providing a patient the highest quality of care, it becomes quite evident that all team members are at par, fallible and should be open to challenge.
In recent times, there has been a positive shift in the work culture with adoption of new leadership styles/management frameworks, all attempts towards flattening the hierarchy.
References:
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