The Three People Who Can Make or Break Your Clinical Practice

Every hospital, every clinic, and every surgery center has at least one physician who is “that doc.”  As you read that just now, the name of “that doc” in your company popped in your head.  “That doc” is the one that the nurses don’t like, that rubs patients the wrong way, and that “just doesn’t get it.”  They could be the most productive physician in your group, but nobody wants to be around them, and nobody is eager to work with them.  

How did they get to that point?  The truth is, you probably identified these people as early as medical school.  By the time I graduated from medical school, I had a list (a short list, fortunately) of colleagues to whom I would never want to refer patients, and I’ll bet you had a list too.  

Nearly every time that someone made it to my list, it was exclusively due to their personality, not their competency.  Some of them smartened up during residency and fellowship, but most of them didn’t.  Usually, the ones who did were the ones who got a stern lecture from an attending or staff at the hospital and took heed of the warnings.  

The ones who didn’t were usually so ego-driven that they had no capacity for introspection and wouldn’t listen to the people in their practices that could have helped them improve.  

So, who are the unsung heroes who can make or break your clinical practice?  To whom should you pay respect in order to have the reputation and job satisfaction you crave?  The obvious answer is “everyone,” but let’s look at three specific individuals who have incredible influence over your career and reputation.

Nurses

This should surely be obvious by now, but some physicians just can’t get it through their thick skulls that nurses run the wards.  They wield tremendous influence, so common sense should dictate that physicians should be kind to their nurses.  Even that is not a strong enough motivator for many physicians.  The number of times I continue to observe physicians being rude or disrespectful to nurses is staggering.  

Showing kindness to nurses is smart, in addition to being the right thing to do.  

I remember when I was a resident on night float, I was chatting with the nurses up on the medical-surgical ward of our hospital.  One of the nurses took a call from a particularly brash general surgery resident.  It was actually pretty easy to hear both sides of the conversation because of this resident yelling and cursing at the top of her lungs.  The nurse was extremely calm and polite, which took an impressive amount of self-control.  

She acknowledged the resident’s orders, took some notes, and politely hung up.  

This was a mesmerizing scene.  

I asked her, “How can you be so calm in the face of that physician’s rudeness?  She said, “Oh, these young doctors think they’re so big and important.  I’ll page her three times after midnight to empty offices and she’ll never get any sleep.  A few nights of that, and she’ll come around.”  

I replied, “Ok, if I ever forget, just remind me to always be nice to you.”  She said, “Don’t worry, you’re always nice to us.  That’s why you always get to sleep unless a patient’s crashing.”  Message received!

I’m not endorsing the nurse’s “vigilante justice,” but this illustrates the self-destructive nature of disrespecting our nursing team.  

Even more valuable than just showing basic human decency is teaching the nurses anything that makes their job more interesting or enhances their clinical skills.  So few physicians do this that your nurses will LOVE you for doing this for them on a regular basis.  You will have personal brand ambassadors on every floor of the hospital.  Every conversation about you will start with, “I love when Dr. X is on call.  He’s so nice, and I’m always learning something new.”  

Love your nurses well, teach them often, and you’ll do very well. 

Ward Clerks

The ward clerk in the hospital is another person that can be the difference maker for you.  If you have ever heard the expression, “Secretaries run the world,” believe me when I say this is 100% accurate.  

I remember an attending recounting a great story to me one time, by way of illustrating this point.  He was a resident talking to the ward clerk who got a call about an admission.  She took the patient’s information, then went back to her conversation with him.  Five minutes later, she got a call about a second patient.  After getting that patient’s information, she gave the second patient’s information to “Hospitalist A”, and she called “Hospitalist B” for the first patient.  

My attending asked the ward clerk why she went out of order on calling the hospitalists for the admissions.  She said, “Hospitalist B is the meanest doctor here.  He always has something nasty to say to me.  The patient I’m assigning him is going to be a nightmare: a belligerent, uninsured drug overdose patient.  Hospitalist A is getting the really interesting Wegener’s granulomatosis case.”  

My attending realized that nearly all of his cases that had been assigned to him from that floor had been interesting and enjoyable patients, while some of his colleagues had some of the most difficult, most time-consuming cases on the floor.  He assumed it was luck of the draw, but it all had to do with how well he treated the ward clerk.  

Patient

This should be painfully obvious by now to all physicians, but your patients are your business.  You can’t run your clinic without them.  Treating them poorly will result in them referring doctors sending future patients elsewhere.  If you work in a hospital as an employee, this may not affect your compensation directly, but I assure you that it will negatively impact your reputation.  On the other hand, if you serve your patients above and beyond their expectations, and you communicate clearly with great empathy, you’ll build loyalty for life.  

Failing to provide excellent customer service in the digital age is especially hazardous.  

There are so many ways to put negative ratings into a variety of websites and social media outlets that can cripple your business and ruin your reputation.  People are nearly twice as likely to post something online about a negative experience as they are to rave about a positive experience.  

Take the time to talk directly to your patients.  Show empathy, teach them about their conditions, and really listen to their concerns.  

Conclusion

The good news is that your career is in your hands, but the bad news is…your career is in your hands.  It’s up to you to claim ownership over your reputation, and that starts with some inward reflection.  

When was the last time you told a nurse “thank you” or took time to compliment your ward clerk on their job performance?  If you can’t remember, today is your day!  Start building those relationships and the dividends will be huge.  You’ll stop being referred to as “that doc” and start hearing “my favorite doc.”  

Leave a comment below and tell us about a time when you had a great interaction with someone that unexpectedly changed how you practice medicine.  

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