There is a reason why people often say “the art of medicine.” It’s not just the fact that so much of what we do is based on culture and habit rather than science, but also the fact that there is a lot of finesse when it comes to relationships as a doctor. Oh sure, we know all about patient-doctor relationships and its importance. There are a lot of studies about it, and most medical schools spend time teaching students how to break bad news and so on. But what about doctor-doctor relationships? In the years since leaving residency, I feel like I have left a bubble and been deposited face-first onto a cold hard sidewalk, and have had to learn to pick myself up, dust off the grime and scrapes and keep walking. I’ve had to learn the hard way how to get along with my colleagues.
I trained at a major academic institution, where residents would impress attendings and each other with detailed discussions about scientific studies and their merits and flaws. Over a few years, we all become indoctrinated with the importance of evidence based medicine and more than that, the fact that it was the gold standard of practicing medicine. There’s a sense that practicing according to evidence is the RIGHT way, and everything else is morally reprehensible.
Fast forward then to my first job out of residency. I was in a small rural community in a group practice with a nurse practitioner whose husband was her supervising physician. After a few months of working there, I started becoming really incensed at some of the practices she had, which to me, were questionable in some instances, and in others, outright harmful. They were not supported by any kind of scientific evidence, and in some cases, even actively discouraged by the evidence. I printed out guidelines and papers for this nurse practitioner to review, and in return, she gave me a book written by a layman which supported her practices. Feeling helpless and outraged, I vented to other staff members and was ultimately confronted by her husband, who called me rigid and inflexible for not being able to accept that there were different ways to practice medicine. They threatened to fire me, and “demoted” me to a separate office location in another part of the medical building.
I did apologize to the nurse practitioner just to make peace, but have always maintained that her practices are wrong and detrimental to patients. I have even contemplated reporting her to the board of nursing and him to the medical board, but have been afraid of repercussions (which is a separate discussion in and of itself). I established my own patient base and kept my practice separate from hers. With that separation, I was able to regain a sense of sanity.
After a period of time, I was finally able to move to a new job. In this new job, I work with a couple of physicians who do some things that are not evidence based, although it’s nowhere to the degree that the prior nurse practitioner does. I had a run in with one of the physicians who got very upset when we had a disagreement over a patient management issue. Not wanting a repeat performance from my former job, I apologized to him for any hurt feelings, reiterated that we should have the freedom to practice the way we want, and stated that I wanted to have a separation in our patient population. He was pacified, and the relationship was repaired.
At the end of the day, I realize that there really is an “art” to mastering relationships. At the heart of being a physician is this fundamental conflict. On one hand, we are supposed to tell patients what to do, because quitting smoking is the right thing to do, getting a flu shot is the right thing to do, going for the stress test is the right thing to do. On the other hand, we are supposed to maintain an encouraging and positive relationship with patients when they don’t follow our recommendations, and we are supposed to respect their choices. It can be hard to let go of the sense of what’s right and overlook that in treatment of the patient.
In the same way, when it’s been drummed into your head that practicing evidence based medicine is the right thing to do, it can be hard to accept other physicians disregarding that tenet. It’s like what a young woman physician said to me about another physician, “I hate to tell him that he’s wrong, but… well, he is!”
Regardless of our position on evidence based medicine, we still need to be able to work together and get along. We need to be able to depend on each other for backup and allow for differences in practice styles without getting too upset about other doctors not practicing according to guidelines or evidence. After all, we’re not perfect ourselves and have to constantly strive to improve our own knowledge and habits.
Have you had conflicts with your colleagues about patient management issues? How do you resolve it? Do you think being a woman or being young has any impact on this?