Have you ever been in a critical situation when you wanted to do something unconventional and received some pushback from staff, but you knew it was the best thing for the patient? In this episode, our hosts, John and Drew are joined by Molly Estes and George Willis at ACOEP Spring Seminar 2023 to discuss navigating team dynamics as the doctor when asking the team to do something out of the ordinary.

Keys to Success:
  • Emergency medicine is a team sport
    • Having your team on board is very important for patient care
  • Education is key
    • People are more likely to get on board if they understand the “why” behind what you’re doing
    • As physicians, it is our responsibility to educate those around us
      • Patients, nurses, respiratory therapists, pharmacy, etc.
      • Our dedication to teaching our team will aid in making the team stronger and ultimately lead to better patient outcomes
      • This pushes us to be masters of our craft to be able to think outside of the box and be able to explain it to others.
    • Everyone has a right to refusal
      • Any staff member can refuse to participate at any time if they feel uncomfortable
      • If someone refuses, there is probably a good reason; often based in lack of experience or prior bad experience
      • Refusal should be met with respect
      • At the point someone is refusing, your job as the physician is to figure out who is going to do the task, whether that’s the charge nurse, most experienced nurse or even yourself
    • Trust, Reputation, Relationship Paradigm:
      • The more reliable your reputation and the better working relationship you have with the team member, the more likely they will be to trust you in critical situations.
  • Non-Critical Situations
    • When putting in orders that may be outside of the norm, try to explain the thought process ahead of time to address questions up front and avoid confusion or potential errors
    • If you’re being met with resistance and other strategies are not working, consider a treatment option that the team may be more comfortable with, if possible
  • Critical Situations
    • “As soon as we stabilize the patient, I will explain why I’m choosing to do it this way.”
    • Two question approach:
      • “Do you believe I am doing my very best to help this patient?”
        • Yes = Proceed to question 2
        • No = Full stop
      • “Do you think I would ever intentionally ask you something to harm the patient?”
        • Yes = Full stop
        • No = Ask “How can we work together to do this?’
Take-Home Points:
  • Education and communication are key!
  • Challenge yourself to have a backup plan
  • Everyone has a right to refusal
  • Be kind

Post by Patricia Capone, DO PGY-1

About Our Guest:

Molly Estes, MD
Clerkship Director, Medical Education Fellowship Director, and Assistant Professor of Emergency Medicine, Loma Linda University

George Willis, MD
Associate Program Director, UT Health San Antonio Emergency Medicine Residency

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