Doctors and Nurses: Doctors need to Order Less, Listen More

Posted by Dike Drummond MD

doctors and nurses doctor and nurse listening physician leadership 150x150Doctors and Nurses form a TEAM in healthcare

Often that team is quite dysfunctional because of a basic cross wiring in the command and control of the team.

A doctors and nurses post on last week hit a nerve. It was titled “Listening to Nurses is a Key to Being a Good Doctor”.

I couldn’t agree more.

Think about the average hospital situation where doctors and nurses (and other professionals) form the patient care team …

  • How many minutes a day does the doctor spend with the patient?
  • How about the Nurse?
  • The nurse’s aides?

Given that imbalance of simple time with the patient, their symptoms and their responses to your therapeutic interventions – who knows more about the patient and how they are responding (or not) to your treatment … the doctor or the nurse?

And how often are doctors curt, dismissive, in a rush, don’t listen to input from other members of the care team or just flat out don’t ASK the nurses what they have noticed. In most cases the quality of the communication between doctors and nurses is poor … and, when that happens, typically the doctor is to blame. There are two main reasons this happens …

1) Doctors get no formal training on team leadership

… and are notoriously horrendous at listening. The relationship between the doctors and nurses on the care team is dysfunctional and set in historical stone. Doctors “write orders” for the nurses to follow. As in “my way or the highway”.

Outside of medicine, the only place the leaders give orders is in the Military. Generals know who is doing the fighting and don’t mistake front line intelligence with wall maps back in the command post. When it comes to doctors and nurses, the nurses are in the front lines. They hold the most important information on the patient’s condition and response to treatment.

2) Doctors are often Burned Out

Studies have shown for decades that 1/3 of doctors are suffering from Physician Burnout every day – worldwide and regardless of specialty. The presence of Burnout in your Physician has a Dramatic Effect on their leadership abilities day-to-day. On teams of doctors and nurses you will see variations in they physician’s engagement depending on how busy they are and how well they are getting their needs met outside of their career.

There are plenty of great doctors out there … ones with natural leadership skills. AND there are doctors and nurses who form amazing teams to care for incredibly difficult patients. Nevertheless, when it comes to teams of doctors and nurses, we have to acknowledge  the following as built in biases …

  • The doctors are distracted by multiple patients and other priorities in their day
  • Physician Burnout plays a role here … ask your doctor how they are doing and really listen between the lines of their answer
  • The doctors and nurses spend dramatically different amounts of time with an individual patient. It is as if doctors and nurses are  entirely different species on the hospital floors.
  • In order for doctors and nurses to communicate more effectively … the doctors must ask more questions and then  listen, value what they are hearing and take action on it. This is a core leadership and communication skill on teams of doctors and nurses.

Here’s a quote on doctors and nurses from “Kill as Few Patients as Possible” by Oscar London, MD:

“Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom.”

Two signs of a quality doctor, who values the contribution of his team members, has some team leadership skills (and is not suffering from physician burnout!) are these.

  • How little they talk
  • How much they listen

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Tags: Physician Coaching, Physician Leadership