A young doctor’s advice

by MIPS member Dr Antony Ji

Royal Brisbane & Women's Hospital

Life as a junior doctor can be tough; especially as an intern. Indeed, it’s often the intern or resident (RMO) who has the closest patient contact under a team and acts as the first port of call when things go awry. 

While thoroughly rewarding, being the initial point of contact can also generate some of the most nervous moments in a RMOs day-to-day life. Not only with a patient’s clinical status but also in dealing with patient complaints and the clinico-legal risks involved. It only feels like yesterday I was starting out as an intern. On my first day, I was thrown in the deep end when a nurse asked me to review a rather clinically sick patient who was threatening to leave the hospital. This was the first incident that helped me develop some ‘tricks’ over time that could potentially help you deal with upset patients in an easy and empathic way. 

Clear communication is important, but this also comes with practice and preparation. The few tricks I possess, have helped me out in tough situations. 

Always involve someone – sharing is caring. No matter what the issue is, there is always someone higher who should be notified in case of an issue arising. It is certainly great to problem solve at the time, but involving your team is also key. A short ‘FYI’ and perhaps even how you are thinking the team should be approaching the issue is a fantastic way to frame things when dropping a delicate situation bomb. Randomly upset people don't really exist. There is always a trigger, conflict, breakdown or issue which has caused the person to feel the way they do. The exact root why they are upset, is critical. Asking them “what has made you feel this way?” and the phase “it sounds like … is the reason behind the way you’re feeling” are regulars I tend to use. Knowing the issue is half the battle to solving it (with the team!). 

Empathy: See it, Learn it, Do it. Empathising with a patient and their situation is a large part of figuring out why they are upset in the first instance. It also demonstrates to the patient that you have listened and acknowledge their concern. Often simply expressing this can help win over a patient when they feel like they are being ignored. 

Understand where you stand. Making clear you are a junior on the team, and acting largely as a facilitator will help reduce direct blame onto your shoulders. 

Apologising for a situation is caring and empathetic, it is not an admission of incompetence or guilt (or admission of liability). Equally, the idea is also not to expose yourself to making rash decisions – especially in vulnerable situations. 

Opacity is not ideal. Transparency is a big part of open communication. That said, it is important the team also has a consistent message to avoid miscommunication when discussing delicate issues. Constant feedback between the patient and team, clarifying aspects the patient is unclear or has questions about is another method to make the patient appreciate a transparent line of communication about their care. 

Keep calm and document everything! That old adage, if it wasn’t written down, it did not happen or was not said rings true. No matter how heated or unfair a situation, maintaining professionalism, documenting the interaction and escalating are the three steps that will get an RMO out of most tough situations with minimal risk. Be mindful of your stress levels and stop to ensure you maintain your composure and stress levels.  

Finally, I conclude with some food for thought over an incident which occurred two months ago on my last rotation. It's a fitting scenario that highlights what a colleague might face on the job. I was paged about a lady due for an extensive operation. She was next on the list, but the present case had developed an unexpected complication and so had gone significantly overtime. Theatre had to delay her surgery until a later date. The team Consultant, Fellow and Registrar were all scrubbed into this very complex case. Forewarned by the pre-op nurse she was already quite upset at the current delay, it then fell to me to break this unwelcome news. How do you think you would go about communicating this to her? 

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Dr Antony Ji is currently a rotational PGY2 doctor at the Royal Brisbane and Women's Hospital. He has an interest in anaesthetics and is passionate about junior doctor wellbeing. Most recently, he was a member of a panel discussion in navigating complaints and risks as a junior doctor at the AMA Intern Readiness Workshop. In this article he shares his insights and tips for his intern and RMO colleagues.

 

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