Forging Relationships with Physicians
Written By: Mark Wentlandt R.N.
Back in 1996, I took an Interpersonal Communications class from Dr. John Daly at The University of Texas at Austin. I was still shopping for a major so most of my class schedules looked like an expensive dim sum menu. I covered the full gamut from Art History, Biology, Chemistry, probably something that began with D, Economics, and so on through Spanish. I somehow never got around to Zoology, but only because it was probably wait-listed. Literally everything was wait-listed for freshman at UT, especially if your last name began with a “W”.
Dr. Daly turned out to be one of those professors you remember forever. He was an older guy who was a dead-ringer for Phil Donahue, the first ubiquitously famous daytime talk show host, Dr. Phil. Dr. Daly was engaging and charismatic. It didn’t matter that all his TAs had the personality of wet paint because the hour you spent with Dr. Daly, despite the fact it was amongst a huge sea of other adrift freshman in one of the campus’s largest auditoriums, was usually the best hour of your week. He was that good.
The most resonant thing I took from his class was this: In any relationship, the person with the least degree of interest holds the most control. I inadvertently proved this theory correct when I found myself utterly ignored by a classmate who I took out for dinner that semester. That’s a different story.
This week’s topic is about forging relationships with physicians. As a nurse, you’re sort of by-default subject to the person with the least amount of control in the relationship. Some of it is structural. The reality is that docs are higher up the food chain than nurses, so there’s a sort of built-in disparity from the get-go. Despite that, it still comes down to recognizing doctors are human beings. Well, most of them.
Every nurse had that one weird experience either in nursing school or during orientation where you got stuck with the psychotic weirdo who seemed to thrive on sewing discord between them and the docs. It didn’t matter if they were calling for a critical change in condition or asking for Colace, every single interaction was marred by acting like an utter sociopath followed by behaving like they were persecuted by Pontius Pilate himself once they were met with resistance from the doc. Hopefully, you learned this is not the way to forge good relationships with your docs.
In my experience, the single most effective way to forge solid working relationships with physicians is consistently demonstrating you’re an engaged stakeholder in their patients’ plans of care. This is not to be confused with being an adoring sycophant, as they will never, ever take your recommendations seriously. It means knowing your patients’ medical histories. It means knowing morning lab values and what they might reveal about progress in the POC. It means conducting thorough assessments. It means reading progress notes and participating in rounds with every opportunity. It means alerting them to new results that are critical to determining the next step for their patients.
From the intern to the attending, docs recognize clinical competence, especially when that clinical competence is put to use in advancing the plan of care. I’ve had countless experiences in which my suggestions have been shot down by a lower-level only to be upheld by the fellow or attending who’ve come to trust my judgment. Granted, this doesn’t happen overnight. It takes time. But the dividends are well worth the time investment.
And listen, I hate to dispense slow-pitch advice, but there’s a lot to be said for simply acknowledging a doc’s humanity. You have to remember some of these people have been on-shift for 24-hours or more without sleep. If you pass them in the hall and they look a bit frustrated, it’s likely not because you’re the one in the hallway. They may have just come from a code. They may have just gotten smacked down by the MOD on a grossly inappropriate admission. The attending may have just ripped them to shreds for overlooking an elevated vanc trough on one of their 20 patients. Just like ours, their world is high-stakes and not particularly forgiving. If they shoot down your suggestion, it’s not because they don’t like you. It’s usually because they need a moment to think it over.
The other reality is not everybody is going to be your friend. Some docs have been burned by poor nursing care in the past and, no matter what you do and no matter how professionally you serve their patients, you’re simply not going to win them over. Meanwhile, some are just awful people who are best suited to the company of houseplants. And that’s ok, too. Here’s the thing—you are not bound by your license to be popular with physicians. You are bound by your license to protect your patients—first, foremost, and with all the skill and talent you can muster. Do that every time and chances are good you’ll find yourself with far more physician allies than you imagine.