From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.
The American College of Healthcare Executives (ACHE) held their annual national meeting in Chicago the week of March 22, 2010. During the meeting, Joseph Bujak, a physician and vice president of medical affairs at 246-bed Kootenai Medical Center, in Coeur D’Alene, Idaho and co-presenter Kathleen Bartholomew, a registered nurse and well-known author on nursing, acted out a unique role-playing presentation on doctor-nurse communication. See the full article here (free registration required).
“In the opening skit Bartholomew phones Bujak, the on-call physician, at home in the early morning hours to ask whether she should adjust treatment in response to changing creatinine levels in a kidney failure patient. The physician berates the nurse for waking him, because she’s the fourth person to do so and because she doesn’t seem to even understand the clinical difference between rising and falling creatinine levels. ‘I’m surrounded by incompetents!’ Bujak says. ‘You’d have to be a Neanderthal to think I would put up with this abuse,’ Bartholomew tells the audience.”
Both presenters agreed, one of the main reasons for physician-nurse communication problems was that doctors often don’t know the nurses. In our series on using mediation skills in the health care setting, we used an example of physician-nurse communication problems in Part I, where we highlighted the use of the principled negotiation method to resolve conflict. One of the key points in this method is separating the people from the problem as seen in Part II.
In their book, Getting to YES, Roger Fisher and William Ury outline three categories to think about in terms of dealing with people: perceptions, emotions and communication.
1. Perceptions: In the doctor-nurse situation described above, the conflict exists because it exists in each side’s perceptions. If the nurse or the physician can put themselves in the other’s shoes, it allows them to gain useful information to help address the overriding patient care issues.
2. Emotions: When parties recognize and understand emotions, both theirs and the other persons, they are freed from the burden of unexpressed emotion and can more likely work on the problem. During the skit, it was stated, “nurses see doctors as being able to flout the rules, which destroys the sense of collegiality on which the new team-centered approach to healthcare relies.” If physician and nurse had better communication, the emotion around this issue could be recognized and addressed.
3. Communication: Skills that can be learned to improve communication include: listen actively and acknowledge what is said, speak to be understood, use “I” rather than “you”, and speak with a purpose in mind and communicate what purpose the information will serve.
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