Why you (almost) never have to fight

As a resident, I found myself confused as to why some colleagues struggled to achieve agreeable outcomes, while others seemed to float through their interactions with ease. Lacking the insight to see where the first group was going wrong and the second right, I found myself in the first group.

Eventually, I did gain this insight with guidance from mentors, and hope I can save you the discomfort of having to go through that same learning process.

Maybe they’re right

When you disagree with someone else, stop and listen. Hear what’s being said and seek clarification – they may have a point you haven’t appreciated and is worth considering. It helps to develop the mindset of ‘we have this challenge out there’ instead of ‘I have this challenge with you’. If you’re still comfortable with your position, move forward to the next steps. Even if you can’t agree, you can gain social capital by listening and respecting others’ opinions.

Power differentials are real

There is a significant power differential between residents, registrars and consultants. It’s quite simply inappropriate to have arguments between levels. Discussions or questions? Yes. But a battle of wills? No. A disagreement will be clouded by the power differential and isn’t in anyone’s interest.

It’s not a resident’s job to ‘fight’

Residents should never ‘fight’ over a management plan, request, or other aspect of patient care. The resident’s position is to learn and help enact the team plan formed by the registrars and consultants. If two residents still disagree after listening and considering both sides, then simply pass it up to your registrars and go back to your day.

A registrar should advocate, but not to the point of frustration

While registrars develop management plans and advocate for their patients, it’s not their job to make the final decision. If you disagree with another registrar, then stop and listen to their counterpoint. Work together against the external challenge and come to a mutually agreed plan. If this isn’t possible, then don’t ‘fight’. Kick it up to your consultants and let them figure it out.

What about ‘toxic’ colleagues?

It’s rare for someone to genuinely come to work to do a bad job. Labelling the overworked or stressed colleague as ‘toxic’ goes against the idea of ‘you-and-me- against-that’. If they are one of the rare toxic individuals, there’s all the more reason to use the strategies discussed.

The simple truth is: We are a team, working together for the patient, the hospital and the system. We see the problem as external to the two of us.

For those of you, like me, who find yourselves in more frequent acrimonious discussions than expected, I'd recommend Getting to Yes by Fisher et al as a good read.

A helpful video to watch is Dr Victoria Brazil’s talk on Timing, Tribes and STEMIs.

Dr Eric Richman (MDA National member)
Emergency Medicine Specialist