Challenging interactions with colleagues

Poor communication between doctors lies at the heart of many complaints, claims and disciplinary actions. Dr Mark Dinwoodie, Medical Protection’s Director of Education, explains the importance of maintaining good relationships with colleagues and communicating effectively with other health professionals

Read this article to:

• Understand how and why professional disagreements can harm patients
• Take steps to manage your interactions with colleagues
• Learn from a real life case where a patient was harmed as a result of ineffective communication between doctors

Interactions with colleagues can be one of the most challenging aspects of medicine. The people you work with have a profound effect on how you practise – colleague interactions can lighten the burden, or make it considerably heavier.

Our experience is that poor communication between two or more doctors providing care to patients lies at the heart of many complaints, claims and disciplinary actions.

It is inevitable at some point throughout your career as a doctor that you will come across at least one colleague whom you have issues working with. It is therefore important to be aware of different strategies and techniques you can use.

Identifying risks

There are many reasons why doctors may not communicate sufficient clinical information to their colleagues about patients under their care. These can include pressures of time, difficulty in accessing colleagues, and difficult relationships with them.

Changes in working patterns and the resultant increase in shift work and cross cover mean that a greater number of doctors may be involved in a patient’s care. This has increased the risk of failures in communication, as passing care between doctors, in a referral or a handover, increases the possibility that patient information will not be optimally shared. As a result, abnormal investigation results may be missed, treatments may be inadequately monitored, or important comorbidities may not be taken into account, which all put the patient at risk of harm.

So what can you do to reduce the risk around difficult colleague interactions?

Pick your battles

Use your energy wisely – you might have several issues with colleagues but some will generate more risk to patients and yourself than others. It is wise to concentrate your efforts and energy on high risk areas, with the best interests of the patient at the centre of discussions.

It is important to balance the amount of respect you show for your colleague with the level of your concern for your patient, in order to get an effective response.

Catch and stop risky assumptions

Assumptions are a common human error that we all make. They are especially prevalent when dealing with colleagues we dislike or find challenging. We can be more likely to make an assumption relating to clinical communication rather than check with that colleague. This generates a variety of risks that can lead to catastrophic outcomes.

Checklists can reduce this type of risk. They are a useful method of ensuring completeness of communication when referring a patient, and they can be used as memory aids or integrated into the records or correspondence. They also enable doctors to focus on more complex tasks by reducing the amount of information they need to remember and process at one time.

Handover

Where all responsibility for patient care is being handed over – for example, to the hospital at night team or to a GP colleague when going on leave – a handover model such as SBAR (situation, background, assessment, recommendation) or the Medical Protection SHIFT© model (status of patient, history, investigations pending, fears of what may unfold, treatment planned) can be used to ensure all relevant information is passed on and recorded. It can be useful to ask the recipient to repeat back a summary of what they have understood, to confirm the accuracy of information transfer.

Actively manage disagreements

Differences of opinion between doctors also pose a risk. Disagreements may arise over diagnosis, treatment and management, as well as interpretation of investigations, resource allocation and end of life issues. The breakdown of a working relationship between doctors can have a detrimental effect on colleagues and patient care. When raising concerns with colleagues over a disagreement about patient care, you should emphasise the importance of achieving the best outcome for the patient, while maintaining dignity and respect for your colleague, and attempt to negotiate a mutually agreeable resolution.

If you think that a colleague is routinely putting you or your patient at risk through inadequate communication and your attempts to give subtle feedback have not been effective, you should raise your concerns with the colleague directly, making suggestions for improvements to enhance clinical communication and framing the conversation in terms of the risk to everyone concerned. You should emphasise that you are committed to taking action, document your concerns, and explain what you have done to tackle them. If that does not work, you should discuss the matter with your clinical lead or defence organisation for support and advice on what to do next.

Find out more

• Medical Protection has a series of online learning modules on a range of topics including communication and interpersonal skills
• Learn from a real life case where ineffective communication caused a patient harm
• For advice when needed, call our medicolegal helpline on 0800 561 9090