Consultant from Hell: how to keep your doctors unhappy and unproductive

01.03.2017

Pre-disclaimer: While I think there are probably more female doctors than male doctors (and apparently the former are more effective than the latter) and the patient population is probably split 50%, the English language requires me to use a pronoun - i.e. either "he" or "she". I used "he" and "him" for convenience, as repeating "him or her" all the time seems heavy.

    After reading the excellent “Want to Attract Malpractice Lawsuits? Here’s How!” by Craig R. Hildreth, MD, I thought there should also be a quick guide for consultants on how to annoy and burn out their colleagues and here it is:

    Forget about teamwork and collaboration and communication, you are the boss now. Show them that you are in charge and you are the only one who matters in the ward. Treat them as pupils. And yes, it’s you vs. them.

    Begin the day by reviewing all the patients from the previous day. But don’t go to a common room, have the doctors wait for you and then summon them into your presence. If anyone is late, no matter what their rank, tell them that this is inexcusable. Remember, it’s you against the doctors, so show no mercy. Don’t allow them to describe the patient in generic terms – have them read the full notes they have made, including auscultation findings even when not relevant. When they are reading, interrupt them a lot, criticise their choice of words, pronunciation and accent. Never make them feel safe. Adopt the setting of a headmaster’s room: sit behind a huge desk and have them squeeze in uncomfortable sofas, have five sit in the place for three. Don’t let them have any opinion. Only your word counts. Find something to criticise them collectively: if nurses are quitting the ward, it’s the doctors’ fault. Make statistics, such as how often their signature was illegible. And never say anything positive. Be especially careful with doctors that are actually more qualified than you are – if they have a PhD and you don’t, if they studied something that you didn’t, make sure they know that they are just not good enough for you.

    Having given them this good start of the day, you can relax in your command centre (surely you have not forgotten to equip your desk with several monitors: more computers equals more power). At some point review the patients in the company of the doctor who is actually treating them.  Now, do not forget you are superior. Do not make the mistake of reviewing the patients as if you are just two colleagues discussing as equals. Adopt the style of a 12th century bishop going on a procession for your visits. Tell the doctor you will be reviewing the patients around 9:30. Not before 10, call the doctor and say you are ready, so that he spends at least half an hour waiting for you. Make sure your call results in the doctor frantically calling the nurse and the junior doctors and have everyone stop whatever they are doing to follow you. Have them walk in strict hierarchical order: you go first, followed by the specialist, followed by the junior doctor, followed by the nurse. Have the doctor or its junior carry charts and other documents. Do not hold anything yourself. Ask for something random (an unimportant form or a result: CRP at discharge in a previous admission will do) and complain if the junior doctor doesn’t have exactly that piece of paper right on hand or doesn’t know that result. Also, and this is very important, create some ritual to show your power: stand by the patient and have the nurse unbutton or raise him, then have your inferior doctors take off his socks or something. After examining him, extend your hands, and have them disinfected and wiped clean by the nurse. Do not do anything yourself. Enact strange, illogical rules in order to criticise the nurse too (e.g. no watches on the night-stand – and it’s the nurse’s fault if the patient wants to keep one there). Insist that the junior doctor always carry lots of papers, related to other patients too. Don’t let him rest the documents anywhere. Remember to make it all very slow, try to waste as much time as you can. Then go back to your office, leaving the ward again procession-like.

    The doctors will begin working. Let them work for a little while, then go and sit in the common room. If two of them start talking, remind them that this is a place of work and not a playground. They should focus on their work and not talk to each other. Make sure the nurses feel that the doctors think that they themselves are superior to them – none of that teamwork in your ward! Imagine if they would ally against you! Discourage doctors talking to nurses. Better, create an atmosphere of mistrust – have the nurses report on any doctor who tries to help them. Divide and conquer. Spread rumours.

    Pharmaceutical reps are your allies in wasting doctors’ time. Tell the reps that they cannot talk to any doctor before talking to you. Make them wait, make them feel it is a great honour to be admitted in your presence. They will often want to make a presentation. Make the presentation compulsory, i.e. have all the doctors drop everything to watch thirty minutes of slides on a new wonder drug (or on something they are using anyway). Make sure it is obvious that they are wasting their time just because you want. Take attendance, like in school. After all, we have already established that you must treat the doctors as pupils.

    After the presentation, let them work some more. Once you are ready to go home, have them check with you the documents they want to give the patients that are going to be dismissed. Find something wrong in everything, especially in grammar or style (make sure you also correct – wrongly – what had been properly written. This is yet another display of your power over the puny doctors. Have them print everything at least three times, always finding something wrong. Don’t let them find anyone else to help them, in your ward there is no talking.

    About three hours before the official work day is over, just go home. Why? Again to show that you can. Have them work much more than you – with no overtime – because of your constant interruptions. Make sure your ward is known as the ward where doctors have to work the longest. In sum, just follow this simple guide and you will have stressed and overworked doctors in no time and you will be feared in the whole hospital.

    Disclaimer: this does not refer to any ward where I have worked. Nonetheless, I have heard from colleagues that some consultants do actually follow some of these rules and of course the whole work atmosphere suffers.

In these days of Evidence-Based Medicine one cannot say whether the ‘Consultant from Hell’ results in lower patient mortality and morbidity compared to a workplace where there is actual teamwork and open communication – a double-blind, placebo study is impossible and I doubt anyone would consent to have their ward analysed. I think, however, that it is in the interest of the patients to keep all the health providers satisfied with their jobs. A happy doctor wants to help the patient, a doctor trapped with the ‘Consultant from Hell’ just wants to go home.

  

Article last time updated on 01.03.2017.

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