Physician leadership sometimes means stopping the work to support the worker.  Here’s an example.  “I’m not sure why I chose this job!”  A very competent and normally confident advanced nurse practitioner came to me recently and was distressed about a patient she had seen who was nearing the end of life.  She felt ill-equipped to have end-of-life discussions or shoulder the difficult questions or decisions that would occur with the patient and his family.  The full weight of provider responsibility and the impact we have on patient outcomes was especially heavy that morning. I offered some reassurance and even some “advice” I had received 30 years ago from a mentor: “If you can’t take the heat, get out of the kitchen!”  Of course, I was not serious with my advice.  However, it reminded me of the dysfunctional culture that we sometimes practice in.   Certainly, as young physicians, despite being sleep-deprived, exhausted, and hungry, we were told to “suck it up” or to “man up.”  We were taught to be self-sufficient, and that support should not be expected.  Keep working, stay in your silo and tough it out!  How insane!

This mentality needs to change.  My colleague was suffering from what I call “silo syndrome.”  Good physician leadership can turn the silo syndrome into a highly motivated, well-functioning team of healthcare providers if we will recognize that it isn’t just the patient that needs care.

Her work situation had been designed such that she worked alone and was expected to run an independent panel of patients.  While a physician might do initial consults, she was expected to do all of the follow-ups and make the follow-up decisions based on testing results. She was technically part of a multi-provider “center,” but she certainly did not feel part of a team.  No time was set apart for consultation with a physician, no patient reviews were performed, and trying to get advice on the fly was nearly impossible. 

Because healthcare workers are subjected to continuous work environment stress, I cannot emphasize enough the importance of teaming. Every physician interested in good physician leadership needs to take into consideration the fact that all of us need personal interaction.  We need the brief encouragements, the brief moments of celebration for a nice patient outcome, and a brief intellectually stimulating review of an interesting case.  My colleague needed to have someone to process her feelings with and someone to walk with her through the process of making difficult decisions.  Make an effort to build teaming activity into your day today.   If not for you, one of your colleagues needs it!