The first day of residency in emergency medicine approached. I eagerly anticipated the responsibility of being a physician. Patients were going to place their lives in my hands. I knew the breadth of medical content necessary and was adept to the process of achieving an accurate diagnosis. The next steps of my journey were to learn the nuanced art of clinical practice. Questions permeated my mind as I prepared for day one. After the diagnosis was made, what exactly would I be doing and how would I spend my day? I read book after book on being an intern. Ultimately, I found the answer in a pocket sized, self-printed book – The Intern Survival Guide. While it was printed in 1993, the guidance was both perennial and goal oriented. The job of the intern is to, “Get a patient what they need.” For example, consider an inpatient who needs a CT scan but has not yet obtained the study. The job of the intern to find out why, remove the hurdle, and get the study for the patient.
Within weeks of adopting this mantra, the next question naturally arose, “But how?” What about when circumstances don’t go according to plan? What happens if there is a debate on what is right for the patient? As a medical student, I had been insulated from these hurdles. I quickly learned that in order to get a patient what I believed was right, I would need to master the art of debate and negotiation. What was a $15 purchase from the local bookstore led to understanding the importance of excellence in critical thinking, writing, and speaking – all focused on what was right for the patient.
To start this process, I actually hired a speech coach the first year of residency. I contacted the Director of the Speech Center at the University of Richmond. We set up an initial assessment to guage areas of weakness and come up with a performance improvement plan. She gave me homework and we met again to assess for positive change. She focused on body language, content, structure, and delivery. Years later, I still remember her guidance. It was the best $150 I ever spent. I am certain her insight helped me get the best treatment for many patients.
In 2018, I became a chief quality officer at South Central Regional Medical Center in Laurel, MS. As CQO, I directly oversee hospital accreditation, internal audits, and our hospital’s mandatory quality reporting process. In this role, the need for mastery of communication continued. I quickly learned that poorly written policy does not age well. For example, a telltale sign of a good policy is how many clarification emails are sent after the original policy. Policy should account for all possible circumstances and not need revision. Policy writers can choose to use “should”, “may”, “must” or “shall”. Each word has downstream effects on how the policy is enacted in everyday work. And no, the answer to everything is not “We should make that a policy.” To have meaning, all policies must be enforced. That takes a lot of work, which could mean time away from patients. Lastly, poorly written policies have unintended or unrecognized consequences.
The influence and power of language cannot be underestimated. Being able to see what is right is an essential first step. But to successfully implement what is right requires successful debate and sometimes savvy negotiation. These skills are not explicitly taught in undergraduate or graduate medical education. Many of us learn this on our own.
If the power to implement what is right depends on mastering the art of debate and negotiation, should we explicitly arm our replacements with these invaluable skills?