PART II: In difficult moments with doctors, Physician Compact is immensely powerful

“Sometimes it turns out that the doctor got upset because we didn’t hold up our side of the compact.”

-Dr. Joyce Lammert, Chief of Medicine

As we continue on the topic of compacts, we ask this question: Is there anyone in health care who has not experienced the angry doctor – the physician who raises his or her voice, pulls rank or bullies subordinates? When doctors behave this way, it is always unattractive, often counterproductive and occasionally dangerous.

Sometimes, though, there is more to the story than meets the eye. Sometimes a physician blowing his or her stack is an alarm of sorts. And when there is a physician compact to measure the behavior against, it can be a valuable learning experience.

Consider this scenario: It’s a weekend. Dr. Jones (not his real name) is home and gets word that one of his patients is experiencing atrial fib in an emergency department out of state. The doctors at the out-of-state hospital send a message asking what Dr. Jones had seen on the patient’s recent tests. Dr. Jones calls the Virginia Mason Emergency Department to see if he can get someone to look up the information for him, but all ED staff members are busy with patients and Dr. Jones is left on hold for a long time. Then someone mistakenly hangs up on him.

Frustrated, he tries another route and calls Bed Control. There is a bit of miscommunication during the call and Dr. Jones grows more frustrated. He is so frustrated that, uncharacteristically for him, he begins yelling at the staff member on the phone.

Dr. Joyce Lammert, who today serves as VM’s chief of medicine, sat down with Dr. Jones and said, “Look, you can’t work here if you don’t respect other people because it’s all about patient safety. Do you think somebody is going to feel safe to tell you when you’re ready to fly the airplane into the mountain if you yell at them about other kinds of things?”

So what on earth does this have to do with the physician compact? Everything.

First, from Dr. Jones’ side, he has an obligation – based on the explicit language in the compact – to “treat all [staff] members with respect.” Dr. Jones knew he was wrong, conceded as much to Dr. Lammert, and he made a sincere apology to the staff member he had yelled at.

But thanks to the compact, there is another way of looking at this incident. It’s not that Dr. Jones was right, but the compact is a two-way street, and while it requires Dr. Jones to do certain things for VM, it also requires VM to do certain things for Dr. Jones.

“Sometimes it turns out that the doctor got upset because we didn’t hold up our side of the compact,” says Dr. Lammert. While Dr. Jones is required under the compact to “practice state of the art, quality medicine,” the organization also has a responsibility to Dr. Jones to “provide information and tools necessary to improve practice.”

As Dr. Lammert reflects upon the situation, it seems clear the problem started with Dr. Jones’ inability to get the information he needed about a patient. Was there something VM could have done to remove that barrier? To make it easy for Dr. Jones to access patient information quickly – even while at home?

Of course. He needed access to the EHRs from home. You can argue, of course, that this is Dr. Jones’ responsibility, but Dr. Lammert sees it differently. “Some of our docs are not computer savvy enough to do that on their own or they have these old computers unlike the computers at the office,” she says. “And docs don’t like to tell people they’re not smart enough to do that kind of thing.”

So if we look at the compact shouldn’t the organization recognize the barrier and help Dr. Jones get past it? Wouldn’t it be a relatively simple matter to set up the technology in his home – a system exactly like the one at the office? Wouldn’t that enhance his ability to “practice state of the art, quality medicine?” Wouldn’t it improve his ability to put the patient first? And isn’t that what he was trying to do in the first place?

Dr. Jones started the whole incident fully faithful to the most important commitment the compact calls for – that he “focus on the patient” – put the patient first, as the VM strategic plan requires.

“So we had someone from IT go to the docs’ houses and update their computer equipment and make sure that they could pull up the EKGs and the echoes, etc. at their houses. And that was because of our part of the compact and that is not something we would have done in the old days before the compact.”

How does your organization turn moments of conflict into opportunities for lasting improvement?

Next: Compacts for board members and VM leadership.

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1 Comment

  1. Are your leaders, doctors and board members aligned with your organization’s mission? « Virginia Mason Medical Center Blog

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