Dealing with demands outside your comfort zone
In healthcare settings, situations involving angry or aggressive patients or families can escalate quickly, putting health and safety at risk.
Dr Peter Walker, GP and Avant Senior Risk Manager
Wednesday, 25 February 2015
You are at the end of a long shift at the hospital, when the hospital’s obstetrician and gynaecologist (O & G) nonchalantly asks you to “fill in” for a few days for a senior obstetrics registrar who is sick.
A knot suddenly develops in your stomach. As an obstetrics registrar in your first few months of training, you are not entirely comfortable with this request. Although, this would be a great opportunity to dazzle your superiors, you are concerned about making a serious error as the role requires a higher level of expertise than you currently possess.
You immediately raise your concerns with the O & G and tell them that you are worried about being left alone in the medical ward without access to a senior obstetrics registrar.
However, the O & G dismisses your concerns, saying you will be “fine.” You don’t want to make waves, so you agree to fill in.
Steps to minimise your risk of errors
Working as a trainee can be challenging enough, so our specialist medico-legal team shares some tips with you to help you deal with unreasonable work requests and minimise your risk of making a serious error.
Clearly express your concerns
Initially, if you are asked to perform a duty or role that you feel uncomfortable with, you should voice your concerns to your consultant. This may not work, but at least you have clearly expressed your concerns about the request to your consultant.
If you harbour serious concerns that you will not be able to safely complete the shift because of your skill level, even with support from the consultant, then escalating your concerns to your hospital training supervisor is advisable. Ultimately, you will be accountable for your professional conduct if things go wrong.
Contact the consultant on call
This is a good time to remember that all members of the medical profession are united by their common experience of the demands of hospital-based training and learning to work and train in a collegial manner. No doubt your consultant will vividly recall their own hospital training and most consultants will be more than willing to cut you some slack in such a situation.
If you need to phone the consultant on call for some advice/assistance, it’s always a good idea to preface your phone call by identifying yourself and your level, and to explain that you have been asked to cover for the senior obstetrics registrar, before proceeding with your questions. Most consultants will be more than happy to help you in these circumstances.
Establishing some ground rules and clarifying with the consultant on call about when they want to be contacted for advice and when it’s not necessary is also a good idea.
When to pick their brain
However, refrain from putting the consultant on speed dial and calling them incessantly for advice – they will quickly lose patience with you if you call them about every decision you need to make.
You should aim to call the consultant and request advice only on major decisions; and preferably before you do, always ensure you have formulated your own assessment/management plan or considered the options, so that you will demonstrate your own clinical thought process and the consultant can then concur or offer an alternative. This approach turns the call into a genuine learning exercise, rather than imposing on the consultant to tell you how to do routine work.
You should also inform the consultant if there are any significant changes in the patients’ clinical condition or if you have any concerns about a patient’s clinical condition.
Of course, it is always crucial to document thoroughly the content of any clinical discussions in the medical file.
If you cannot contact the consultant for any reason, you can take the following steps:
– Call another consultant at the hospital
– Call another consultant you know – from a previous rotation or another hospital
– Ring last year’s obstetrics registrar or another registrar that you know
– Call the Medical Superintendent at the hospital for help
– Call one of the major hospitals in your capital city – you will find someone to help you
Your legal responsibilities
From a legal perspective, according to the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia good medical practice involves “Recognising and working within the limits of your competence and scope of practice”. The Code also states that good medical practice involves “Ensuring that you have adequate knowledge and skills to provide safe clinical care”.
While taking on a higher level role can be a great learning exercise, to proceed to act as a senior obstetrics registrar when you really feel that it’s beyond your skill level can leave you open to a professional conduct complaint if there should be an adverse outcome for a patient.
Keeping this in mind, if you really feel that you do not possess the expertise to act as a senior obstetrics registrar, even with support from a consultant, you should decline the request.
You might also be interested in…
Advice on 'Dealing with workplace issues’ on the Avant health and wellbeing site.