What are the qualities which come to mind when you consider a good doctor? Your immediate thoughts might focus on medical knowledge, clinical expertise and patient communication. Spend a little longer on the question and you might add ability to teach, keep calm in a crisis and good time management to your list. Or, perhaps you came up with a different set of qualities. Now let’s consider a slightly different question.
What qualities do all good doctors have in common, regardless of experience or seniority? Think of doctors in their foundation years, in specialist training, SAS, locums and consultants. Think of the best examples and what they all have in common. Where does “asking for help when required” appear on your list. Does it matter?
Reluctance and the consequences.
In 2018, BMJ Leader published Team interaction for medical leadership, the output of our study into the behaviours of over 200 doctors. We found that 39% of doctors stated that they don’t discuss the support they required to fulfil their role either enough or at all. Participants ranged from FY1 to Medical Director. They included consultants, locums, physicians and surgeons. That’s effectively 2 out of 5 doctors not asking for help when they need it. Again, does that matter?
Failing to ask for help or discuss support required can have serious consequences. Patient safety is the most obvious. But there are consequences for doctors themselves. It can begin with the immediate stress of struggling with a situation. That can affect confidence. Unresolved, this can easily derail a doctor’s career away from an area of interest. Worse still, chronic exposure to stress and isolation are directly implicated in burnout. And there are consequences for teams, departments and organisations too. Failure to identify problems, shortfalls in performance and inefficiency to name a few.
So what’s the root cause?
If reluctance to seek help is the symptom, then diagnosing the reason can help to identify the solution. Unfortunately there are numerous potential causes. And the problem in any one case may be multi-factorial. Let’s consider the issue in three broad categories.
Doctors who don’t think they need help.
We regularly discuss unconscious-incompetence during our various Medical Teaching Skill courses. The inexperienced doctor who is out of their depth without realising it is the most obvious. Any doctor involved in supporting the development of others must be constantly vigilant to this possibility.
But it can easily affect the experts too. When we spend long periods of our time practising with unconscious-competence, our lack of attention and awareness allows bad habits and shortcuts to creep. That’s a step away from returning to unconscious incompetence. Revisiting and refreshing knowledge via Continued Professional Development across the entire scope of practice is therefore essential.
Those who are highly-skilled and knowledgeable with a long sequence of successes can also develop a sense of bravado and hubris. They may not see their errors or even be willing to discuss the possibility. So doctors need to be able to have the tough conversations required to prevent their colleagues joining the ranks of the problematic divas.
Doctors who want help but can’t ask.
Sometimes, a doctor may believe that they can’t get help. This may genuinely be the case. A time-pressured emergency situation arising when the department is over-stretched is one example. But sometimes the lack of available help is only a perception, rather than reality. In our “Team interaction challenges…” study a quarter of the doctors involved reported that they believed their colleagues were unwilling to take on additional tasks to support them. Yet almost every participant said they were willing to help their colleagues.
Practical leadership and management is essential to ensure that the team learns from it’s difficulties, establishes robust support processes and that everyone knows how to get the assistance they require.
Doctors who choose not to ask for help.
Good doctors are appropriately knowledgeable, competent, confident, consistent and reliable. Unfortunately, some interpret the expectations that others have of them, or that they have of themselves, to mean that asking for help is a sign of weakness. In fact, there’s evidence that the opposite is true. People who seek advice in the right circumstances are generally perceived as more competent than those who do not.
Another barrier to seeking help is the expectation of a poor response. A doctor may feel intimidated in approaching a more experienced colleague. “My door is always open if you have a question,” is easy to say. But attitudes and actions speak far louder than these well worn words. Why would anyone approach someone for help if they expect to be dismissed, ridiculed or greeted with irritation?
The way forward.
The days of the infallible, heroic, solitary doctor are long past. In contrast, the demands of modern healthcare mean leaders must strive to develop real teams with a strong sense of interdependence. This is where everyone is willing and actively engaged in supporting each other. This requires an understanding of team dynamics with awareness of each members attitudes, strengths and insecurities – and even the most experienced doctor is willing to ask the most junior for input and ideas.
What are you doing to ensure that you and your colleagues around you are able and willing to ask for help?
Stephen McGuire – Managing Director
