Collegiality

This blog post was immensely difficult to write. Akin to rejected scientific papers, massive revisions were required. I had initially intended to write a post poking fun at inappropriate phone requests that a radiology registrar typically receives, but as I recall these anecdotes, they become less and less funny, and in fact triggering me to reflect on my own conduct during these calls.  Over the last few days, I have had loved ones who were unwell, and had received amazing care and advice from colleagues who helped them get better, which also prompted further reflection.

So I’m going to write about collegiality amongst Junior Doctors.  There are tons of definitions of collegiality in the medical context and excellent articles written by eminent Professors in local and international publications. A simple definition is “the co-operative relationship of colleagues” (Merriam-Webster Online Dictionary). In its purest and simplest sense, I feel that this is what we need to achieve amongst ourselves between disciplines, and especially between the ranks from HO to registrar.

We all work incredibly hard. Perhaps as a coping mechanism, a lot of our work processes have become “game-ified”.  There is an unspoken “self-worth” as determined by how short we can keep our ward lists, how fast we can get our scan appointments, or how many referrals/requests we manage to handle (away) on call. Unfortunately, this pits us against each other. Its team HOMO vs radiology registrar for the urgent scan, debate between (unnamed) disciplines as to who gets that hip fracture for conservative management, or team vs overworked cardio registrar for that (not really urgent?) atypical chest pain referral.

But the practice of medicine is not a game—it is a co-ordinated multidisciplinary effort, towards appropriate patient care. We are playing on the same team, and this is where collegiality enters the picture.

At the centre of collegiality, is honesty. A lot of hostile behaviour directed towards juniors from registrars being referred cases is because of a myriad of bad experiences with junior colleagues “crying wolf”.  How many of us have invoked the “I cannot exclude aortic dissection/ischaemic bowel/*insert life threatening diagnosis here*” to accelerate an urgent scan or review, even though we know it is a differential diagnosis far down on our list? I know I have, as a HO. Reviewing this non-urgent case may take away the registrar’s time from managing other complex, urgent cases on call. If a case is a “social” urgent, it would be best to declare it privately between the referring and reviewing doctors. The reviewing registrar has invariably experienced such cases first hand and understands the inherent difficulty. He/she will most likely agree to see the patient expediently, but this information provides some breathing room to manage the acutely unwell cases first.

Equally important, is humility. This is especially pertinent for newly minted senior residents. There is the temptation to be fierce and pseudo-obstructive, as one has been so treated in the past. Many will fall to the Black (Tag) Fever. As a new registrar, I quickly realised that this sort of behaviour was rarely constructive. In fact, I discovered that I had a lot to learn even from the most junior ward HOs—I started asking about the management plan for the patient, not to challenge the urgency of the scan, but to help me understand the impact of my scan report on the patient and tailor the reports accordingly.  Unfortunately, I confess that there still were some bad nights, sarcastic remarks, and flared tempers. I apologise to my “victims” who may have been spoken to unreasonably. Registrars are expected to know everything—but don’t. This is terrifying and emotionally stressful, especially on-call, and I hope you can empathise, especially when you receive your own black tag.

May we all repay honesty with humility, and humility with honesty. Cheers to a great month at work ahead.