"Wait...What??!!" moments - Conclusion

Our starting facts were mild. But, the operative factors are the same as in more provocative cases, e.g., the student whose fund of knowledge seems inadequate, the scrub who hands the wrong instrument, or the patient who persistently behaves against his own best interest.

Regardless of our precise negative emotion, its volume, and the individuals involved, a set of rules apply, rules firmly supported by evidence. Our belief in the rules gives rise to our chosen actions.

Rule #1

Every health care relationship affects the patient, directly or indirectly.

Rule #2

Every interaction creates, strengthens, or changes the underlying relationship. (This is where each individual’s instincts or choices exert their power.)

Rule #3

Interactions with negative valence affect patient care and outcomes negatively, directly or at a distance.

Rule #4

Interactions with positive valence have additive positive effects on patient outcomes and are in themselves therapeutic.

Many nonverbal and verbal responses are available to us. Here, a colleague is oblivious and interrupts a sensitive moment. Yet, they are as devoted to the well-being of the patient and her family as we are. Lesser responsibility, yes; lesser motivation in choosing a healthcare career, no. We can support, educate, embarrass, or estrange our mission-driven colleague. We should be intentional in our goals and actions.

Recall what we know about working memory, this time from the perspective of our colleague. Our actions will focus or distract them. We will shape their interaction with the next patient or colleague. Our ability to take perspective from within that person determines whether we inhabit the rules and how skillfully we respond.

Back to our patient, her understanding, recall, and capacity to participate in their ongoing care hinges on the valence of how we interact with them, the interactions they witness in their transit through our spaces, and our interactions that condition the behaviors of others within our spheres. None of these is neutral.

The operative action is: kindness.

It is tempting to imagine that a harsh response will provoke the desired understanding. Harshness is blunt and imprecise. Our goal is clarity, precision, and improvement.

We might invite them to join us to witness the discussion, reinforcing the learning points in a post-discussion debrief. (“Ms. Patient, would it be all right for your nurse to hear our conversation? It might help you and him to know details we are discussing.” Alternatively, we might rise to face them and smile, “Would you please give us time to finish an important conversation?”

Respect is the norm we wish to reinforce. In the first response we are clear that the patient has control. It clarifies that the colleague is an observer, not a participant. In the second, it excuses them until the discussion is complete. Both types of responses provide space for a respectful recognition and apology from our colleague.

Deliberate practice, discussion with colleagues, or coaching can acquaint us with many options for verbal and nonverbal responses.

A personal commitment to the deliberate practice of open, respectful interactions, even if we are being corrective and, when required, punitive, results in improved personal skill and a therapeutic health care environment for all.