What do you do if your relationship with physicians is strained and you want to improve it?

As a nurse, I have worked with physicians caring for hospital patients. As an attorney, I have taught nurses that the Nurse Practice Act in many states (i.e. CA) requires the nurse to act as the "patient's advocate." This can sometimes put the nurse in conflict with the physician. If this happens, I advise nurses to confer with the physician about their care concerns in a factual and professional manner. Explain specifically why you are concerned. Sometimes nurses are carrying out facility policies that physicians are unaware of. Other times the nurse may have some knowledge about the patient the physician doesn't know i.e. recent lab results. Make it a collaborative process. Be tactful. You may also want to get your supervisor involved.

Find both the underlying perspective and ultimate target that is driving the contrasting disposition of the physician by asking directly or learning indirectly from a credible 3rd party or mutual contact. Is it your personality, affiliation, specific opinion or behavior with which they clash? Reflect on your role in harming the relationship and take full responsibility. Even if another person, teammate, or your affiliation is to blame based on facts you possess, take responsibility in front of the physician, inform them of the root cause quickly when it counts and most importantly, discover a different mutual cause the physician shares with you or your affiliated organization based on which your relationship started, and pursue it together!

Empathy is key. Soft skills aren't compulsory in healthcare training (I think they should be), but they're vital for all of us who work with people and animals as stressed and overloaded as healthcare workers. Identifying root causes requires knowledge of coaching and leadership techniques that sometimes only group leaders have, so empathy is our basic tool.

1. Never forget why you first started out together 2. Make room to accommodate each others deficiencies 3. Be open minded and correct with the intention to improve rather than criticise 4. Ensure you have an impeccable character and are well versed in the area you want to see improvement. 5. Admit your weaknesses as well. 6. Reassure your partner and let them know you are in this together in spite of any setback. 7. Find out what is causing the straining and provide practical solutions to solving it.

Considero que una de las causas raíz es la actual estigmatización que recae en los médicos; pues, se encuentra a una gran mayoría que necesita mejorar las formas de atención a sus pacientes y mejorar la sinceridad en la descripción del diagnóstico, el cual debe ir acompañado no sólo de la mejor alternativa de solución sino debidamente explicada del porqué de ésa y no de otra solución. Adicionalmente encontramos a profesionales de la salud, enfocados en obtener réditos económicos antes que en cuidar de la salud de las personas.

Whenever you wish to improve relationships at any level good communication is essential. The concept of the emotional bank account (EBA) maybe helpful. As outlined by Stephen Covey in “The seven habits of highly effective people" and developed in a clinical environment in my book “The Health Practitioners Journey” the EBA is a useful model where you view a relationship like a bank account. You can assess what the current state of said relationship is and if in debit them you make a deposit or several deposits until the relationship is back in credit. Such deposits maybe making a kind gesture, to offer assistance, or to provide positive commentary or feedback. The relationship status should improve.

Communication is the key ! In medicine, especially Sports Medicine, there are many professionals involved in the care of athletes. Everyone involved at the Athletic Event needs a written job description that is shared and agreed upon. These responsibilities vary with athletes under 18 years of age as the parents must be involved with decision making. Successful plans also involve the coaches as well as assigning the athlete's with responsibilities so they know how they might help or where to go. At higher levels of athletics, an MD is usually responsible for making the medical decision. In the absence of a MD, everyone must know and agree, who is the person making the medical decisions. This improves athletic health care.

Communication is key no matter what level a person may be within an organization. This includes relationships with physicians. It is imperative to understand different communication styles to transmit information effectively. If you are not familiar with different communication and personality types, it would be good to take a course or read a book or two on these topics. With improved understanding of communication, you will be able to better understand the physician’s point of view and improve relationships overall.

Active listening, avoiding at all costs generalisations, comparisons, minimising the other person's approach and, above all, paraphrasing and asking questions to understand and not just to answer, always paying attention to the most powerful communication, nonverbal language. The battle that is won is the one that is avoided.

While this is a double-edged sword as it depends a lot on the ego of the professional involved, it is true that many people love to have a mentor or someone who recognises their work and is willing to learn from them, and this kind of action is perceived as such. If you are one of those people, then this is a really great opportunity for you.

Find the right time and setting for feedback. Ask questions you truly care about and start with those you think both you and the physician find important. Acknowledge and apologize as loudly and as quickly as you criticize them. Show that you respect the physician not only for their role, knowledge, or potential value to you, but for the unique person they are. Open up and grant them your trust to challenge or advise you through feedback. You will earn their trust in the process. Show how you follow up on their feedback in practice. Share what makes them or their interests memorable to you after you gather enough answers/data through listening. Find what you can both improve together.

Collaboration and cooperation is a key factor in working together no matter who the person is. When looking to improve relationships with physicians, this is just as important. Ask for physicians’ input on projects. Show value towards their contributions. Work with them to help them achieve their goals, not just focussing on your goals. Help them understand that everyone is working together towards the singular goal of improving patients’ lives.

The concept of the emotional bank account (EBA) may be helpful. As outlined by Stephen Covey in “The Seven Habits of Highly Effective people and developed in a clinical environment in my book “The health practitioners journey” the EBA is a useful model where you view a relationship like a bank account. You can fill a relationship's band account by not being reactive and put effort into being more present in your interactions as opposed to just smiling and nodding. Such behaviour will see the relationship improve and communication become easier and more constructive. Once again as you build rapport trust will return. Don’t push to hard, just be consistent in your approach and the reward of a good and less strained relationship will return.

I come froma family of doctors. They all got into the profession for passion to help people and not for the money. They all say two things: doctors are humans and as such fallible, you should always get a second opinion, especially if you are a new patient. Respect the experience. Internet is great but it doesn't teach you everything, that's why you go through medical school and have years and years of practice. This is the base to build a long lasting relationship. If on the doctors' side there is too much pride to understand and explain the internet phenomenon or the need to a second opinion, then they are not good doctors and not in the profession for the right reasons. Finally be a patient, in the literal sense of the word. Patience.

Simply talking to physicians and working with them does not entitle one to expect a great relationship with physicians. Rapport and trust must be built. This means building a real relationship with them. This can be done through open communication, cooperation, and collaboration. Rapport can be built through open communication. This can be accomplished by discussing things not only confined to work, but things outside work. In the book, “Traction” by Gino Wickman, Wickman describes an interesting way to improve this rapport by asking people to speak of 1 positive personal and professional thing that happened to them over the week. With continued rapport and collaboration, trust can be established.

We are all human and it is always the human relationship that prevails, beyond the positions and situations of the moment: "We forget who we were, but not how they made us feel". Genuine interest in people beyond the professional sphere, including humour and positive non-verbal language, is a great help. Small details make a big difference. Always maintain standards of respect, professionalism, integrity, consistency and credibility.

Simply building a relationship with physicians is not enough. It is important to maintain and nurture the relationship. This means not taking the relationship for granted. In order to do this, continued communication is required. Recognize the wins and successes of the physicians. Let them know that you appreciate their work. Help them understand that you support their efforts and know they are working with the patients’ best interests in mind.

My supervisor when I trained in endocrinology had a reputation for being tough, hard to talk to and very secretive, and it wasn't just a reputation. When I started he tested me on my knowledge and performance and, despite being pregnant, he always showed respect for my condition. My performance earned his respect and his respectful attitude towards my pregnancy earned mine. He became a mentor to me and to this day he remains one of my most important teachers.