Doctor VS. HR Manager: Finding Balance

“Dammit, Jim, I'm a doctor not a human resources manager!”

Okay. Dr. Leonard Horatio “Bones” McKoy never said those exact words on Star Trek, but it's a sentiment that anyone in private practice has thought at some point (or at many points). As medical students, we stood in awe watching a senior resident at the foot of a patient bed calmly but firmly state commands during a code. In the OR, we listened with trepidation to every word from the chief surgeon—“scalpel,” “hemostat,” “retractor”—awaiting our cue. None of these instructions was prefaced with “please” or ended with “thank you.” But we were excited to be a cog in the well-oiled medical machine.

To me, being part of that machine—or team—was one of the attractions of becoming a physician. However positive or altruistic, the work of lawyers, politicians, and financiers includes some antagonism: If I win, you lose. But in medicine, the clinical and nonclinical staff are all working with the patient toward the same goal. “Onward and forward” into battle against the common foe: disease, infection, scar. And toward the common goal: health, happiness, and in aesthetics, radiant youth.

But here's the rub: In real life, i.e., non-clinical and/or non-emergent daily activities, most people haven't had the trial by fire training we have. And that includes our office staff. From our perspective, we are still in that crazy world, just juggling different balls. Instead of collecting the labs of 30 patients, making sure eight others are NPO before their procedure and three more are ready for discharge, we're managing patient expectations, office finances, staff coverage, and the jobs we were actually trained to do—being a physician and surgeon.

This came to mind for me recently when my staff asked whether a CoolSculpting patient who was already in the office having treatment could add additional applicators to a prior financial package and thereby get a greater discount or whether that patient needed to start a brand new package, which would start at a lower discount. The complication was that someone had already collected money from the patient that day that added to the prior package. Some would say it is an issue for the office manager to handle. The problem is that at times you realize you haven't made a policy clear, and the buck does stop with you, the practice owner/physician. I knew if this shot to someone else, it would come back to me, anyway. I was between patients and wanted to expedite. In classic doctor style, I grabbed the paperwork, shushed everyone, wrote out the calculations (I process visually), and came to an answer. I acknowledged that the staff hadn't had all the information and I had to clarify our policy on adding to prepaid packages. I thought, “Problem solved! It's a win!” It was off my plate.

That's the difference between medicine and human resources. Later that day, I was told that a staffer left in tears and followed up with an email complaining she'd been disrespected. I was flummoxed. I have nothing but respect for my staff. Otherwise, they wouldn't be my staff. And I thought I'd made it clear that I was jumping in to speed things because I had a break when I could help, not because they couldn't do it. As a female physician, I learned long ago that some conduct and speech acceptable from my male colleagues, especially older male colleagues, is not acceptable from me. That's the same in the business environment, where women must be “friends” not just “bosses.” But to me that's a bonus. I like being able to be open and friendly with my staff. This was different. Although as a dermatologist I haven't had to use a defribillator in years, it was still my problem-solving style: Clear. Shock. Get the patient's heart at a regular rhythm. (I suppose the cosmetic dermatology equivalent would be “Hyaluronidase” and seeing the skin go from white to pink again.)

We smoothed things over in my office, but how as a busy physician do I keep this from happening again? Here are my recommendations for all of us:

Remember that not everything is life and death. For a scheduling or financial question, it is often reasonable for a staff member to tell patients that the office will get back to them with an answer rather than getting it immediately (as long as they follow through).

Whenever possible, don't upset the chain of command. Let your office manager or supervisor deal with the individual day-to-day issues, even if that means the extra step of her or him then having to bring the issue to you.

Just because you know you can get to the answer more quickly than everyone else, you don't need to and you shouldn't. As long as it doesn't impede patient care, allow others to get there in their own time. Let them build their problem solving skills.

Internalize an “off” switch for those extraordinary automatic emergency responses you've honed over years. If necessary, stop and breathe before responding to staff.

“Dammit Jim, I'm a doctor” doesn't cut it in today's world, and that may well be a good thing. Live long and prosper, everyone!

—Heidi Waldorf, MD
Co-Chief Medical Editor