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Getting Our Egos Out of the Hierarchy!

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Discusses how inferiority and superiority ego complexes make the hierarchy unsafe and challenges both nurses and doctors to reflect.

Specializes in Communication, Medical Improv. Has 30 years experience.

Getting Our Egos Out of the Hierarchy!

Recently on FB there was a lively discussion about this sign that was posted in a waiting room somewhere, it read, "Don't confuse your google search with my medical degree". Some found it funny, some thought it was informational, and I thought it had an obnoxious tone! I googled the message and found all sorts of shirts and coffee mugs proclaiming the same message.

There seems to be something more going on in this proclamation than simply a statement intended to inform or honor one's education. There's an underlying theme of superiority and inferiority going on here and I don't think it has anything to do with education at all! The language is polarizing and flies in the face of respectful communication and collaboration that are so necessary for safe, compassionate care and patient empowerment. I'm not against the hierarchy, but I am against power dynamics that feed our egos.

Discussions about the hierarchy in healthcare can quickly turn into a power struggle. Physicians who have long been at the top of all decision-making are reluctant to share power, nurses face increased accountability in taking more power on, and patients present along the entire spectrum from wanting to be in charge to totally dependent.

Although the old hierarchy makes sense sometimes, (such as during a cardiac arrest with the physician yelling out orders to the team) it has also contributed to ineffective communication and teamwork, poor conduct, and unsafe care. When the hierarchy is toxic these dangerous behaviors are all too common:

Nurses who are afraid to speak up or challenge authority

Physician's who don't know how or when to listen to others' expertise

Patients who withhold information or concerns because they are totally dependent on medical providers.

If we are going to have safe care, healthy workplaces and rewarding careers we need to ask ourselves and each other; What makes the hierarchy healthy? In my opinion we need the hierarchy for clinical decision-making and related use of expertise, but not for egos-driven goals involving power and status.

google-search-message-on-cup.jpg.457789c433291ed478f519dc70058865.jpg

I'm referring to superiority and inferiority complexes that plague doctors and nurses respectively. Those with more power in the hierarchy falsely believe that they know more about what others need and want and listening is therefore unnecessary. Those on the other end have little faith in the value of their own ideas or observations and hesitate or worse don't speak up.

For the hierarchy to be healthy we need to balance it with collaborative leadership and followership. In such a system, the hierarchy is the structure and the collaboration is the process. The former requires knowledge and skills where the latter requires respectful communication and emotional intelligence. Healthcare professionals must be adept at both. Yes, physicians may lead more often than not and yes the nurses's assistant will follow more often than not, and nurses will be leading and following almost all the time, but we must all be able to do both! And with respect and grace.

Collaborative leaders at all levels are confident and emotionally mature. They use their expertise and authority for optimal clinical outcomes. They are not rattled when challenged by team members and are able to consider new input. If they input shifts care decisions they are grateful and if not they explain their reasoning, making it a teachable moment.

Collaborative leaders understand this dance of being in charge while listening and following as necessary and supporting others so they are able to bring their best to the table. Their egos are in tact and they are using the hierarchy with great wisdom. All the while making healthcare safer.

Beth Boynton, RN, MS is the author of “Successful Nurse Communication: Safe Care, Healthy Workplaces & Rewarding Careers”. She’s been teaching healthcare professionals about communication, collaboration, and culture for a decade and is excited about using ‘Medical Improv’ as a fun and powerful way to develop these skills and promote healthy workplaces. Well known for her blog “Confident Voices in Healthcare” Blog and youtube, Interruption Awareness: A Nursing Minute for Patient Safety, she and can be reached at beth@ bethboynton.com or www.confidentvoices.com.

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39 Comment(s)

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

Interesting perspective. I see it as a "poke" at the patients and families, who come in with a litany of requests for meds ie the "purple pill" because I know I have XYZ. Right or wrong, I think it is a light hearted attempt to remind folks that indiscriminate"googling" can have very negative outcomes. There are those who think every sign or symptom is a death sentence and those who ignore the REALLY BIG things, 'cause- you know, they read it on Facebook, Pinterest, Twitter etc.

I don't think it is specifically aimed at the MD/RN/PT/OT etc relationships in the hospital/medical arena.

twozer0, NP

Specializes in Urology. Has 14 years experience.

I don't tell my mechanic how to fix my car. Sure I have some knowledge and I change my own oil but I've never done a cylinder compression test or a full engine swap (though I would love to learn!). I don't think it is rude to have a statement like that, infact I think its more rude when I have patients/family/friends coming in and acting like they know what they heck is going on when they have no clue. We call them Google MD's. While they might be able to swap an engine, they do not know how to take care of a DKA patient or manage an acute larygospams in a child. To each there own. Leave the ego at the door, leave google at the door, and let everyone do what they are here to do, provide you with the service you showed up for!

BeachsideRN, ASN

Specializes in NICU, Trauma, Oncology. Has 7 years experience.

According to Google you can cure cancer with a coffee enema and by alkalizing your body. People actually believe this stuff and think that healthcare is a scam. It's scary.

macawake, MSN

Has 13 years experience.

Recently on FB there was a lively discussion about this sign that was posted in a waiting room somewhere, it read, "Don't confuse your google search with my medical degree". Some found it funny, some thought it was informational, and I thought it had an obnoxious tone! I googled the message and found all sorts of shirts and coffee mugs proclaiming the same message.

I agree with previous posters. I think that the sign was directed at patients, not at nurses. Eventhough I agree with the message on the sign (knowledge aquired through Google does not equal a medical degree), I question the wisdom of posting the sign in a waiting room.

I'm referring to superiority and inferiority complexes that plague doctors and nurses respectively. Those with more power in the hierarchy falsely believe that they know more about what others need and want and listening is therefore unnecessary. Those on the other end have little faith in the value of their own ideas or observations and hesitate or worse don't speak up.

I'm sure there are individual physicians with superiority complexes and individual nurses with inferiority complexes (as well as the other way around) but I think that when hierarchies threaten safety, it's due to workplace culture, not the individual MDs or nurses. It's a problem on an organizational level, not individual. A person high up in an hierarchy can feel ever so superior but if his or her behavior isn't condoned/supported by management, it won't be allowed to continue as it would be to the detriment of patient safety.

Creating a workplace culture that actively promotes safety should (at least in a perfect world ;)) be a priority for management in any hospital or medical facility.

Culture of Safety

Edit: @ RainMom, that's just sad beyond what words can express. Ignorance can be deadly. (I liked your post because I think that it's important to bring things like this to the public's attention).

Edited by macawake

OCNRN63, RN

Specializes in Oncology; medical specialty website.

I agree with others. In fact, a doc I know has this on his/her FB page...I think it's funny. We've all had that patient or family who drove us crazy with printouts from WebMD and the like.

It's not about feeling superior. It's about having the knowledge and skill sets for a particular profession. Nothing more, nothing less.

I agree with the consensus so far. The statement was aimed towards patients and their families who come in with "Google-knowledge" and don't listen to real medical advice.

Just hang around vaccination/immunization threads here and read the anti-vaxx stuff. :sarcastic:

Magsulfate, BSN, RN

Specializes in ICU. Has 13 years experience.

I feel like I just wasted 5 minutes of my life.

I don't think there is anything wrong with someone using the Internet to gain more knowledge about any specific medical or health topic. I believe most people have a vested interest in educating themselves (it's their health, after all). And blind faith is, in my opinion, a rather stupid way to approach this.

The key is in how to present that (from patient to health professional and vice-versa). I understand I will never be as knowledgeable as a doctor (or some nurses), but that doesn't mean I take every words coming out of their mouth as pure gold. A certain dose of skepticism is actually healthy. And when you show up at an appointment with a certain amount of knowledge (that you have researched yourself), it only indicates you are taking things seriously.

I always tell my PCP when I have "looked things up" myself. I don't self-diagnose, but I use it to learn and improve my own knowledge. Could this be perceived as challenging their authority? You bet it can. But that only points out how confident they are about their own level of expertise. The ones that gets annoyed with you only make themselves looks less professional.

Health professional aught to welcome and encourage determined patients. After all, they are their own advocate. Just make sure you redirect/guide them if they are falling off the bandwagon.

Dany

Edited by Dany102
typo

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 45 years experience.

I think the sign may be intended for those patients who approach the provider with an intention to present their Google information in a confrontational manner, to test their knowledge base, or otherwise create a "gotcha" as some patients will do owing to their personalities. Whoever posted that sign is telling his or her customers something about their personality too, whether it is meant in a humorous manner or a "don't waste your/my time" manner.

We encourage people to learn as much as they can about their diagnosis so it seems disingenuous to then tell them not to consult the Google although sometimes the provider knows the Google search may serve only to further scare the **** out of the already scared patient, and the provider will have to talk them down, as it were.

In terms of the "hierarchy" personally I've experienced much more collaboration in my employment history than not. I've never seen a nurse who is too frightened to call a doctor strictly due to their job title. It's a combination of the individual personalities at play there.

Eschell2971, BSN

Specializes in Med-Surge; Forensic Nurse. Has 4 years experience.

This is a very timely, relevant, and succinct article. I wonder, will those who need to read this and reflect upon it, do so (i.e ALL of us in some way, shape or form)?

By the way, I agree with you that the sign was all about ego, arrogance, and bragging rights. These are never admirable traits and this sign does not convey to patients the idea that their healthcare providers are encouraging of their autonomy and their desire to learn more about their own health conditions and ways to get and remain healthy.

As a nurse and teacher, I encourage my patients to use the internet to find out more about their condition. I also encourage them to bring their questions to the physician/nurse, and let us answer your questions. I believe that I am encouraging and honoring my patients as adults, and as adult-learners, capable of learning how to navigate the internet for credible sources, just as I and many others, whether we are nurses or not, have learned to do.

Just as physicians, lawyers, and other professionals, need to be reminded, so to do nurses: We do NOT have the upper hand on knowledge, information, education, and the ability to learn.

I have also had patients/family members who got their "medical degrees" from WebMD or the like, and those are who I believe the sign was aimed at. I believe it was an attempt at humor. I have no problem with patients/family discussing what they have read (in fact I encourage it) and educate about web sites (I tell them "Joe Blow on the corner can start a web site and say anything they like, so be sure it is a web site from a knowledgeable person or organization.") I can then (hopefully) refute wrong information and reinforce correct information. Just don't attack me with your WebMD degree please. If it was that easy we would not have to be licensed.

CHESSIE

Specializes in Med/Surg, OR, Peds, Patient Education. Has 30 years experience.

Inflated egos are detrimental to good patient care. This is true whether the person who is overly impressed with him/herself is a physician, one of the administration or one of the staff nurses. A superior this attitude undermines those who wish to learn more, without being castigated or demeaned, whether they are other staff nurses or patients. None of us "knows it all," most people want to know more without being made to feel foolish for asking questions. Years ago, one of my wise college professors said, "The only stupid question was the one that was not asked."

I believe that you're reading waaaay too much into the purpose of this sign. You likely do this with everything in every area of your life, creating unnecessary stress and conflict. I agree that the sign shouldn't be in a doctor's office, but I don't believe that it's located in a doctor's office. It was made and posted on social media to be taken in a tongue in cheek manner.

I think it's a funny joke. My mother is a WebMD person and frequently thinks she has a major health problem that in all actuality is something minor. Our running joke is "uh oh, did WebMD figure out you have cancer?"

That being said, how inappropriate to show that joke to patients. I think providers, nurses, and CNAs can all laugh at the joke, but it's insensitive.

Vandenhs

Specializes in Radiology nursing, emergency nursing. Has 29 years experience.

2:08 am by Dany102

I don't think there is anything wrong with someone using the Internet to gain more knowledge about any specific medical or health topic. I believe most people have a vested interest in educating themselves (it's their health, after all). And blind faith is, in my opinion, a rather stupid way to approach this.

The key is in how to present that (from patient to health professional and vice-versa). I understand I will never be as knowledgeable as a doctor (or some nurses), but that doesn't mean I take every words coming out of their mouth as pure gold. A certain dose of skepticism is actually healthy. And when you show up at an appointment with a certain amount of knowledge (that you have researched yourself), it only indicates you are taking things seriously.

I always tell my PCP when I have "looked things up" myself. I don't self-diagnose, but I use it to learn and improve my own knowledge. Could this be perceived as challenging their authority? You bet it can. But that only points out how confident they are about their own level of expertise. The ones that gets annoyed with you only make themselves looks less professional.

Health professional aught to welcome and encourage determined patients. After all, they are their own advocate. Just make sure you redirect/guide them if they are falling off the bandwagon.agree! I'm a nurse and I try not to pull the nurse card, but I also know my body and my history. Trouble is some doctors don't listen to their patients and find out their concerns. I've seen this many times working in the ED. It's mostly education. If the doc doesn't think that the dx is xy or z, than gently explain.

Edited by Vandenhs

Vandenhs

Specializes in Radiology nursing, emergency nursing. Has 29 years experience.

I agree with Dany. I'm a nurse and I try not to pull the nurse card, but I also know my body and my history. Trouble is some doctors don't listen to their patients and find out their concerns. I've seen this many times working in the ED. It's mostly education. If the doc doesn't think that the dx is xy or z, than gently explain.