Communicating With Your Boss

a)     Your clinical competence?
b)     Your communication competence?

As a junior doctor, you’re expected only to have the clinical competence reasonably expected of someone at your level of experience. You’re allowed not to know everything and not to be able to do everything. But you must be honest and acknowledge what you don’t know and can’t do.

The correct answer to the question above is “b” – you will be expected to have a high level of communication competence, which boils down to:

• thoughtful consideration of what the person you are communicating with needs to know (at that time
• being concise, precise and clear.

Hence, your communication competence will be measured by:

• the quality, accuracy, legibility and completeness of the notes you write
• your ability to ring a supervisor at 3:00am and, in less than 30 seconds, explain the reason for your call and what you want from them
• your ability to communicate accurately and empathically with the medical, nursing and other staff you work with.

Notes need to be detailed, but a phone conversation should only include the information the supervisor needs in order to make the decision or action you want at that time from them. For example: I’ve got a rapidly deteriorating 68-year-old leaking AAA in Emergency and I need you to come in. On hearing that opening sentence, it’s up to the supervisor to decide how much further information they need then and there before they leap into their car.

Inexperienced juniors load in detail which is fine in the notes, but not relevant as the answer to the question: “Why are you ringing me?”

Tell your supervisor the reason for your call in very few words:

• What’s the problem?
• What do you want them to do?

A very useful aphorism to remember in acute situations is: “Don’t just do something, stand there!” By that I mean give yourself a little time to think – not much, if it’s urgent – but enough to order your thoughts and think through what you’re going to say.

Whether on a ward round or over the phone, your supervisors will be impressed if you don’t need to be told twice to do something, but are also not afraid to say, “I’m not sure I got that correctly, would you mind repeating that?” You might get your ear chewed off if the supervisor is tired or running late (or both), but on reflection they will be impressed that, even to your possible detriment, you wanted to make sure you got it right in the interest of patient safety.

Many hospitals have adopted “SBAR” as a communication template – the acronym stands for:

• Situation
• Background
• Assessment
• Recommendation

A skeletal version of SBAR can be used in a 3:00am phone call. But a complete version, e.g. one used on a ward round or for an end-of-shift handover, will still convey all the necessary information succinctly.

Hopefully most registrars or consultants nowadays, when giving you an order, will use “tell back”, i.e. ask you to repeat back to them the orders they’ve just given you in order to check that what they “transmitted” has been “received” accurately. If they don’t, do what most pizza shops and Chinese restaurants do with phone orders – initiate the “tell back” yourself.

For example: So that is… send blood for typing and cross typing, get four units cross-matched, put in a nasogastric tube and a central line, give plasma until the blood is available, then run in two pints over two hours, book a theatre for about 8:00pm, check we’ve got an Anaesthetist and tell the relatives what’s happening.

Here’s a simple test.
Think to yourself – “When (not if) I get to be a boss, how will I want my juniors to communicate with me?” – and do it now.

Dr Paul Nisselle AM
Consultant and VIC PMLC Member
MDA National