Don’t Shoot The Messenger

As the junior resident on my surgical team, I am often the bearer of everything related to the inpatient floors, which includes much bad news and a number of messages that are not taken to kindly.

I do what I can to manage things on my own, but often times, I get sent on little missions (or big missions) from the staff or seniors to ask for scans, sort out orders and do all sorts of other things.  That is my job.  That is how I learn about how to manage the more complicated things.

Sometimes, though I get sent to ask for things that are a touch on the outlandish side.  Or difficult to do.  Or just plain disliked.  And then I am the one who gets to hear and bear the brunt of the reaction.

Take today, for instance.  I was told to go order a CT scan for my septic post-op patient with a known history of Crohn’s.  Seems simple enough.  Problem was, this patient already had 2 CTs in the last month (and one was only a few days ago).  The team agreed it was a tough call, but we just had to be sure there was nothing there we needed to drain or operate on.  I, of course, got to go to radiology to ask for the scan.  And of course, they didn’t want to do it.  Because the interval was so short.  And the indications, though good, were limited, as the patient has had so many prior surgeries and had identified potential sources of infection on the last scan (fistulae and such from underlying disease).  I got a lecture explaining radiation risks, and resources and the effective use of scans.  I know these things.  But, I was stuck.  I already had questioned it.  And it didn’t work out.  In the end, I had to get my senior to talk to radiology.  The scan did get done.  It didn’t show anything.

In another instance, I was told that another unstable patient did not need to be transferred to intensive care unless vitals did x, y and z.  I did agree with this, it only made sense.  They were stable, but happened to have a giant clot in an extremity and a tiny one in a lung.  I had the misfortune of reporting this to the unit staff.  They are extremely experienced and very helpful 9 times out of 10.  But this time, they were extremely busy and pushing for me to get the patient transferred.  I couldn’t do that.  It wasn’t my place.  And it wasn’t necessary.  I heard the brunt of the complaints.  And I heard them discussing it (and me) in the next room.

Then, there are the really not warranted reactions (at least not on the grounds of my action alone).  The people who flip out at me for coming to assess them on morning rounds, for instance.  Or the resident that gets angry when they get paged for a reasonable consult.

Yes, there may be other things going on to cause their reactions.  But that still doesn’t make it a completely acceptable way to respond to others.

I understand that the natural human reaction in upsetting circumstances is to vent or get angry.  And I understand that I am still learning and sometimes do some REALLY stupid things (take when I cancelled and reordered different doses of the same med three times between discussions with the team and then pharmacy and then nursing).  I get frustrated with me too.  And that is a way of learning.

But sometimes, I have to do things, not because I want to or even because I think it is best, but because it is what I am being required to do (whether it be for medical/legal or team hierarchy reasons).  I appreciate the learning opportunities and hearing opinions, but there is no good reason to shoot the messenger.  Even if she is the easiest target and the one who appears most at fault.

These experiences will help me as things move on.  I will remember and maybe make different choices.  And maybe stand up for what I know and believe to be right or true a bit more.  But also, I will try to not create situations in which other people will want to shoot the messenger unnecessarily.  And maybe I will not shoot the messenger so much myself.  Because some of these behaviors are a cycle, not just learning or human frustration.  By stopping the cycle, maybe I will save someone the angst of being talked to for things they can’t change.

Sometimes, people have good reasons for doing things you see as wrong or stupid.  Your reaction may be warranted.  In fact, in my first two examples, the reactions were, at least somewhat warranted.   There were things that could have been changed to make things make more sense and the actions may not have been the best.  I get that.  Sometimes, you have to tell someone and get upset.

But, sometimes, more thought needs to go into who and why things are happening.  And who or why to be angry.

I guess it all comes down to not shooting the messenger.  Unless, of course, they are the source of the message that could otherwise be improved.

Please, share your thoughts!

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