Family physicians are leaders, even if they don’t own a practice or have a formal leadership role in their organization, says Vu Kiet Tran, MD, MHSc(Ed), MBA, CHE, a family physician who is also board certified in emergency medicine. According to Tran, who presented a session titled “Leadership Skills for Non-leaders” at the 2017 AAFP Family Medicine Experience (FMX), physicians can make their work life easier, resolve conflict, and achieve better outcomes for their patients by cultivating five leadership habits in everyday practice.
Humility is a key component of emotional intelligence, which is the ability to identify and manage your own emotions, as well as to recognize and understand the emotions of others and think about how your words and actions will affect them. In the four medical practices he owns and operates, Tran has seen a lack of humility lead to festering conflict. For example, a physician in one of his practices was seeing a patient who became verbally abusive. She called to the front desk for help, but the staff member didn’t respond. Later, the physician accused the staff member of not doing her job. The staff member said she didn’t hear the request and felt offended by the accusation. Weeks later, the two are still fuming. “Each has a point,” says Tran, “but they’re both feeling they are in the right and can’t acknowledge any alternate point of view. The lack of humility and protection of ego is making this conflict persist.”
Tran describes a time when careless communication made an unfortunate situation worse. The emergency department had a 30-patient backlog, and Tran was the only physician on duty. He was carrying suturing supplies toward another patient when a man approached and asked why he had already waited an hour-and a-half for a minor procedure. “I told him, ‘The night is very busy, and you will have to wait. I will come to you later,’ ” says Tran. But this only made the man more frustrated and upset.
In retrospect, Tran says, “I did communicate the right information, but I didn’t do it in the right way. My tone and my body language were defensive—even aggressive.” If he could do it over again, Tran would have taken 30 seconds to put the equipment down and sit with the patient to acknowledge his frustration, apologize for the wait, and tell him they were doing their best to get to him. “Clinically, those 30 seconds I took to communicate carefully would not have affected the care we were providing,” says Tran. But taking the time to listen to the patient and show empathy would have improved the outcome of the encounter.
Recently, Tran had the opportunity to practice this leadership skill when a nurse didn’t carry out a request to transfer a long-term care patient to the hospital because she selected the wrong transfer service. Tran explains, “At the debrief, I didn’t blame the nurse for the mistake. Instead, I tried to educate the staff on the different ambulance services and the criteria required for each one.” It all comes down to remembering that everyone makes mistakes, he says. “We have to accept they are mistakes, not personality flaws. When we discuss a mistake, we need to work on the problem, not the person. That’s the essence of a true learning culture.”
Effective leaders know that they can accomplish more if they don’t try to go it alone. Tran finds that he can do his job more effectively when he invites the involvement of his team members. Being receptive to ways that others can contribute to a task or project is key to building an effective coalition. “It’s a way of bringing together resources, knowledge, and networks you wouldn’t have access to if you attempted the same goal on your own,” says Tran. For example, he is currently working on a project for his department to create a new order set for post-intubation sedation. “I have to collaborate and get insight from the doctors and nurses who will take care of the patients after they leave the [emergency department],” says Tran. “If I don’t, the workflow could be wrong, inefficient, or too costly.”
Finally, Tran stresses the value of forming partnerships with your patients. In his experience, patients are much happier when they make mutual decisions with their physician than they are when the physician gives them an order. “I try to understand and voice the concerns the patients would have,” says Tran. “[For example,] I tell them I understand how my advice may not work for them in light of their work, their schedule, or their meal prep challenges. I ask them what they think. And we solve it together.” At the end of the encounter, he and the patient have a shared understanding that they both feel better about. And most of the time, he says, patients are more likely to improve.
Although putting these five leadership habits into practice can be a struggle at times, Tran says that doing so has increased his sense of job satisfaction and improved his relationships with his family, his colleagues, and his patients.
Written by AAFP editorial staff.
Vu Kiet Tran, MD, MHSc(Ed), MBA, CHE, is an attending physician in the emergency department of the University Health Network (UHN) in Ontario, Canada. In addition to his medical degree, he holds master’s degrees in health sciences and business administration. He is the medical director of the UHN/St. Hilda’s Transitional Care Program/Assisted Living Partnership, medical director of HumanaCare Organizational Resources, Inc., and peer assessor for the College of Physicians and Surgeons of Ontario. He is a master instructor for the Canadian Emergency Ultrasound Society and assistant professor at the University of Toronto.