Rethinking Roles: Your Colleagues' and Your Own


How can you foster teamwork when you aren't “the boss”?

Fam Pract Manag. 2019 May-June;26(3):4.

“Rethinking who does what” is not only a strategy for reducing work after clinic — the subject of our cover story — but also a critical step in implementing the quality initiatives described in so many FPM articles, including several in this issue. Kevin Fiscella, MD, MPH, and colleagues describe the necessity of approaching screening for patients' prescription cost concerns as a team effort that benefits from the unique rapport that often develops between staff and patients. James Dom Dera, MD, describes the value of incorporating the perspectives of staff when determining patient risk levels for risk-stratified care management and the commitment to quality that results. And Neela Patel, MD, MPH, CMD, and colleagues describe how nursing staff are the linchpin of a workflow for transitional care management.

In each of these cases, quality of care, patient satisfaction, and physician satisfaction depend on the contributions of engaged staff working in care teams. But what if your “team” is just a group, not so much teammates working together as co-workers working side-by-side? What can you do to optimize the roles of staff when “delegation” seems presumptuous because you're not “the boss” and staff seem entrenched in the status quo?

You can take an important step today to set the tone for collaboration simply by encouraging insights from the clinical staff you work with and being open to adopting them. More than just an aspirational concept, according to the AMA Code of Ethics this is among physicians' ethical obligations as leaders within health care teams.1

So ask the medical assistants, nurses, and others you work most closely with what opportunities they see for improving patient care. You may have to ask the question several times, in different ways, but eventually they will realize that you value their opinions and see them as vital members of the team. If you do this, you'll be well on your way to establishing the core team values the Code of Ethics describes — honesty, discipline, creativity, humility, curiosity, and commitment to continuous improvement.


1. American Medical Association. Code of Medical Ethics Opinion 10.8, Collaborative Care. Available at Accessed April 23, 2019.


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