What to do when your expertise is under attack

Consultants can be disrespectful to you or your colleagues and fail to recognize your expertise. Be prepared to respond in a professional manner, says Kathy Clem, RN, emergency medicine division chief at Duke University Medical Center in Durham, NC.

"Part of our daily job is to interact with our colleagues in medicine," she says. "While it’s rewarding to problem-solve together, and it’s part of the variety of emergency medicine we all enjoy, it’s also one of the biggest sources of stress."

Here are tips for dealing with such situations:

• If a consultant insults you or your colleagues, don’t be defensive. "Maintain a perspective. Accept the fact that you practice fishbowl medicine in the ED, and as a rule, consultants can outshine you in their area. It’s enough to practice excellence in the ED," stresses Clem. Project confidence, and don’t apologize for doing your job, she advises. "It’s OK to use blameless apologies. Saying, Sorry I woke you up,’ is not implying you’re incompetent. But it’s not OK to apologize for involving them in patient care with you, because that’s what you’re both there for."

• Accept that not all facts will be known in the ED. "People outside the ED will always use a retroscope to second-guess you," says Clem. "In the ED, a concrete diagnosis is not always reached, and that’s OK."

• Share strategies. If a clinician has an unpleasant encounter with a consultant, bring it up at a group meeting. "That way, you can determine as a group what is effective. You should have a unified-front strategy for consultants who are difficult to work with," she says.

• Categorize problems. When you have a difficult interaction, write it down and put it into a category, she suggests. "When you collect them over a month or so, you will have several categories and can develop a strategic plan for each. Then you can take your negotiations off the emotional plane."

The best negotiators communicate in a professional, calm manner with a well-thought-out strategic plan. "If you do, you will work well with colleagues," she says.

Be clear when communicating. Give a one-minute presentation to the consultant. "They want to know who, what, why. So give them exactly what they need," she says. "Make sure when you’re through talking to them, they understand exactly what it is you want them to do. If you don’t know, they certainly won’t."

Don’t expect praise. If you want compliments from consultants, you’ll be disappointed. "It’s important that you know you practice excellence in emergency medi cine. If you need someone to remind you of that, use one of your ED colleagues who knows what you do."