Many trainees tell me they’re attracted to rheumatology because it demands becoming a complete physician. We need knowledge of the brain, eye, lung, kidney, liver, skin, bones and vascular system to be effective rheumatologists. And because our diseases are frequently multisystem diseases, rheumatologists must be the quintessential collaborators.
For more than 30 years, I’ve directed a clinic for patients with ocular inflammation. Although I’m trained as a rheumatologist and have no formal training in ophthalmology, I’ve relied heavily on ophthalmologic colleagues to forge a collaboration that seems to work for patient care.
We live in an era of dysfunctional compromise. Look at Congress, which struggles to pass a budget and in which members of one party rarely side with their peers from the opposite party.
Unfortunately, sometimes it seems we as physicians don’t do much better than our politicians. Some of us feel powerless in a system that obstructs achieving our ideals. The electronic health record, prior authorization and the challenge to provide biologics to those who lack insurance remain among the obstacles that vie for our time and make it nearly impossible to find a window within the day to discuss patient welfare with another provider. Finding common ground with a doctor from another specialty isn’t always easy. Barriers include defining whose advice is the ultimate guide for patient choice; how we are compensated for the additional time involved; and the difficulty in avoiding making the patient feel like a ping-pong ball batted between two personalities strong enough to survive medical school and postdoctoral training.
I have three suggestions that may improve the way we communicate, compromise, complement and collaborate with doctors from other specialties. I hope they are practical. I should probably try to avoid giving advice about practice because I’ve never been in private practice. But you’re now reading the words of someone who has not let the lack of ophthalmology training deter him from offering advice about the eye.
First, be a good listener. Allow your colleagues to state their perspectives. Then reinforce that you’ve listened by paraphrasing what you heard. After those first two steps, you’re entitled to state your own opinion. And then you work to find a mutually satisfactory course.
I’ve formulated this approach by modifying advice I read in a paper called, “Addressing Physicians’ Impaired Communication Skills” by Barry Egener.1 I’m not aware of any medical school that teaches a class in collaboration, but my assumption is every business school offers some lectures on how to negotiate and compromise.