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“Today, I’d like to tell you the story of one who was exemplary. He was never late to work. He never came in and insisted on finishing his breakfast at his desk before rooming our first patient. He was so personable that they would pour their hearts out to him while rooming patients. They would tell him all kinds of things about their personal or academic life that they were unlikely to tell me in just the 3 to 5 minutes he was there.”

Nanette Nuessle is a pediatric hospitalist and physician coach.

She shares her story and discusses her KevinMD article, “Warning: Your words can kill.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today we welcome back on the show Nanette Nuessle. She is a pediatric hospitalist and a physician coach. Her most recent KevinMD article is titled “Warning: Your words can kill.” Nanette, welcome back to the show.

Nanette Nuessle: Thank you, Kevin. I appreciate it.

Kevin Pho: So for those of you who get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Nanette Nuessle: Thank you. I started out as a traditional pediatrician doing both office and hospital work, and eventually transitioned to being a pediatric locum and then a pediatric hospitalist, which really is my niche. I’m very happy doing peds hospitalist work.

Along the way, however, I was bullied. I was working at a small rural hospital where the charge nurse began bullying me. She was arguing every order that I wrote. When I would go in and educate families, or educate our new nurses, she would go back behind me and contradict everything that I had said. She would argue policy with me, including policies that I had helped write. Eventually it got to the point where she was throwing things. She would throw my things into the call room, or eventually even throw things at me, but always when there was no one else around to see. And when I wrote her up for these things, there was retaliation.

I became a coach, and I learned that her personality type is the exact opposite of mine. When I began speaking to her in the core values of her personality, she had no traction with which to start an argument or to start bullying me. And the people who were watching this, who had been ganging up with her, ganging up on me, suddenly fell back and started seeing things differently. It took a lot of the wind out of her sails, and eventually we were able to turn that situation around. The anxiety in our unit went from here to here in about three days. We had been losing staff to other units and other hospitals, and that stopped almost immediately.

Within three weeks, nurse managers from other departments and other units began asking me to do conflict resolution on their units. Physicians from around the hospital began asking me to help them with contract negotiations. And that’s the story of how I became a coach and why I began using this methodology for burnout and bullying in health care.

Kevin Pho: So before we get into the article, how common are bullying stories like the one that you described? Through your contacts with other health care professionals, how common is bullying?

Nanette Nuessle: Extremely common. Every health care worker I speak to has either been bullied or has observed someone that they work with being bullied. And unfortunately, for years it was swept under the rug, and people were told that that’s just the politics of medicine.

Kevin Pho: All right. So let’s jump into your latest KevinMD article. It’s titled “Warning: Your words can kill.” Now, for those of you who get a chance to read that article, just walk my audience through it and share the story of why you decided to write it.

Nanette Nuessle: This is the story of a young medical office assistant who worked with me. He was in his early 20s, and when he began working with me, he seemed very introverted and very pulled in on himself, and there would be sparks of brilliance that would come out. Over the first, I would say, four to six weeks, he slowly opened up and blossomed, and he became one of the most incredible medical office assistants that I’ve worked with in the 30-plus years of my career. He was a true joy to be around. He would connect with patients in such a way that it was just incredible.

I learned that he had been bullied by the providers he’d been working with previously, and he felt that this was based on him being Black and being gay. He had been working with providers who were very conservative, very religious, and felt that those things were a sin, that both being Black and being gay were a sin. They had bullied him and harassed him endlessly while he was working with them. I was a locum there, and when I left there, he went back to working with them.

When he was working with me, he was just incredible. He would connect with patients in a way that I couldn’t in the few minutes that he was in there rooming with patients. He would find out things that would take me 15 to 20 minutes to learn. We had teenagers who passed their PHQ-9, but he would come out and tell me, “OK, this kid has just broken up with his girlfriend. He’s now failing five classes. Because he’s failing five classes, his coach is going to kick him off his sports team. And instead of being understanding about it, his parents are angry with him. He needs help.” All I would know is that he had passed this PHQ-9, so he passed his depression screening, and I would ordinarily just go in and do a school physical. But that was valuable information that I wouldn’t otherwise get.

Other times he would walk in and say, “Now, I’m not a doctor, and I’m not allowed to diagnose, but I’m going to have a strep screen ready for y’all.” And 90 percent of the time, that kid’s strep screen would come back positive, because he knew what questions to ask besides “Where does it hurt?”

He was just such a joy to work with, in terms of keeping everybody upbeat and positive too, because when the day would start to go bad, he would walk into our little office, a cubicle for four people, and start doing impersonations of Beyoncé. He kept everybody upbeat and happy.

But then when I left, instead of getting paired up with the Black female nurse practitioner who was a major there, or one of the other female providers, he got paired back up with one of the men who had bullied him in the past. He became introverted again, and he started drinking, and he ended up with a DUI, which led to him being fired. He had decided to apply to nurse practitioner school, and he felt that this would lead to him not getting into NP school, and he ended up taking his life, all because of being bullied, all because of the negative words that he was hearing at work.

Kevin Pho: Now, do you have any examples or anecdotes of some of the bullying that he endured?

Nanette Nuessle: I know that they told him that being Black was a sin. I know that they told him being gay was a sin, and that they told him because of these things he would never amount to anything. But the specific, exact wording of that, I do not have examples of. I know that they left sticky notes on his desk saying these things, and because they were not signed, he could never prove exactly who it was.

Kevin Pho: Now, was there any accountability for these clinicians who did this, any type of supervisor or anyone who could step in?

Nanette Nuessle: There was not. This was at a military base. [Remark removed by the editor.]

Kevin Pho: So if you have a health care professional who is in that unfortunate position of being bullied, what kind of options do they have?

Nanette Nuessle: That makes it really difficult. What I’ve learned is this method of personality science that I use in my coaching has helped other people who’ve been bullied in the past, and it has actually saved them from suicide. What we do is we teach people to speak to another person’s core values. Like it did for me in that bullying situation, it disrupts that cycle of bullying, and it gives that other person no traction for the bullying.

But furthermore, for the person who’s being bullied, it gives them the ability to set boundaries. Even though this was a military base, this young man had worked his way up from private to corporal, which gave him a little more leverage than he previously had at the beginning. And within those ranks, there are some boundaries you can set, and knowing the core values of the other person gives you an idea of what vocabulary to use when speaking to them and asking for things.

I wasn’t a coach at that time. I didn’t have the ability to empower him with this, and I truly believe that if I had been, I would have been able to help him more. I feel terrible about that. I feel like I wish I had been able to do more. I think that if I had, I could have saved his life.

And what’s tragic about this is there are over 400 physicians who commit suicide every year, and I don’t know where they keep the numbers on nurses, but I’ve heard the numbers on nursing staff are even higher. This is a national crisis, and we need to be pulling out all the stops and trying whatever methods we have to try to change this.

Kevin Pho: So if you could go back in time, knowing what you know now, what would you have said to this medical assistant?

Nanette Nuessle: I would have sat down with him, and I would have taught him everything I know about this methodology. I would have said, “Hey, your personality is such that you like freedom and flexibility and action and excitement and attention, and you need to tone down the spotlight on you. These other people like systems and planning, and they don’t want any attention. They like low risk, and you need to take the spotlight completely off of you. You need to stay out of the spotlight when you’re at work. You need to focus everything on your patient. And when you do your Beyoncé impersonation, make sure the door is shut. If you want to be that person, make sure the door is shut, and closet that a little bit.

“Speak to them in the language of rules, regulations, discipline, productivity, credibility, titles, because those are the things that are their core values. If you can speak to them using words like that, they’re going to think more of you, and they’re going to listen more to you. But the language you’re speaking now does not resonate with them at all, and because of that, they think that you’re completely off in left field, and they’re not hearing anything you’re saying. They’re devaluing every word that comes out of your mouth. It’s like it’s a completely different language.” And that’s what I would say to him.

Kevin Pho: We’re talking to Nanette Nuessle. She is a pediatric hospitalist and a physician coach. Her latest KevinMD article is titled “Warning: Your words can kill.” Nanette, what are some of your take-home messages that you want to leave with the KevinMD audience?

Nanette Nuessle: The take-home message is that we are different personalities, and our personalities do determine our core values. Until we learn that each of us has different core values, and that we need to listen for those core values and learn to speak the language of one another’s core values, we’re not going to be fully integrated as a team. This is part of what’s not only driving poor staff retention, but is driving people to depression. It’s driving people to burnout, and it is one of the drivers of depression, and it can be solved.

Kevin Pho: Thanks again for coming back on the show, sharing this unfortunate story, but also sharing your time and insight.

Nanette Nuessle: Thank you so much for giving me this opportunity.