I love sports analogies. There is so much in competition and team play that mirrors the way departments work in many sectors of medicine. “There is no ‘I’ in ‘team,'” as the adage says. Michael Jordan, for example, did not win his championships in the NBA until he had fairly decent and dependable team of support around him. The stars in many sports cannot achieve the greatest height of success without the team dynamic. Medicine is no different.
Physicians in the hierarchy of medicine are often considered the clinical “team leaders.” Yes, there has been an onslaught on physician autonomy. Yes, there is a lot more administrative bureaucracy that many physicians answer to which is infringing on the autonomy and leadership of doctors. However, in the big scheme of our clinical work we are still at the helm — but precarious our positioning is. The clinical decision making and fall out from clinical concerns still largely rests on our shoulders.
Some time ago, I found myself working closely with my team on a lumbar puncture. As we prepped our patient and secured the position, successfully extracting CSF our team comprised of nursing staff, residents, and myself as the attending celebrated our first attempt success. A champagne tap never gets old. There is a saying in this situation: “If the LP is a success, the physician doing the LP was good. If the LP fails, the support staff or holder failed”. That saying has been circulating for decades, and it always makes me sad to hear. When we succeed, the team is always the key. If there is a failure, it is the collective that did not meet the goal.
Increasingly, physicians and ancillary clinical staff are in contention in hospitals and practices across the nation. You see it on social media as we uplift one group, the other feels threatened or undervalued. Health care is a team sport. Physicians cannot be in all places and see all things. We rely on our team of nurses and techs as they do spend time at the bedside. The work that these team players do has great value. In the same vein, physicians have extensive and unique training and expertise that give them clinical insight that holds great value. These skills are not the same, these skills can never be equivocal, and there should never be an attempt to do so. Yet, the current climate in health care seeks often to create false equivalences. This tug and pull and pitting of one group against the other creates tension dividing our care teams. Each role, although unique and different, is integral.
We need to come together and continue doing the good work that our teams do every day. Together we save lives. We bring new life into the world, and taking care of complex patients with compassion and expertise. This may sound simplistic, but I do not think this is emphasized enough in medicine today. Our jobs are not in competition with each other. I also believe hospital systems and practices should make concerted efforts to uplift, applaud, highlight every level of team member and place great value in all roles within the system. That is how we mitigate the competition and cultivate mutual respect. Nurses are not people who could not cut it as doctors, they chose to be nurses — and we need them. Physicians are not all lacking compassion. The heart of a physician matters, the mind of a nurse is valued, and everyone at every level counts.
N. Bande Virgil is a pediatric hospitalist.
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