Those who know me know that I am a big fan of Robert Sutton‘s classic book on Workplace Civility (The No Asshole Rule). In this book Sutton demonstrates how one bad egg can have such a devastating effect on workplace culture and harmony. Including, yes you guessed it! Hospitals, where the difficult boss in medicine can and does exist.
That book dealt mainly with how organizations can detect if they have an asshole problem and how to deal with it if they found one. On its tenth anniversary, Sutton has published a follow (The Asshole Survival Guide) which is more of a personal help aid if you encounter a jerk in your workplace.
The main purpose of this post is not, however, about Assholes in Medicine. Its about that Difficult Boss in Medicine. The Consultant or Trainee who sometimes might be temporarily labelled an asshole (sometimes even fairly) for some of the things they do or don’t do. The folks who are not deliberately trying to up set others and who are generally well-meaning. These types of Bosses are much more common than the true workplace asshole but can still create grief and concern for those who work with them.
Bosses shape how people spend their days and whether they experience joy or despair, perform well or badly, or are healthy or sick. Unfortunately, there are hoards of mediocre and downright rotten bosses out there, and big gaps between the best and the worst.
Robert Sutton – Good Boss, Bad Boss: How to be the Best…and Learn from the Worst.
Is the Difficult Boss in Medicine a real problem?
I think the majority of medical trainees would answer yes to this question. In my own research 17-20% of medical trainees reported bullying and sexual harassment in the last year, with 60% of this coming from senior medical staff. And of course bullying and sexual harassment is at the extreme end of difficult or bad bossness!
Perhaps part of the problem is who is a boss in Medicine? Registrars or Trainee tend to refer to their Consultant as “their boss”. Interns and Residents do as well, but then report on a daily matter to their Registrar. Very few of these Consultants or Registrars however have the title Manager or Director or something equivalent. So we have lots of bosses but most of them are not formal bosses. And many Consultants also speak openly about not wanting to be a boss.
I think that’s a real problem. CanMEDS has recognized that at the core of every good medical practitioner is the need to develop a level of Leadership and Management capability, along with other useful “boss skills” such as Professionalism and Communication. Colleges have started to pick up on this in training but sadly a focus n Leadership and Management skills still tends to come late in the curriculum.
When I talk to Advanced Trainees about their worries about transitioning to the Consultant level they tell me that they are not concerned about how to handle clinical problems as a boss, they are concerned about how to handle management problems (mostly people management).
So if we are not adequately preparing doctors for becoming a boss and have systems where nearly everyone becomes a boss at some point is it such a surprise that many are on what Sutton call the “mediocre to rotten” end of the spectrum?
So how many Types of Difficult Bosses in Medicine are out there?
The short answer is too many to describe in a blog post.
The longer answer is that not all Bosses are the same to all medical trainees.
An example of this is what I call the “Micromanager Boss“.
The Micromanager is concerned about avoiding risks and problems with their patients. They tend to have problems trusting others to ensure that what needs to be done is done (problems with delegating). They can be a great source of frustration for an experienced trainee as, despite your best effort, the Micromanager always seems to be wanting you to check or confirm something.
For an experienced trainee a Micromanager becomes a headache and you may start to resent their presence as an annoyance on the Ward. But consider this. What if you are an Intern who hasn’t reached that level of feeling experienced enough to know what to do? All of a sudden the Micromanage Boss becomes the Caring and Nurturing Boss. The Boss who goes the extra mile to make sure you have covered all the things that need to be done for the patient.
First seek understanding.
The point here is that in order to understand the Difficult Boss Problem you both need to understand yourself and your needs as a trainee. Try to understand the perspective of the Boss at question. If possible own your Difficult Boss in Medicine problem.
In our example above it may very well be that our boss has had some very bad outcomes in past. This may have been through a failure to check certain things with patients. OR perhaps under pressure from their own bosses to ensure that some things are done in a certain way?
So one strategy for overcoming your difficulties with your boss might be to seek further information about the source of the insecurities. Perhaps you can engage with them directly. Perhaps a previous trainee or one of the experienced nursing staff can shed some insight. If you can learn about what makes your Boss anxious you can take steps to reduce this. For example, by presenting them with a personal report each day showing how you have checked all these important things. Show them you have their back!
A couple of other examples of Difficult Bosses in Medicine, including possible reasons and how to own the problem:
The not so helpful boss.
This is the Boss that believes in old school teaching, likes to put you on the spot in the middle of the Ward round and quiz you on the 31 causes of hypertension.
This Boss may be very keen to teach and believe what they are doing is helpful. They may never have been taken aside and told that their teaching approach is no longer considered the best.
How to own it:
May be a difficult one to tackle front on. But perhaps if you are more observing this Boss interrogating another colleague you may feel able to take them aside for a private conversation. Otherwise, it might be useful to share with your Boss what you are currently studying and suggest that they could help you to focus on learning this (rather than anything that just happens to come up on the Ward Round).
The too nice boss.
This is the Boss who says yes to anything anyone, staff and patients because they seemingly “don’t want to upset anyone”. They leave you frustrated because a lot of those “yesses” mean you have to do extra things. Like an extra day on take, reorganizing a theatre list, or negotiating with a frustrated secretary about cramming extra time into an outpatient clinic.
Your Boss may be very new to the role and unsure of themselves. They may be wary of establishing credibility with their peers before saying no to things.
How to own it:
Such a Boss may be very receptive to a friendly empathic conversation about feeling new and unsure. Make it clear that you are happy to support more firm decisions when they are needed. But also make clear what you need to get your job done and what you may need from a boss. If possible see if there is another person around who can help with these but make sure that your Boss knows about this.
How to not become a Difficult Boss yourself.
Its never too late to avoid becoming known as one of those Difficult Bosses in Medicine. Of course you can learn the science and art of Management in Medicine by enrolling in a University Management training degrees. But there may be something a little shorter on offer at your local hospital. To be perfectly honest they are more likely to tackle the issues of how to be a good boss to your team members than any Masters degree course will.
An even better start is to think about how well you are currently receiving feedback on your style as a leader and manager from those who report to you. Do you encourage feedback? Are you regularly receiving feedback? Is it the type of frank and fearless feedback that really opens your eyes to the need to change something you are doing?
We are generally very bad at evaluating our own performance. So its well worth considering formalizing feedback every few years by engaging in a 360 feedback process. Done well this process will normally give you one or two key areas for improvement as a people manager so you can avoid those below seeing you as “Difficult”.
Want to hear more about how to deal with a Difficult Boss in Medicine?
I’m giving a talk on the subject at the upcoming onthewards & Beyond Conference in Sydney on the 14th April 2018.
Llewellyn Anthony, Karageorge Aspasia, Nash Louise, Li Wenlong, Neuen Dennis (2018) Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes. Australian Health Review, .https://doi.org/10.1071/AH17224