You Are NOT The Little People

cambodia2 086Dear office staff:

Over all everyone is doing a great job. A GREAT job. But sometimes things slip through the cracks, errors are made. We ID them. We call attention to them. We work to prevent them in the future. You don’t want to wait until someone dies or gets hurt to say “Ooops! Sorry!”

Everything you do or do not do is critically important.

So long as you are doing your best work, we won’t have any problems. Honest mistakes, OK. Learn from it and move on. Do better next time. But if you are deliberately trying to shirk a duty or punt to someone else? That is an issue. There will be consequences.

It is not lost on me that many of you think I am too picky. But I ask you, who do YOU want taking care of your family? Someone paying attention to the details? Or someone who does not give a flying rip about anything?

It is not someone else’s problem. It is OUR problem. We are a team. What is at stake? Someone else’s life. Someone else’s LIFE, people. 

You don’t understand the bigger picture. You don’t know what a particular medication’s side effect profile is or what a patient’s complex medical issues mean. That is fine. No one expects you to. You DO, however, have to trust that what I and the other doctors are asking you to do is reasonable and necessary. If you do not understand, then we expect you to ask. Don’t ignore. Ask.

Sometimes people are mean and ugly. That does not mean we stop caring for them as we would anyone else. They still deserve respect and attention… because they are human beings and because we do not know what is going on in their lives. We are on the front lines of pain and suffering. So many of our patients come from backgrounds where everything they have they had to fight and struggle for. They are not used to being heard. Can they trust you to take care of them? They don’t know! Not yet. But they will, right?

You are NOT the little people.




83 thoughts on “You Are NOT The Little People

      • One small mistake of not giving a message can mushroom out of control. A doctor should not have to worry about this. A good administrator in the office should be on top of all this. I have had this very experience in two doctor’s offices in the past two weeks. Guess that is why I am more vocal than usual. 🙂

        Liked by 1 person

      • I think people understand this better through appreciation than condemnation. As a member of an office staff, my tail feathers got riled just reading this, even though I know it’s well-intentioned and may even be well-earned.

        On the one hand, it’s a post that seeks to demonstrate the importance of their position. But they won’t feel important by being subtly scolded for what they’re not doing. They’ll only feel it–and truly internalize it–by being praised for what they are accomplishing.

        Liked by 1 person

      • You have to understand, they work a job that is devalued by society at large, even if you personally bolster them. Many office staff (not yours necessarily) receive pay that reflects this devaluation, even when those staff members often deal with (as yours do) life and death issues.

        Many staffs are scolded from the top-down by doctors and the bottom-up by patients (in my case, professors/students). No matter where they turn, they see that subtle or brutally non-subtle critique of what they do.

        Try to empathize with their position. As a doctor, you are granted an automatic amount of respect (even rude patients may be so out of fear, not loathing). They don’t get that automatically. Ever. From anyone.

        When they’re asked what they do at a reunion, a cocktail party, etc., and they say “secretary” or “administrative assistant” or “office staff,” they get blank, pitying stares. No one says, “Thank God you’re there. You help save lives, too, with the tasks you do.”

        Just consider it from the other side; that’s all I ask. I understand your frustration, and I imagine it IS well-earned. Some employees, no matter what the job, are infuriatingly disconnected from their work. But for those who care, knowing you understand their side first might be the tipping point.

        Liked by 3 people

      • This is why I make the point that they are not the little people, why I remind them that they ARE saving lives. I am fully aware that patients can be awful and by golly we address that with patients when it comes up, even firing them when necessary. HOWEVER, when an error threatens a patient’s life, it MUST be addressed. It cannot be ignored. No one is going to get written up for honest mistakes. I have not written someone up for many months. This is not about beating staff down. This is about taking care of patients and communicating with each other.

        Liked by 1 person

      • Absolutely. No patient should suffer for the ego of a staff member. I don’t disagree at all, Victo, and I wish you luck with your staff and turning whatever the issue is around.

        I know that you know this, but the way you treat them will impact the way they’ll treat patients. It’s good that you praise them. They need it.


  1. Brilliantly written. I wish I’d had a boss like you while working in health care that would help me learn from my mistakes instead of write ups for stupid stuff. And also for showing your compassion to those who feel the world has let them down. I applaud you for this and for giving your staff positive feedback without making them feel inferior. BRA-FUCKING-VO!

    Liked by 3 people

  2. I love this. The nursing staff where Mom is hospitalized is excellent. The only fault we could find was when we tried to have someone page the case manager when my sister in law arrived Monday. She had told us to have the nurse page her so she could speak to the relative Mom lives with. No one at the nurses’ station knew who we were talking about. We later learned she was a floater so I suppose it’s understandable to a degree but it was less than encouraging at the time.

    Liked by 1 person

  3. Nightmare. But when we don’t pay huge salaries it’s not fair to expect staff to think like us. One if my staff dealt with the first queries about complaints. She had a nice manner, was personable, and read off her little script she’d made herself if pat. Except, it wasn’t strictly accurate … 😦
    It was 90/95% there but she didn’t like grey areas so she made it all black and white. And I picked up any fall out anyway. That was my job, not hers. I think we expect a lot of our staff. Some give 200%. Others never make 100. That’s life.

    Liked by 1 person

  4. Bravo, Victo. I probably wouldn’t want you for my boss (even though I’m the epitome of the perfect staff member), but I sure as hell would want you for my doctor. I certainly don’t want a lackadaisical physician, nor do I want my doctor’s staff to be slugs.

    PS: My real boss makes you look like Mother Theresa – but he backs me up when it’s needed most, so I overlook his quirks most of the rest of the time.

    Liked by 3 people

  5. P.S. And unlike doctors, they don’t go through the brutally harsh competition of med school to get a boot camp of criticism. Some people are never taught how to make criticism constructively, and so of course they fall apart. They take it as personal attack, not as structured guidance. Can you blame them for not having a skill they may never have been taught? Just points to ponder.

    For what it’s worth, I’m really sorry for the struggles you’re going through. I can’t imagine the stress of not having your team working as a, well, team!

    Liked by 3 people

  6. This morning while in the grocery, I stopped at the pharmacy counter. I went to Tom, manager of the group. I told him thanks, that his staff did a really good job and I appreciated the professional way they dealt with me every time, despite my occasional tantrums. I doubt they often hear that from the patients, who are under stresses and upsets of all varieties, and rarely at their best. He appreciated the feedback and said he’d be sure to pass that on.

    Liked by 1 person

    • Thanks from patients is like gold. It almost never happens anymore. My thanks are NOTHING compared to a patient who says, “Thank you!” If you are a patient, please make an extra effort to let staff know when they are doing something well or right. And don’t just direct it to the physicians. Tell staff directly. It means the world.

      Liked by 1 person

  7. Gosh, I wish you were my doctor, Victo! I’ve never thought of you as picky. I always think of you as an excellent doctor with an inspiring attention to detail and a knowledge of human frailties who works under the most difficult circumstances anyone can, short of a hospital war zone. Three cheers for you. Could you move to Crete, please! I’d much rather have a picky doctor having had several who should be struck off. Sarah x

    Liked by 1 person

  8. This in an interesting read. Your frustrations are understandable, but I would agree with much of what dearlilyjune had said on the context of wider power imbalances, devaluation, and the subtle (and non subtle) erosions of hierarchies in the workplace. I would’ve thought an office manager would be responsible for addressing system inefficiencies rather than clinician. Is there one? Also, after twenty years of working in a (non medical) field of community care and advocacy, I have revised my view on the notion of having a ‘calling’, what this means, and the different interpretations it is open to, many of them masking the over-riding need for conscientiousness and efficiency, often as important as a ‘calling’ in my opinionated opinion. I’m assuming as a medical practitioner, you have read The Checklist Manifesto. It certainly places a premium on a systems efficiency.

    Liked by 1 person

    • I do have an office manager who addresses issues. The practice is small enough that they all know where it is coming from, though. I agree that workplaces are not what they used to be but we strive very hard to make this place special. We have to because we need staff that are motivated to perform their best. I cannot fix societal ills but I do have control over what occurs in my clinic at least to some degree. Case in point, one of the physicians is out. I spent time addressing her desktop and found many things that were urgent that should have been routed to a physician that was here or least a note on the request that says that the patient was aware the physician was out for four days and they were cool with waiting. After we discussed as a clinic THREE times in the past two weeks how to handle work flow and with a personal reminder from the office manager, it STILL happened. What would you recommend be the next step? It is very difficult to be faced with issues like this dozens of times a day, particularly when it affects a patient who needs their blood clot medication (who is gonna die without it). I think that it is important to note that virtually all staff members who leave my clinic beg to be allowed back within a few months AND they want to continue to have themselves and their families seen as patients.

      Liked by 2 people

      • I hope I didn’t give the impression that your frustrations aren’t real and valid. When it comes to life and death, I’ve no doubt it can’t be over-emphasised. You sound a very fair and reasonable boss invested in acknowledging the contribution of all. I agree with you on the inability to fix societal ills, but underlying contexts and power dynamics are always at play. So of course it’s easy for me and others to comment from a world away in the name of generalisation. Just chipping in to the discussion prompted by the dilemma. It’s fairly universal. That’s all really. I hope things change for the better at your place. It’s good to hear meetings occur on a clinic broad basis. Giving folk a stake in the solution is probably the best way to validate and motivate them. Before enacting the disciplinary procedure. Yes, I would be that harsh eventually. Good luck!

        Liked by 1 person

  9. Feedback, criticism, or what we call in Toastmasters “gifts “- done well people can look forward to hearing them especially using a sandwich technique.
    Marshall Rosenberg also is excellent at sharing how to communicate with others for results and I liked his 3 hour workshop on youtube.
    Communication is not optional and in your position of leadership I expect you must be proactive with communication on behalf of the patients who rely on you and your staff. Success to you and them.

    Liked by 1 person

  10. I believe you mean this. This, from what I see, puts you in the minority. As one of the “not little people” too often the “big people” make mouth noises about doing a job thoroughly, and that mistakes are kinda ok if you learn from them and no one dies, and that competence is valued, etc. From my experience in the administrative end of medical practice that tends to be lip service in reality (not saying it is from you). In this overly female dominated field cattiness, playing games, and playing politics takes precedence over the actual “job well done.” It isn’t enough that you are good, or even excel in your job responsibilities, you also have to be able to be shat upon while simultaneously maneuver politically so that you always have a smile in response to the poor treatment while simultaneously stabbing everyone else in the back. Usually this is for a few dollars less an hour than in the non-medical field. I am great at my job. I suck at ridiculous game playing and being treated rudely. So guess who that leaves in the employment pool? The game players and the shirkers. I realize that probably not every medical office environment is this way, but so far in my experience, that’s the reality. I would like to get out of this field but I kind of got type cast for it and fear I’m stuck with the mess.

    By the way, THIS admin employee also has been in the clinical end of things, has written SOAP notes and treatment plans. This doesn’t make me anywhere near a doctor but it does make me realize that medications, treatments, referrals are timely and often crucially so. Apparently being able to come up with a pot luck meal plan is more important in the field. :::sarcasm alert:::

    This grumbling is one reason I’m not blogging. I’ve got a lot of it pent up.

    Liked by 1 person

    • First, you need a huge ((HUG))! Second: All of the people I have now came from other offices in the system. They transferred in. And so I am sure that a lot of what you are saying is absolutely correct. They get used to being defensive and on edge and they cannot simply relax and hear. Any communication is always perceived as an attack. This has been a ton better with the male office manager I just hired, but it is still a regular occurrence and quite frankly it is draining and exhausting and I need for it to stop. :-/

      Liked by 1 person

      • {{{hug back}}} Even worse, add “temp” to the general dysfunction. (Which is my recent issue, temp was…temp.) There are things that can be done but from what I’ve seen it involves time and money, in part. It means re-evaluating what “open door” means and how it is used. (In my observation, it was a means of passive, very aggressive back-stabbing.) It is doing away with the very fake HR-type new “professionalism” where words like “reach out” are used instead of “speak.” I could write a book… I could also write a book about how temp employment is a huge detriment to the employment situation in the USA except in the specific situations where a temp is actually needed (covering for maternity leave, etc.)

        Liked by 1 person

      • I agree. Temps are set up for failure. They do not receive proper training like everyone else would starting in that role and paying 150% of what you would normally pay a staff member to fill that role creates unrealistic expectations when value for money comes into play. Further, they are generally lied to by the staffing agency and by the employer regarding long term plans…

        Liked by 1 person

  11. There are many doctors who are mean and ugly and don’t give a rip. Not you. I applaud you for trying to make a difference. I’ve learned to avoid medicine as much as possible. I’ve been so hurt and I continue to hear horror stories about others. I honestly don’t know how you can stay sane in the field you are in.

    Liked by 1 person

  12. This makes me feel very grateful for one particular counter lady in the hospital psychotherapy clinic I go to. She’s always friendly, warm, yet isn’t intrusive.

    She occasionally asks patients “Hi, just out from 2 hour therapy with Dr C?” to confirm when we’re billed the “complex” code,but she’s always nice about it.

    I really should thank her because how she handles billing and stuff is soothing and unobtrusive, especially after I’ve had a tough session.

    I’m office staff doing IT in the justice system and I agree that as office staff, we’re often looked down on, but we’re important. Every job is important

    Liked by 1 person

  13. I really hope the relevant staff members you have realise that they matter, and doing their job well is a positive contribution to the lives of patients. They really do help make a clinic’s reputation.

    Liked by 1 person

  14. Bravo. And I might use this in one of my classes. There are no “small people” in health care. One wrong piece of information can kill. I start teaching this in orientation by saying that everyone in this room will affect someone’s life. I say they are all teachers whether they work with the patient or a vendor. I also say that the patient is not mad at you, they are mad at their situation. Let it go…. And to the person who said that they are the downtrodden, they are not. They are integral to the system. When they feel that they are not, it is on them. If you are feeling inadequate in any job, then do something about it. Speak up or leave, go back to school. Being upper management or a doctor comes with a cost of schooling. Being disenfranchised from your job is costly and it is up to the individual to give a crap about what they do. I do not think Victo would ever make anyone feel less than they are, that’s all on them. I could not survive without my coordinator (secretary) and I make sure she knows it. But as this post states, being disengaged and sloppy has deathly consequences and it is never acceptable. Working in health care is hard, underpaid, and never glorious work. Even the top surgeons get crap from someone. But aren’t we lucky we have people who will work in this field, be it from a cash poster to the Medical Director

    Liked by 1 person

    • The emotional payoff can be huge, the charge you get from making a difference. (The responses to this post have been incredibly interesting… including my own! Sometimes posting helps me work through problems. This one helped me immensely!)

      Liked by 1 person

  15. The greatest strengths of organisations lie in their greatest weaknesses. As a temp I learnt that the manual labour and dirty jobs enable everything else that follows.

    I respect cleaners and dish washers more than politicians.

    Liked by 2 people

  16. Every little thing makes a difference in healthcare. Everything! It absolutely infuriates me when the other departments don’t give a shit. It’s because of the registration department’s attitude that I now have to register all the patients in our own department AND do the work I was hired to do.Things can go seriously wrong if you misspell a name, get a wrong birthday or schedule the wrong procedure. I could go on. lol You are right and I really loved this post!

    Liked by 1 person

  17. As a person who is forever going to the doctor, therapist, psychiatrist, etc, I can say with certainty that office staff are who have the power to make a visit a positive or a negative one. I have changed doctors before, simply because my most excellent doctor had the worst possible staff.

    Liked by 2 people

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