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Teaching and Learning Moments

How May I Help You?

Agapoff, James R. IV MD, MS

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doi: 10.1097/ACM.0000000000002666
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“How may I help you?” I asked the consulting physician standing in front of me.

“Why isn’t there a disposition for this patient? Aren’t you supposed to be a good resident?” he demanded in response.

“I’m sorry,” I said, trying to maintain my composure.

The one-sided conversation that followed went on for almost 20 minutes. Beside me, my medical student had a horrified look on her face, like someone watching a car accident. I looked at the consulting physician and thought, “If you’d stop complaining about a system problem I have no control over, I might be able to help the patient.”

The consulting physician stared down at me over the edge of his wire-frame glasses. “Do I have to talk to your attending?”

Feeling my heart flutter slightly, I forced a smile. “It’s okay; I will call her right now. This is a difficult disposition and she may be able to help.”

“Good.” The physician stomped off, his white coat flapping behind him like an angry tail.

I turned to my medical student and asked, “Are you okay?”

She nodded unconvincingly. “I’ve never seen someone just go on and on like that.”

I assured her everything was okay and sent her on break. I turned back to the note I was writing, still a little frazzled, and thought, “If I was an attending, I wouldn’t put up with that.” Then I thought, “If I was an attending, he probably wouldn’t have done that at all.”

Swallowing my pride, I took a deep breath and started typing. In medicine, the patients come first, and they deserve 100% of my attention.

Thankfully, this incident was not characteristic of my residency experience. Over four years, I worked with dedicated faculty who inspired me to take a position supervising residents.

I nearly forgot about the incident with the consulting physician until one day when my phone rang. “How may I help you?”

“James,” the voice of the old consultant sent a shiver up my spine. “I have a project for you in mind.”

As I listened, it became clear my colleague was in over his head and wanted me to assume responsibility for most of the venture, while he took the credit. My ire grew as he began to lecture me. “You should be grateful I’m asking you to participate. You are a junior attending. These kinds of opportunities don’t come around every day.”

If my teeth were longer they would have cut into my gums. I asked myself, “How is this happening to me again?”

I remembered my reflections as a resident and thought: “Ha! Now I can say to him all those things I wished to say then.”

Feeling the words on the tip of my tongue, I opened my mouth, then slowly closed it again. As much as I wanted to speak my mind, I considered the consequences of my words. In a not so tactful way, he was asking me for help, and I couldn’t be angry at him for that.

Instead, I responded: “I appreciate the opportunity, but I’m pretty busy right now. I can help you with a smaller piece of the project, if you like. I’m sorry I can’t do more.”

The silence on the other end of the receiver made my palms sweat. “Here it comes. He’s going to lose it,” I thought.

“Thank you, James. I always could count on you. I’ll email you the details.”

“You’re welcome,” I said, hanging up.

In the end, my compromise served us both. I made a meaningful contribution to the project, and my colleague got the help he needed. Given our past encounter, I could have declined his request. If I had chosen to allow pride and anger to dictate my response, I may have permanently damaged our working relationship and missed an opportunity for professional development. If I had agreed to take on the entire project like he wanted, I might have served my colleague but felt exploited and resentful in the process. Instead, I chose a middle path.

I used to think that establishing boundaries required strong emotional responses. I was wrong. Learning to say no and express oneself in an empathetic way is a valid alternative. The more authority I have gained, the more I have had to consider how to exercise that authority with grace and maturity. My team members, including the residents under my supervision, will use my behavior as a model for their own.

In residency, I fantasized about a time when I would be at the same level as my attendings so I could speak my mind. My experience has taught me that, regardless of the situation, some opinions are simply best left to oneself. When dealing with difficult people, the best action is to listen and ask, “How may I help you?”

Acknowledgments: The author would like to express his appreciation to the staff of the Department of Psychiatry at the University of Hawai’i at Mānoa.

Copyright © 2019 by the Association of American Medical Colleges