This is the Drive Time Debrief, episode 221.
Hey, guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we are going to talk about building effective collaborations in medicine. There is a dangerous myth in medicine that the best physicians are the ones who can do everything themselves. They don't have to ask for help. They just know.
It's the physician who carries the whole team, the one who double-checks everything, handles every detail, answers every message, solves every problem, and somehow still stays standing at the end of the day. Independence is definitely reinforced in our training, and maybe that's not always for the best. We're going to talk about it. If you've been in healthcare for more than five minutes, you already know that model breaks people. Today, we want to talk about something that completely shifts the way that we think about work, leadership, and patient care.
It comes from the book Who Not How by Dan Sullivan and Benjamin Hardy. The core idea is simple. Instead of asking, "How do I do this?" start asking, "Who can help me do this better?" And honestly, medicine desperately needs this mind shift. This needs to be collaborative instead of all independence. Healthcare has become way too complex, too specialized, and too emotionally heavy for isolated excellence to be sustainable anymore.
The future of excellent healthcare is collaboration, not martyrdom. Yes, collaboration is one of my favorite words β it's so helpful, not only at work, but at home, just everywhere. So we're going to talk about the lone wolf physician. We have many clients who come to see us experiencing burnout, and this is often how it shows up. Many physicians were trained in environments where independence was glorified, and oftentimes we might have been afraid to ask for help for fear of looking stupid or being humiliated. So if we needed help, we would figure it out ourselves. Overwhelmed? Push harder. Drowning? Don't let anyone notice.
I remember β this is bringing to mind a specific Valentine's Day, I think it was probably 2001 because I was an intern. I'm on my internal medicine rotation and my supervising resident left me on call with this morbidly obese man who was circling the drain. The man needed to be put on the ventilator and she just said, "Just call anesthesia to do it." And I called anesthesia, and they couldn't come for some reason, and I'm freaking out, and I just felt pretty alone in that moment. I remember calling my husband, who was an anesthesia resident. He was not on call that day, but he did β bless him β he came into the hospital and just sat with me while we got that figured out.
But I just thought, you know, how many times does that happen? Trainees are kind of just left on their own, not feeling fully equipped to handle a particular situation. Sink or swim, baby. Baptized by fire. Right? Yeah. It's rough out there, y'all.
And then we slowly become bottlenecks in our own systems, because that becomes a habit β we're like, "Well, I guess I have to do it." Maybe we over-chart. We try to be perfect in our charting, and then we get behind, sometimes critically behind, where it's a big, big problem. Maybe we have MAs or APPs who work with us and we micromanage them. I work with some APPs who experience this with certain physicians β these are excellent, excellent practitioners who are so smart, and they get undermined by doctors who, in some cases, don't even know as much as the APPs do. So that's one way it shows up.
We might delay projects because we want everything perfect β I'm certainly guilty of that. And we resist delegation because sometimes it's "nobody else will do it right," and sometimes it's "it's faster if I do it myself." And sometimes those things are true, and yet they can still be maladaptive. So just something to be aware of, because eventually that approach is going to create exhaustion, resentment, and inefficiency. It's going to create a lot of stuff you don't want β not because you're weak or incompetent, but because no human being was ever designed to do all the things that we do.
If you think about the sheer amount of information our brains process every day, and then think that 100 years ago most of us were still working on farms without computers or phones or any of the stuff we deal with on a daily basis β and all the decisions we have to make β it's just that we have made a huge leap in what we're expecting from ourselves versus what our biology or our brains can actually manage.
Yeah, and we think about this in medicine because, like we said, in medical school you got in by yourself, you study by yourself, and you're expected to make it, and then you apply and get into residency, and some specialties are better at collaboration than others. I know in the ED we're a team sport, and that's one of the things that actually drew me to EM. But if you think about the best patient outcomes you've ever seen or been part of, it wasn't just one attending or one doctor on the case that saved the day. It might have been that once the patient got to the ICU, the nurse caught some subtle deterioration early, or the pharmacist noticed a better medication or a different dose, or the case manager said, "Hey, I think I can get this patient out of here sooner," or found an appropriate placement, or arranged that timely PCP follow-up. It's all of those things together that lead to a very efficient, very good patient outcome. And communication is right up there with everything. For the most part, great patient outcomes always have an element of teamwork. It is never single-handedly one department, one attending, or one person.
And often we see that the physicians who thrive in this career long-term are very, very good at collaborating. They know who to call β if they have a complex patient, they're like, "I need to get ID on this, I need cardiology and nephrology input," whatever it is. It's a fostering of collaboration. It's not pitting one specialty against another β it's, "I need all of you because we need to optimize this patient." And that is very, very effective. There are lots of studies written about collaborative medicine, where specialties and subspecialties working together leads to better patient outcomes.
Now we're going to talk about the eighty percent rule. One of the most powerful ideas from the book is this eighty percent rule, meaning that if someone else can do something eighty percent as well as you can, you should probably let them do it. And I will say that my house cleaners clean my house a hundred and twenty percent better than I can β and why it took me so long to get house cleaners, I don't know, but ten out of ten recommend if you don't have them.
Now, the idea of having someone else do something at eighty percent as well as we can β I know that probably doesn't land well for some of us, because we're proud perfectionists. A lot of us are proud perfectionists. We're hoping that you've listened to us long enough to know that we don't look at perfectionism as a virtue, and this is a great way for us to start doing some B-minus work where we can β allowing somebody else to do that B-minus work.
Medicine has trained us to value precision and control, not in small part because we don't want to look bad or face public humiliation. And there is a problem when physicians insist on doing everything themselves at a hundred percent perfection β they create delays. We see this often in doctors who are over-charting. If you're writing a novel in your patients' charts and you are charting at home, you must stop. You can continue to do it if you choose, but it is not helping anyone. It's definitely not helping you or your family. It's creating delays, it's driving your burnout, and it's making you more inefficient. And even when one individual is inefficient, it can hurt the larger system.
Here's the example: a doctor spends two extra hours every night perfecting charts instead of using efficient templates or allowing staff support. A B-minus chart can get everything in there that you need from a coding and medical-legal standpoint to allow continuity of good care. Not everyone has the resources to have someone else help manage their inbox, but if you do, please delegate that. Let someone else help you with your inbox. Hopefully the nurses you work with have protocols and can start ordering some tests or handle things without your direct oversight β I think almost all of us have some version of that, and if not, that would be a must.
Hopefully you're not redoing work that was already done competently just because it wasn't done exactly your way. I think most of us, no matter how perfectionistic we are, might have given up on that one β but it does show up, and many of us do have some obsessive perfectionistic tendencies. It's important for us to look at those and ask ourselves, "Is this really who I want to be? Is this really as virtuous as I think it is?" Because doing all that stuff makes our stress skyrocket. Our families get a totally fried version of us that is snappy and not so fun to be around. And we eventually get to a point where we're like, "This is not what I signed up for. I had no idea that working in medicine would be like this," and we want to quit and go do any number of other things.
The goal is not to be careless or cavalier or sloppy. The goal is to be sustainable. The goal is to have appropriate excellence. When we pursue perfection, we are always going to be frustrated because it's an impossible goal. Excellence is achievable, and there's a huge difference there. And I would say a B-minus chart definitely falls within excellence. Save your A-game for clinical decision-making, for procedures, for direct communication and connection with patients β but the charts? Come on. B-minus. Yeah, maybe save your A-game for the things you actually went to med school for, what your intentions were when you started all of this.
You know, B-minus is still better than average. It's not a failing grade. It's still pretty darn good for the things you had no particular interest in in the first place. Yeah. And even if that sounds cringey and you're like, "I've never gotten a B-minus in my life" β I've gotten plenty, thank you, and I'm still a doctor.
And I would say sometimes we can look at this through the lens of an hourly rate. If there's someone who gets paid $50 an hour to do that job at eighty percent or better, and your hourly rate is $300 an hour, which is the better use of the budget? The $50-an-hour person. Save yourself. Your expertise, your professionalism, the thing you went to medical school for β that's worth $300 an hour. Do your $300-an-hour tasks and let the person who makes $50 an hour β and can do it at least eighty percent as well, probably better, just like Laura was saying about her housekeeping β handle the rest.
Like, I can't even get my housekeeping done. I get stuck in a closet and then my day's over. Five hours later I'm still in the same closet. So I praise God for my housekeeper. Yeah. That's a funny thing. Kendra and I work in a place where we are blessed to have so many other women physicians that we hang out with socially, and we would go shopping sometimes with some ladies who didn't work in the ER, and they would just be on shopping sprees, and we would be like, "Mm-mm, that's a whole other shift I have to work." I do not need that purse and those shoes. Brings a little perspective. Yeah. I would rather take a day off. Yeah. But on the other hand, there are so many tasks that aren't rewarding, and I could pick up one extra shift and cover all of it for maybe the whole year. And that's the sort of option that's available to you.
So let's talk about how to create better systems, and one way is with fast feedback. Another key to effective collaboration is shortening the feedback loop. In healthcare, we often wait way too long to communicate problems. A nurse might notice a workflow inefficiency but says nothing for six months. A physician feels frustrated with referrals but never addresses it directly, just mumbles under their breath. A clinic process clearly isn't working, but everyone just adapts silently instead of improving it collaboratively.
Strong teams normalize fast feedback. But that means we have to be open to feedback. We have to be seeking feedback. We have to create an environment where feedback isn't punitive. And the other thing I would say is I felt like I gave feedback a lot and nothing came of it β and then that leads to the learned helplessness that sometimes we arrive at. Anything we can do to normalize and speed up fast feedback is going to be helpful for our system. Not aggressive feedback, not humiliating feedback, not punitive β but fast, clear, actionable, respectful feedback.
So like, "Hey, this discharge workflow keeps creating confusion," or "Can we adjust this order set? I notice most of us aren't using this particular lab," or "I notice patients keep misunderstanding these instructions. How can we make this easier for everyone?" Things that could lead to a benefit sooner are worth raising. Faster feedback happens when there's faster trust and a shared desire for efficiency to grow.
Yeah, that's a really good point, because you're right, Amanda β we do develop that learned helplessness over time. But I'm also thinking about bringing it inside your sphere of control. The biggest bang for the buck on fast feedback is really just the things you can actually control. Amanda and I work in a shop that's kind of off main campus, which is great because we do have autonomy and control over a lot of things, and that's where I've shifted about eighty percent of my energy as medical director β the things we know we have the autonomy to shift or change that make our shop run so much better.
I do hand off a lot of things and put them out there to the powers that be, but I don't expect a lot back. The eighty percent of stuff I choose to spend energy on are the things within our shop β that fast feedback loop. Is this workflow working? Is this lab thing working? I'm constantly asking my team. And I'm like, "If this isn't working, let's troubleshoot." If the nurses find a workflow clunky, let's work with them to make it better. We handle a lot of different things for a lot of different specialties, and we take that and make it work in the most efficient way. So that fast feedback loop is so important when you bring it into the things you actually have control over.
And this is probably one of my favorites β this idea of being the hero to the people you work with. Not trying to be the hero of the whole hospital. Like I said, we have to reel this in to our close proximate team, the people we're dealing with on the regular. It's about making shared goals and looking at it through the lens of: how could I make a nurse's workflow a little bit easier to get patients through efficiently? How can I make a smooth handoff to consultants, or a cleaner way for our team to communicate with consultants? How do we hand off patients? How do we support our mid-levels? How do we teach students and make them feel part of the team from day one? How do we include the PCP in the follow-up so that patients get to the appropriate place and don't keep coming back? Those are the kinds of workflows that really engage the team, and using your energy to be the hero of the people you're in close proximity with makes a real difference.
Like a cardiologist who sends a clear, actionable consult note because they genuinely want that follow-up with the PCP to succeed. We have a program in our shop with CHF patients that we work really hard to keep out of the hospital. We worked with cardiology to develop a whole fluid management protocol β we went back and forth several times with feedback β and it is very successful now. We have lowered readmission rates. We've made big strides hospital-wide on the metrics, but we started with our team. We worked alongside cardiology and made that happen. That was that fast feedback loop. They were a hero to us, and we really tried to be a hero to the cardiology team.
And this is the same when you're in the ED trying to admit a patient, or in the OR when the surgeon treats that whole OR staff as people to be supported β be the hero of that OR staff instead of seeing them as obstacles or things that slow you down. This is really the core of what changes culture, and it starts with the people you're in close proximity with. Remember how it feels to work with someone you trust. You want those people to want to work with you just as much as you're there working with them. And ironically, the physicians who become the most respected are often the ones who make everyone around them better.
My daughter and I talk about this all the time. We want to be on teams with arm linkers. And what are arm linkers? They're the people who link arms with you on the way up β or if you're on your way up, you link arms with your "who's," not just your "how's," and you bring them along with you.
But this requires a very uncomfortable thing, and that is ego reduction. I know β your eye might be twitching a little bit, but it's okay, because true collaboration requires that physicians let go of needing to be the lone hero or the smartest person or the one with the most expertise in every room. It really does cause us to reflect and eat some humble pie. Humility will take you down the right road with the right people at the right time. Because when you've built your team around humility, that MA is going to speak up and say, "Hey, Dr. Morrison, didn't you want this?" or "Last time you took care of this, you ordered this." And you're like, "Oh my gosh, yes β I totally missed that." Or the nurse says, "Hey, this dose seems a little higher than last time." They are comfortable coming to you because you've already built that trust. And you know, administration might even ask you for some useful insight. I know, it stresses me out sometimes, but maybe it might happen.
But really, when you model that teamwork β especially in front of a patient β they know that not only does your team feel heard, but they feel heard too. They can feel that collaboration and that teamwork.
So collaboration is not losing authority or respect or honor. It's multiplying your effectiveness, and you can only do that through humility. When we are willing to create those systems, build trust and relationships, have efficient workflows, communicate in a way that truly advocates for your team, and build a culture β that's how medicine really starts to function better for everyone involved. And the beauty of it is you don't carry this whole burden yourself. You were never supposed to.
So the best physicians are not necessarily the ones doing the most. They're the ones creating environments where everyone can do their best work together. So this week, I challenge you β look at your life or your practice or wherever you are, and instead of asking "how do I do more," ask yourself "who could help me do this better?"
Because collaboration is not weakness or failure. It's actually seeking to do the best work with the best team to achieve the best results.
And that's it. Thank you for listening to today's episode, friends. If you found this conversation helpful, the best way to support us is to subscribe β so click that button now β and rate us five out of five stars. Nothing less. And leave a review, because it helps other physicians find us and moves us up on the list. And we'd love to hear from you. If you have a great team story, a collaboration story, something your practice went through, we'd love to hear about it. Email us at [email protected].
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So thanks for spending time with us today. Until next time β you are whole, you are a gift to medicine, and the work you do matters.
