Strangers to friends: how do we build trust in medicine?

Nauman Malik is a Radiation Oncology Resident (R1) at the University of Toronto

 

As I finish my first year of residency in Radiation Oncology at the University of Toronto, I find myself getting used to the routine: join a new team every few weeks, exchange contact information, and perhaps make a team group chat to stay on top of things. The days go by — rounding on patients, keeping up with the flow of operations and emergency consults — and the nights are spent trying to stay afloat amidst a barrage of pages and tending to sicker patients. At the end of the rotation, you sit down to discuss your experience with your staff, receive feedback, and move on to the next adventure. Often, goodbyes are kept brief and formal.

However, every so often in this sea of strange faces, you notice your team really starts to come together. The environment feels more supportive, and residents and medical students begin feeling more comfortable around each other. They ask for help from each other more often. They share more about themselves: who they are outside the hospital, as well as their interests, hobbies, plans, and aspirations. Precious minutes between surgical cases are used to receive updates on relationships and families, and the walks from one ward to the next are filled with laughter. These moments invariably build trust and comradery, leading to improved resilience and performance — with lasting friendships and good memories as a bonus.

But how do you replicate that? How do you take a team of strangers and, over a few weeks, transform them into a well-oiled machine?

Some months back, I was fortunate enough to be sponsored for the Caring Physicians of the World course by the World Medical Association. Hosted at the Mayo Clinic in Jacksonville, Florida, about 40 leading physicians from around the world came together for a week of career development in leadership, advocacy, and media training. National medical associations sponsored their chairs and senior ranking physicians to attend, representing countries such as Iceland, Kenya, Japan, Sweden, South Africa, Myanmar, South Korea, Malaysia, and more. And then there was me. Newly minted with an MD and just getting into the flow of residency, there I was — sitting in a room full of leaders, prolific scholars, and visionaries who had transformed healthcare in their countries. Yet we were all gathered for a common goal: to understand how we could improve our leadership and communications skills to help us face challenges at home.

Speaking of challenges, many of the physicians attending were facing pressing concerns in their respective countries. Their organizations had rifts and rivalries, there were resource shortages, and their governments were seemingly not doing enough. Time here was valuable. Laptops ready and notebooks out, we were eager to take in every single drop of knowledge we could. Now, as many clickbait articles will promise: what happened next will surprise you.

We spent a fair bit of time on the concept of collective intelligence — a sort of “team intelligence” arising from group collaborations. Essentially, the higher the collective intelligence of a group, the better a team performs. We learned, surprisingly, that individual intelligence has no bearing on team performance if all members are capable: the key factors are the average social sensitivity of group members, having fewer individuals dominating group conversations and decisions (meaning other members are not staying silent or being talked over), and the percentage of female group members. This meant the best teams were diverse and emotionally in tune with each other. It made sense, then, that those resident groups I observed at home who asked each other for help more often and formed friendships were performing visibly better.

The other highlight of the week was our daily morning “check-ins”: quick one-liners about what was on our minds and preventing us from being 100% present. The initial response was exactly as you would expect: most of these seasoned physicians objected, wondering how sharing our feelings would make a difference in how smoothly their surgeries would go or how productive their meetings would become.

The goal was simple when I think about it now. It humanized us. We weren’t just “the plastic surgeon with five cases to get through,” or “the chair running a meeting,” but individuals with lives outside work. We were thinking about our children with the flu, worrying about our patients on various treatments, and missing our families (whom we had not seen in some time). The difference these check-ins made was immediately noticeable. We started to feel very comfortable with each other, and there was more empathy. With that — naturally — came stories, laughter, and lasting friendships between complete strangers. We still stay in touch.

My message here is important: I may be a newcomer to medicine, but even I can see that there is so much more to leadership and teamwork than we regularly give thought to. In the clamour of everyday life — overworked with patient care, research, and managerial and administrative tasks — we don’t often spend time engaging everyone on our teams to make sure they feel safe speaking up, and we seldom pause to explore all alternatives and their rationale as a team. This undermines the trust we should be building. And in the end, trust is what cements a team together.

Medical teams are short-lived by nature. Residents, students, fellows, and staff all rotate. In our short-lived interactions, it is hard to make time to build trust. But we can do better. Ask your senior next time she seems stressed if she’s having a bad day. Ask your medical student when he is late and flustered if there’s anything you can do to help him give his 100%. Building trust can be hard — but I know you can do it. I trust you.

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