OSCE: Registrar Complaint

OSCE 6: Inpatient Registrar Complaint.

Scenario Stem:

It is 22:00 hours mid-week. You are an emergency physician in a tertiary ED. Your ED senior Registrar brings to your attention the following problem: He has been unable to contact the duty O&G registrar, Dr Andrew Kidd over the last 2-3 hours. Despite ringing his mobile 3x and on the first occasion the phone was answered and put down. Paging the registrar 3x and also paging the HMO in an attempt to get hold of the team. Your registrar knows he spends the afternoon in clinic and popped out once to see one of the ED patients before disappearing without writing any notes and now that patient has been unable to get home as no one knows the follow-up plan.

There are still 2 patients waiting in ED for the O&G registrar:

1. 30 yr old lady with an ectopic pregnancy confirmed on ultrasound but no signs of rupture and she is stable.
2. 55 yr old lady with very heavy PV loss over one week and Hb 10.0 Stable. Examination and ultrasound are suggestive of a malignancy.

You have not met Dr Kidd before and are also aware that all the registrars changed rotation a week ago, and some are new to the hospital. Dr Kidd has now arrived in the ED and has discharged the previous patient and seen the other two waiting. He has agreed to meet with you at the end of his shift and is waiting in your office.

Talk to Dr Kidd about the concerns raised by your senior registrar.

You have seven minutes

Domains assessed:

• Health Advocacy
• Professionalism and Communication

Advice for an inpatient registrar complaint scenario:

1. Thank them for staying on to meet with you.
2. Quickly get to point, “I have a difficult conversation about ……” or “I have been informed about …… and I wanted to understand what was happening with you at the time”.
3. Listen to their version and be non-judgemental. State the facts as you know them and you can be honest about this. “I overheard you say …….. , I felt this was confrontational to the junior who is only trying to learn, what do you think?”
4. Deal with any complaints that they may have about what the ED department has done.
5. Check their work load, mental health, supports. Often there is another story, even in real life. The registrar is overworked, under supported, not had any sleep for 36 hours. Speaking of which, make sure they are safe to drive, carry on working, finish their shift.
6. Explore a safe working practice where appropriate, escalate to their head of department or medical work force.
7. If the registrar is being generally rude and you can’t find any other reason for this behaviour then you can try to change their frame of thinking “this is a teaching hospital and if you feel you are not getting the right information from the junior staff please contact a consultant instead so we can address these issues”. If they are still being belligerent then you may have to state that it is inappropriate and you will discuss their behaviour with the head of department. This is a last resort because most people at work come with the best of intentions and are only reacting to stress. We should be trying our hardest to support them, you don’t want your conversation to be the last they ever have!

Additional comments on this video:

• Good comments about the workload being beyond safe, illegal and not a reflection on their work ethic.
• Loved the line “I can see you are very dedicated”.