Dear Dr. Nice Guy,
Real-time conflict resolution and giving corrective actions is one of the most difficult aspects of being the “Captain of the Ship.” Personally, I think the ED clerk is probably the most important non-physician in the ED. Give me a Radar O’Reilly and I can increase my productivity by 25%. Your clerk probably decreases your productivity and efficiency whether you realize it or not. If your clerk really doesn’t slow you down, as you say, I might let it pass the first time. Next time round, give the clerk the chart and tell them what to look for in the orders. If the clerk is slowing you down, ultimately you have one of two options. Tell them directly (in private) that you rely on them to contribute to patient care, you count on them to do their job as part of the patient care team and that you notice how the non-work activities slow them down. Option two, if option one fails, write a formal complaint to the nurse manager. No one in a leadership role wants employees who bring down the system, but to eliminate these employees, we need very clear written complaints that we can counsel employees about and give them the opportunity to improve before terminating them. Sounds cold, I know, but if you’re bringing your A-game to work every day, don’t you want those on your team to do the same?

Michael Silverman, MD, is the Co-Director of the Johns Hopkins/TeamHealth Administrative Fellowship

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