Elbow-to-elbow with my NP "roommate"

They shared a cramped, busy, sometimes noisy office. The experience yielded valuable lessons in office etiquette and practice management.

By Samuel N. Grief, MD
Family Physician/Chicago

A private office, an inner sanctum from the hectic pace and noise of a busy practice, is a luxury we physicians often take for granted. It seems inconceivable to coexist elbow-to-elbow with another health care provider in a personal and private work area. But that's what I did for a full year when I shared my precious space with the nurse practitioner in our office. More accurately, he shared his space with me!

I was the new kid on the block. The NP had been there for two years, in a prenatal clinic that boldly decided to evolve into a primary care practice. In the primary clinic's first 15 months, the NP had watched a parade of physicians come—and go. I came aboard when the executive director sought the services of a full-time family doctor who would help develop medical protocols.

All 1,200 square feet of a cozy little health center in rural New Hampshire was now my domain. Well, at least some of it was. In one office, three nurses shared two desks. In another, a social worker greeted her clients. Next door, the dietitian and substance abuse counselor saw patients on alternate days. The only other office, about 6 feet by 10 feet, belonged to Jim, the NP. It had two desks, one at the back of the room, next to a window that caught the late afternoon sun. That was Jim's desk. The other one, a single step inside the door, was destined to be mine.

One look at that office, that wooden desk—graced by an old-style rotary phone—and I knew I was in for "interesting" times. Virtually every working day over the next year, my roommate and I found a new way to collide with each other, and a new way to get along. Jim was roughly 20 years my senior and had worked in a number of medical settings, yet he seemed somewhat daunted by my presence. He always deferred to my authority.

In the end, we got along very well—not without a pet peeve or two—and I was grateful for the experience. I learned a lot about office privacy, protocol, and camaraderie, lessons that can apply in any office setting, no matter how "space challenged":

Be careful about private conversations at work. When I wanted to make a phone call, I closed the door and assumed I would not be disturbed. Then, when Jim entered without knocking, I would hem and haw, struggling to regain my composure. Jim would then rush right back out as if nothing had happened. Meanwhile, I had just made a complete fool of myself to a patient or colleague.

The most humbling moment, though, came as I was talking to my wife. It was the end of the day, and I had phoned home to solidify plans for a night out on the town. I was in such a wonderful mood that I was blowing kisses over the phone line when in walked Jim with a patient in tow. There I was, feet propped up on the desk, cradling the phone lovingly, caught in the act!

We never reached an agreement on phone etiquette, but simply learned to tune out each other's phone conversations.

Make the time, space, and quiet you need for dictation. I like dictating my medical encounters as soon as possible after seeing a patient or two. Unfortunately, our shared office space was usually a beehive of activity. Whether it was the phone ringing, the nurses or secretaries knocking, patients and nurses scurrying by outside, or any other number of distractions, the sound level could rise dramatically.

Ultimately, I learned to dictate rapidly and quietly to save my sanity—and my hearing. I also learned there is no magic secret to finding a quiet place to dictate notes or think about a patient. One suggestion: Let the staff know that you will be unavailable for, say, the next five minutes unless it's a real emergency. Or retreat to the bathroom to get the notes done.

Take turns dealing with drug reps. In our shared office, neither Jim nor I had much refuge from sales calls. Sometimes, I would greet a drug rep and usher him or her back to our cozy little corner. Other times, Jim did the honors. Either way, it became almost impossible for either of us to come into the room without acknowledging the rep and being asked for a signature or some feedback on the latest wonder drug.

Set up a system for storing medications. After each drug rep's visit, an armful of samples would sit atop the counter directly outside our cubbyhole. Jim and I took it upon ourselves to place the meds in the storage cabinets. In just under two months, it is safe to say that neither of us could find any medicine sample without rearranging half the cabinet. We had not discussed how to store the meds—alphabetically, by disease system, therapeutic category, drug manufacturer, whatever.

Eventually, we figured out that the best way to store the meds was by therapeutic classification. But hours were lost in searching the cabinets for a lone cholesterol-lowering agent that I knew just had to be there.

Return charts promptly. I prefer to return the day's patient charts to the receptionist's area as soon as possible. That way, the front office staff can refile each one expeditiously and increase the likelihood that it will be found by someone else who needs it.*

Jim liked to keep his charts for the day with him at all times. His daily quotient of charts stacked up on or around his desk, making for frequent knocks on the office door by other personnel in search of the documents. The carpet along the path to his desk wore rather thin. So did my patience until I taped a "Do not disturb" sign on the door.

Enjoy the collegiality. In the world of family medicine, with all its daily vicissitudes, it is a comfort to know that you are not alone. Jim and I became good friends during our year as roommates. Whether it was taking a brief walk at lunch to clear our heads from the morning clinic, or going out to a dinner conference to share our stories with colleagues, each of us found that sharing an office with a fellow health professional was truly enjoyable.

Jim cared for many patients who were in dire straits, both financially and emotionally. So did I. That was the nature of the indigent population we served. We grew to respect each other with each passing day of taxing yet compassionate work. Not surprisingly, I consulted Jim a few times just to see what he thought of a patient's symptoms; he did likewise with me.

At the end of the day, when everyone else had left and Jim and I were finishing our dictating, chart work, callbacks, and desk cleanup, I realized what a pleasure it was to share an office with a capable NP who knows his abilities and his clinical limits. It was a time to share the stories of the day, the medical tales that enrich our lives and serve as the building blocks for our professional experience. This reflective time bonded us as professional brethren more than any other. Thanks, Jim.

Epilogue: The primary care clinic has relocated to a much larger building. I've relocated, too. In January of this year, I moved to Chicago to work in academia as an assistant professor of clinical family medicine.

*For tips on maintaining chart files efficiently, see "Re-engineering your practice: Never lose a chart again!" July 24, 2000.

 

Samuel Grief. Elbow-to-elbow with my NP "roommate". Medical Economics 2001;6:111.