Note from the Instructor: Myth Busters—Physicians can only learn from their peers…other physicians

By Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC

Let’s consider the CDI myth that the only people who can teach physicians are physicians. I hear this all the time. It makes my blood pressure rise. I’ve been a nurse for more than 30 years. I taught physicians every day. Just like they taught me. We worked as a team and a team benefits from the skills of all. We all bring different skills to a table and these skills support each other.

Physicians admire assertiveness, competence, and confidence. We need to present ourselves with these qualities front and center. It will not matter if you are a nurse, coder, physician, unit clerk, or house keeper—keep these qualities in the forefront of your interactions and physicians will listen to you, respect you, and learn from you.

Assertiveness

Twenty-four years ago, as a nurse manager, I had a significant exchange with a provider that stayed with me over the years. He was quite abusive with my staff, especially those on the night shift. My night charge nurse was smart and well qualified, but often lacked assertiveness in her communication.

One morning, after a particularly challenging night, I found her in tears. I had spoken with this provider on multiple occasions. He called my office, “Laurie’s attitude adjustment chamber.” I pulled him aside and asked him why he didn’t treat my night staff with respect. I observed him the day before being very respectful, open to approach, and receptive to suggestions.

His answer was profound. He said, “I do not behave that way during the day, because you would not allow me to, but she does.”

So I provided my entire staff with training on assertive communication skills.

Being assertive means you express yourself effectively and stand up for your point of view, while ensuring you communicate in a manner that is respectful of others. Trust me, assertive communication will help you earn the respect of those you speak with every day. If you have difficulty standing up for yourself or receiving someone else’s respectful attention, research assertive communication techniques. I use them every day and soon you they will become a natural part of your communication.

Competence

When people ask me why I like CDI so much, I tend to say, “I learn something new every day!” The fact you are reading this tells me you’re a life-long learner, too, and do your best to be a competent in the CDI role as possible. The best CDI professionals seek out learning opportunities, they seek change and situations of growth to store in their skill bank.

You can too. If you feel your awareness of clinical conditions related to the area of neurosurgery might be a little weak, look for opportunities and exposure to this patient population. Do not run from what you don’t know—run toward it with a smile on your face and an open mind to learn.

To communicate competence, you can’t fake it. Be honest if a provider asks you a question and you have no experience or understanding of the issue. Then follow up that honesty with a genuine willingness to dig in, do the hard work of researching the concern. Tell the provider something along the lines of “give me a bit of time and I will have an answer for you.” If you come back with solid, well-researched information and later find that your instruction was wrong, follow up, and re-teach the issue with the correct information. Demonstrate your desire to do things correctly and competently.

Confidence

Have confidence that you know your craft, confidence in your abilities to assist others and improve their work. I admit this is hard if you’re new to the role of CDI, but with time (likely a brief time), you will soon be better versed in healthcare reimbursement, documentation needs, and code assignment than the average physician. Begin each conversation with providers with the thought, “I got skills…” Start your conversation confident that you have something of value to offer and something that will benefit their daily work.

As I said, confidence will increase with every exchange. If you have to approach a provider about a specifically thorny issue, or you have to give a presentation at a medical staff meeting etc., practice. Pull aside a person you trust and ask them to listen and critique your presentation. If you find you lack that confidence, work on it. If the issue is public speaking, seek assistance through educational opportunities or find a mentor. I promise you, it gets easier every time you do it. Heck… I do it for a living now!

In closing, we need to shatter the myth that only a doctor can teach a doctor. Arrive at work each day knowing that perhaps you cannot perform a spinal fusion, nor can you diagnose the etiology of the patient’s altered mental status (although you might have a good idea what is going on), but you can assist in ensuring the provider documents in a manner that tells the patient’s story in a way that the most accurate codes can be assigned and the patient’s complexity of care can be captured. Teach those physicians assertively, competently, and confidently. Remember, you “got skills.”

Editor’s note: Prescott is the CDI Education Director at HCPro in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps, visit www.hcprobootcamps.com/courses/10040/overview.