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Ovid: Oxford Handbook of Clinical Medicine

Editors: Longmore, Murray; Wilkinson, Ian B; Turmezei, Tom; Cheung, Chee Kay Title: Oxford Handbook of Clinical Medicine, 7th Edition Copyright ©2007 Oxford University Press > Front of Book > Prologue to clinical medicine: Dag Hammarskjöld on teamwork Prologue to clinical medicine: Dag Hammarskjöld on teamwork Good doctors are good team players, because health care is complex, and nobody knows everything; and nobody knows how to relate to every patient and his or her unique needs. Because we are all fallible, we all see many examples of poor teams, where bad communication, power struggles, and personality clashes lead to poor outcomes. Stress, overwork, and resource restrictions contribute to this, but not inevitably. So it is worthwhile, at the outset of this journey through clinical medicine, to commit oneself to being a good team member. 3 rules help: (1) All members are valuable; none is irreplaceable, and members are valued for who they are, not just for the resources they bring. (2) ‘Innocence is no excuse’—ie you may not be ‘to blame’ for a group’s malfunction but in the end each member is responsible for everything. (3) Every member needs encouragement. Just how important this is, is shown by this comment from a well-known statesman:1 ‘He was impossible. It wasn’t that he didn’t attend to his work. But his manner brought him into conflict with everybody … When the crisis came, and the whole truth had to come out, he laid the blame on us: in his conduct there was nothing, absolutely nothing to reproach. His self-esteem was so strongly bound up, apparently, with the idea of his innocence, that one felt a brute as one demonstrated, step by step, the contradictions in his defence, and, bit by bit, stripped him naked before his own eyes. But justice to others demanded it. When the last rag of a lie had been taken from him, and we thought there was nothing more to be said, out it came with stifled sobs. “But why did you never help me? You knew that I always felt you were against me. And fear and insecurity drove me further and further along the course for which you now condemn me. It’s been so hard—everything. One day, I remember, I was so happy: one of you said that something I had produced was quite good—” So, in the end, we were, in fact, to blame. We had not voiced our criticisms, but we had allowed them to stop us from giving him a single word of acknowledgement, and in this way had barred every road to improvement. It is always the stronger one who is to blame.’

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