Communication & Correspondence

This section may well have a feel of an old person ranting but this is an amalgamation of experience and observation. Personally, I still can’t call those who were my seniors but are now my peers by their first name without feeling uncomfortable, but different specialties have different habits.

A slow but steady change that has been occurring in the NHS and in many other organisations is a shift towards flattening the hierarchy. The biggest advantage of this is the empowerment of those who may otherwise be reluctant to speak up due to perception of their ‘position’, and ultimately means that issues can be raised sooner and managed earlier. For patients this can improve their overall safety and satisfaction, whilst stamping out bad behaviours such as bullying and harassment.

This openness cannot be interpreted as an opportunity to be casual. It is still absolutely vital that as you engage with colleagues you remain appropriate. How you interact and behave will create a perception of you that can help or hinder you. Politeness and courtesy cost nothing, and is the best way to be until you’ve scoped out any given individual’s preferences.

Flattening the hierarchy also cannot be taken as an opportunity to assume total equality in a given situation. Ultimately, the hierarchy exists with accountability. The more senior the individual in the situation, the more responsibility and accountability rests on their shoulders. In the operating theatre, everyone has a role. During the anaesthetic and transfer of the patient, the anaesthetist is the second most important person in the room; during the surgery, the operating surgeon is the second most important person in the room; and during closure, the scrub nurse is the second most important person in the room. The most important person is the patient.

This isn’t to say that input from other colleagues isn’t welcome or is ignored out of hand, but at certain points you need to be leader, though you always need to be a team player.

Face to Face Communication

• If it is a meeting, be punctual — we all acknowledge that there will be instances when you are late, but in those cases letting your colleague(s) know the situation is important.
• Dress appropriately — this can be a point of contention, but every organisation has a uniform policy, and these are more focused on ensuring appropriate attire for your job and to fulfil requirements of other hospital policies (such as infection prevention). Very few people will call you out on it for fear of a complaint, but it won’t stop them from raising an eyebrow and changing their perception of you.
  • Dress for the job you want, not the job you have — as a junior colleague you should be developing behaviours for the next stage of training.
• Use titles — if you’ve never met someone before, use their title. It’s not about servitude but a demonstration of professional respect that will then be returned. If you’re later invited to address someone differently, that’s fine.
• Respect your seniors — again, not about servitude, but the fact that your senior is the one who will be on the hook for anything that goes wrong. If the senior invites you to call them by their first name, that’s different.
• Be kind to everyone — it doesn’t matter what you think of yourself, that view will never be shared if you are horrid to others. Everyone should be afforded respect and kindness, especially junior colleagues who will look up to you and learn from you. If you behave badly, this passes on to the next generation.

Email Communication and Correspondence

I received a memorable email once — one line, no introduction, just a demand. I replied bluntly and received a feisty response. When this individual realised I was a consultant, the grovelling started, which was even worse: they said if they’d known I was a consultant they wouldn’t have been so rude. That shows a lack of insight, common sense, and a heap of arrogance — no one should ever receive a rude email. So here are my tips for sending emails:

• Greet the recipient — if you have a relationship with them, go with first names; if not, use titles.
• Introduce yourself, if needed — if they don’t know you, it helps them work out what your needs will be.
• Acknowledge or thank them — e.g. “I appreciate you may be busy but…”, or “Thank you for your email…” if replying.
• Ask the question — make your purpose clear, specific, and keep it short.
• Finish with a polite thank you and a closing with your name.
• Have an email signature that clearly identifies who you are and where you work.

As an example, read the two emails below and decide which one you’d prefer to see in your inbox from someone you don’t know.

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