Coastal Care Partners News

In my professional experience in the medical world, there seem to emerge two distinct types or categories of healthcare workers: The Collaborator and the Gatekeeper.  A perfectly surefire method with which to quickly and easily identify each type is to look carefully at any front desk in any doctor’s office.  Yes, the front desk.

Striding into the First Office, you might be pleasantly greeted with soft music playing in the background, along with a smiling front desk worker who is both instantly engaging and genuinely welcoming.  She or he, though busy, appears poised to help.  Even the physical reception desk area is open, and there might even be a soothing water feature adorning the wall or placed on the desk.  You could sit a spell there, but, alas, you came there for a reason, and the Collaborator then assists you in accomplishing your goal.

In Office Number Two, you eagerly walk in and immediately find the somewhat intimidating “Closed Glass Windows” scenario, often with that annoying piece of paper neatly taped to it that menacingly warns, “Do NOT touch the glass!”  You stand there awkwardly looking around because you certainly do not want to look as if you are staring directly at the person behind the glass–that might come across as rude.  So, you get busy examining your silent phone and surveying the artwork and plants in the waiting room.  Finally, the glass window opens, and there she is…the Gatekeeper (most likely looking quite put out to have had to open said glass window, which often squeaks).

After twenty years in healthcare, I know the Gatekeeper very, very well.  As a new nurse fresh out of nursing school, I worked in the ER with some of the fiercest Gatekeepers around.  I would walk into work innocently smiling and would often be met with, “Why on earth are you so happy?”  I quickly learned that working fourteen hours without eating or going to the bathroom was a badge of honor in the ER.  (This may have been part of why everyone was so grumpy all the time, but who knows?)  After about a year in the ER, I moved up to a med-surg floor, where I encountered one of the most gatekeeperish Gatekeepers of all time.  We will call her Ms. Betty.  I was absolutely terrified of her.  Part of her job was supposed to be putting in orders into the computer for the nurses.  After a couple of times of me bringing her orders and her looking up from reading her Bible and grimacing at me and ordering, “Set it right here, and I’ll get to it if I have time” and then never getting to it, I quickly learned to put in my own orders.  Not that I minded the work, but it was definitely one more thing that took away from time with patients.  Ms. Betty also liked to write “encouraging” scriptures on the white board in the breakroom, which I loved, but thought was a little funny because they were often about the importance of loving one another and she was viscerally mean to literally everyone.

In my work as an Aging Life Care Manager, I frequently come across Gatekeepers as I am coordinating with doctors’ offices.  Gatekeepers somehow manage to make even the simplest and easiest requests into major issues.  Anything from asking for a client’s medical records to a prescription called in for a patient can be major offenses to a Gatekeeper.  “What?! I work in medical records, and you want me to…send you medical records?!”  The audacity….

I also come across many Collaborators in my Aging Life Care work.  In the hospitals, when I encounter a case manager who is a collaborator, I inwardly say a little cheer.  The outcome for the patient is so much better when the case manager and nurse care manager can collaborate and create a successful plan together.

So, I am writing this today both as a plea and an encouragement to all the Gatekeepers out there—the front desk workers, receptionists, medical record folks, nurses, hospital case managers, etc.  Let’s work together, jointly, with respect and mutual good will.  Because it really is so much easier and much more productive to be a Collaborator!  We can actually all work together and get so much more accomplished.  All of the negative energy that it takes to be a Gatekeeper could instead be channeled into the healthy openness of being a Collaborator.  Which will result in joyfully helping the wonderful people we are in this field to actually help…the patients.

If all of us, the often-overworked front desk workers, the dedicated and caring nurses, the very valuable medical assistants, the loving caregivers, the important hospital case managers, etc. worked together and COLLABORATED, wow, it would be beautiful, not to mention much more efficient!  Let’s get started.

Amy Pierce, RN, BSN,CMC