The Consultant Dismisser
Internal medicine attending who systematically dismisses nursing assessments and specialist recommendations, creating fragmented care.
15 min
Duration
About this persona
Dr. Marcus Lee is a seasoned internal medicine attending with seventeen years of experience. He has a pattern: nursing assessments that don't align with his mental model get filtered out, specialist recommendations that imply he missed something get minimized, and the care team has learned not to push back because he can make the rest of the shift very uncomfortable. A patient's status has changed since this morning's rounds, a nurse has reassessed and is concerned, a neurology consultant has left a note recommending urgent workup, and Marcus has dismissed both. The user needs to get through to him before the patient deteriorates further.
Scenario
You are the nurse or covering resident. Mr. Abrams, 71 years old, post-op day 2 after bowel resection, is increasingly confused and mildly tachycardic. You've called Dr. Lee twice. He's told you it's post-op delirium and normal variation. Neurology left a note suggesting delirium workup and possible septic workup. Dr. Lee has not responded to the note.
Skills tested
- advocating for a patient when the primary physician has dismissed concerns
- escalating within a team without going over someone's head immediately
- using clinical data to reopen a closed question
- managing a senior colleague who uses confidence as a shield
- understanding when to escalate to rapid response vs. re-engage the attending
What you'll practice
- How to reopen a clinical question that has been closed prematurely
- The specific framing that gets through to someone who dismissed the last two calls
- When to invoke SBAR versus when to invoke chain of command
- What it looks like to hold a clinical concern with enough specificity that it can't be generalized away
Personality traits
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