Section 20.4: Professional Conduct and Team Respect

20.4.1 The “Why”: Your Clinical Expertise is Muted by Poor Communication

Throughout your education and career, the emphasis has been placed squarely on the acquisition of clinical knowledge. You have spent decades mastering pharmacokinetics, memorizing treatment guidelines, and honing your ability to detect and resolve drug therapy problems. You are, without question, a clinical expert. However, in a collaborative practice setting, a harsh reality quickly becomes apparent: your clinical brilliance is worthless if you cannot communicate it effectively and respectfully to the rest of the team. An evidence-based recommendation delivered with arrogance is more likely to be rejected than a less-optimal suggestion delivered with humility and respect.

In the siloed environment of a traditional pharmacy, professional conduct is often a matter of customer service and direct, transactional communication with prescribers. In a collaborative team, you are not engaging in a series of transactions; you are building a long-term, high-stakes relationship. Every interaction, every word choice, every tone of voice contributes to or detracts from the team’s collective trust and cohesion. A single act of disrespect—a condescending remark, an eye-roll during rounds, a dismissive tone in an email—can shatter the trust that is the very foundation of effective team-based care. The consequences are not just hurt feelings; they are tangible threats to patient safety. A nurse who feels belittled by a pharmacist is less likely to call with a clarifying question. A physician who feels their authority has been publicly challenged is less likely to seek out the pharmacist’s opinion in the future.

The “Why” of this section is to impress upon you that professional conduct, etiquette, and respectful communication are not “soft skills.” They are core clinical competencies, as critical to patient outcomes as your ability to calculate a creatinine clearance. This is a deep dive into the science and art of interprofessional communication. We will deconstruct the elements of team dynamics, provide you with proven frameworks for navigating difficult conversations, and give you the scripts to turn potential conflicts into moments of collaboration. You will learn that the ultimate measure of a great collaborative practice pharmacist is not just how often they are right, but how often they can help the entire team arrive at the right answer together.

20.4.2 The Bedrock of Performance: A Deep Dive into Psychological Safety

Before we can discuss techniques for feedback or respectful disagreement, we must establish the foundation upon which all healthy team dynamics are built: psychological safety. Coined and popularized by Harvard Business School professor Amy Edmondson, psychological safety is a shared belief held by members of a team that the team is safe for interpersonal risk-taking. It is the belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.

In a healthcare setting, psychological safety is not a “nice-to-have”; it is a life-or-death necessity. The absence of psychological safety is the root cause of a vast majority of preventable medical errors. When team members are afraid to speak up, the organization is blinded to risks and misses opportunities for improvement. As a pharmacist, you are often in the position of being the person who has to speak up the most—to question orders, to report near-misses, and to challenge the status quo. Therefore, your ability to both feel psychologically safe and to actively create it for others is a paramount professional responsibility.

Gauging the Temperature: Is Your Team Psychologically Safe?

Psychological safety is a tangible, measurable quality of a team’s culture. Think about the team you work with most closely. Read the following statements and assess whether they reflect your team’s everyday reality.

The Pharmacist’s Role as a Psychological Safety Engineer

You are not a passive observer of your team’s culture; you are an active architect of it. Every interaction is an opportunity to either lay a brick of safety or to tear one down. The most powerful tool you have to build safety is your response when things go wrong or when you are challenged.

Masterclass Table: Engineering a Culture of Safety

Situation	Safety-Destroying Response (Blame & Judgment)	Safety-Building Response (Curiosity & Humility)
A nurse makes a medication error by giving a dose at the wrong time.	“Why would you do that? Didn’t you read the order? You need to be more careful. I’m going to have to file a report on this.”	“I saw that the dose was given early. Can you help me understand what happened? The system can be really confusing sometimes. Let’s walk through the process together to see if we can figure out a way to prevent this from happening again for anyone.” (Frames it as a systems problem, not a personal failing).
A junior medical resident questions your recommendation for a renal dose adjustment.	“I’ve been a pharmacist for 20 years. I think I know how to dose vancomycin. Just follow the recommendation.”	“That’s a great question. Thanks for double-checking me; it’s exactly what you should be doing. Let me pull up the dosing protocol on my screen and we can walk through the calculation together to make sure we’re on the same page.” (Frames the challenge as a positive, safety-oriented behavior).
You make a mistake by failing to identify a drug interaction during verification. A nurse catches it before the dose is given.	Feeling embarrassed, you say, “Oh, right. Good catch,” and quickly move on, hoping no one else noticed.	You address it openly. In team rounds the next day, you say, “I want to thank Sarah for her excellent catch yesterday. I missed an interaction between warfarin and Bactrim, and she prevented a potentially serious error. It’s a great reminder for all of us how important that final cross-check is.” (Models vulnerability and praises the person who spoke up).

20.4.3 The Art of Respectful Disagreement: A Pharmacist’s Playbook

Your primary value to the care team is your specialized expertise. It is your ethical duty to use that expertise to challenge orders, plans, and assumptions that may not be in the patient’s best interest. However, how you challenge is as important as what you challenge. The goal is not to “win” an argument; it is to collaboratively arrive at the safest and most effective plan. This requires a set of sophisticated communication tools designed to assert your expertise while preserving relationships and psychological safety.

Cognitive Firewalls: Separating the Person from the Problem

Before you speak, you must adopt the right mindset. The most common mistake in a professional disagreement is to make it personal. You are not challenging Dr. Smith; you are challenging Dr. Smith’s order. You are not questioning the nurse’s competence; you are questioning the timing of a medication. This mental separation is crucial. Frame every challenge as a mutual effort to solve a clinical problem for the benefit of the patient.

The Hierarchy Navigation Toolkit

Challenging a decision requires different tactics depending on the professional hierarchy. Here are structured models for challenging “up” (to a senior physician), “sideways” (to a peer like a nurse), and “down” (providing feedback to a trainee).

Masterclass Table: Scripts for Challenging Across the Hierarchy

Direction	The Scenario	The Framework & Script	Rationale
Challenging UP	An experienced attending physician orders a new, expensive, non-formulary antibiotic for a simple UTI when a cheaper, guideline-recommended agent would be just as effective.	The “Humble Inquiry” + Data Approach Script: “Dr. Anderson, I see the order for New-cillin for Mrs. Davis’s UTI. I know you have a lot of experience with these cases. Could you help me understand your thinking for choosing it over ceftriaxone in this situation? The hospital’s antibiogram shows our local E. coli are still 98% sensitive to ceftriaxone, and it would be a significant cost savings for the patient.”	This script does four things: 1) It shows respect for their experience (“I know you have…”). 2) It uses humble inquiry (“Help me understand…”), which invites them to teach you rather than defend themselves. 3) It presents objective, neutral data (the antibiogram, cost). 4) It frames the goal as a shared one (patient benefit).
Challenging SIDEWAYS	A nurse, following an old unit custom, is about to crush a long-acting tablet (e.g., Toprol XL) for a patient with a feeding tube.	The “Collaborative We” + Safety Rationale Approach Script: “Hey Sarah, I noticed that on the MAR for Mr. Williams. I’m so glad I caught you. We need to be careful with that one—crushing Toprol XL can cause the whole dose to be released at once, which could tank his blood pressure. What if we call the doctor together and suggest switching to an equivalent immediate-release metoprolol that can be safely crushed? I can calculate the new dose for us.”	This script avoids any hint of “I caught your mistake.” 1) It uses “we,” framing them as partners on the same team. 2) It clearly and concisely explains the safety rationale (“why”). 3) It offers a collaborative solution (“What if we call…?”) and does part of the work (“I can calculate…”).
Challenging DOWN	During a presentation, a pharmacy student you are precepting misstates the mechanism of action for a drug.	The “Situation-Behavior-Impact” (SBI) Feedback Model Script (in private, after the presentation): “First off, great job presenting today. You were confident and well-prepared. I want to give you one piece of feedback. (Situation) When you were discussing apixaban, (Behavior) you mentioned that it was a vitamin K antagonist. (Impact) The impact is that this could lead to incorrect recommendations for reversal or monitoring down the line. It’s actually a direct factor Xa inhibitor. It’s a common point of confusion. What’s a good way for you to remember the difference between the DOACs and warfarin going forward?”	This script is specific, non-judgmental, and forward-looking. 1) It separates the person from the behavior. 2) It clearly explains the potential consequence of the error. 3) It ends with a collaborative, educational question rather than a punitive statement.