“Sorry, Dr. V. It’s Dr. F. on the phone. I tried to present the patient but he doesn’t talk to PAs,” Lara West, PA-C said matter-of-factly, handing me the phone.

The words and tone were, “It is what it is,” but the expression on her face was more telling. Next to me, Chris, a junior emergency medicine resident, was putting in orders on his new patient. And Jim, my scribe, was wrapping up a note I dictated moments ago. The nurses and technicians were attending to their work within earshot. All have heard such things before and pretended not to hear.

I became acutely aware that my duty as the emergency physician extends beyond patient care. At 3 a.m., my colleague had just been deeply and unjustly insulted.

While never in the mood to fight at work, I would not stay silent today. Someone I’ve trusted for years, someone with great integrity and clinical acumen – a teammate – had been hurt. That was someone worth fighting for. There was no better time, especially with my entire team watching.

“Good evening, it’s Boris Veysman. I am the ED attending tonight, how can I help you?” I began. I was polite and measured.

“Yeah, I hear my patient is in your ER. Tell me what’s going on,” Dr. F responded, wearily.

“Lara is a highly competent colleague of mine; did you have a chance to speak to her?” I asked and paused. His response took a few seconds, perhaps to allow for sufficient steam to build up.

“Listen, you woke me up at 3 a.m., so tell me the story or I am hanging up. I don’t talk to PAs. Do you want me to go up the chain with this?”

Patient care first. “I see, and I am sorry we had to bother you at this hour,” I said, before succinctly presenting the patient.

“OK, fine. Admit her and call the house doctor for orders,” Dr. F answered gruffly.

“Terrific, we will be happy to do that, and thank you for your time and attention,” I said. “Can I share something else with you, please?”

“Sure,” he said, awake by now and sounding surprised, as most of the time the emergency department staff can’t wait to wrap up and get off the phone.

“I’ve been working with our physician assistants for years, and I have the utmost confidence in their professionalism and skills,” I began. “Lara works nights with me, and she has earned my complete trust. I want to reassure you how strongly I feel that your patients are safe and well served in the care of our PAs. They are true professionals. We take pride in our PAs.”

I fell silent and waited, long enough to intubate someone. The time felt well spent and just as vital. He answered slowly, with effort.

“Look, I’m sorry,” he said. “I’ve had a couple of bad experiences a while back, but I know it’s not fair to generalize. You guys do a good job generally, and I see your point.”

“Thank you so much, Dr. F. It means a lot to me that you took the time to listen and reconsider. I know my team deserves my trust and support. Have a good night.”

After the conversation, I pondered the admirable challenge of being a primary physician and working all day to care for your patients only to be awakened at 3 a.m. with admissions. I respect someone with a capacity to grow and adapt to professional change. I hung up feeling the mission was accomplished – firmly defending a colleague while showing respect that converted resistance to positive change.

Teaching Chris, the resident that leadership is more than giving orders. Showing technicians, nurses, and scribes that I will support them if necessary. Physician assistants have become an essential part of emergency medicine. Ensuring they get due respect from consultants and primary physicians is yet another responsibility of an emergency physician. One that I welcome. One for the team.

Dr. Veysman is an assistant professor and attending physician in the Department of Emergency Medicine, the University of Medicine & Dentistry, New Jersey Robert Wood Johnson Medical School.