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Constructive Criticism, Part 2


 

This is the second in a two-part series on providing constructive criticism to your hospitalist peers. Part 1 appeared in the March issue on p. 12.

Have concerns about a colleague’s work performance? Then you have two main options: You can bring it up in a formal peer review (if it’s a clinical issue) or you can approach the individual yourself.

“Medicine is an art and a science. Many problems relate to the art side—communications and relationships, primarily,” says Richard Rohr, MD, director, Hospitalist Service, Milford Hospital, Conn. “You may need to talk to a colleague about how they approach family members or how they communicate with patients. In this instance, you’d offer more of a coaching comment.”

While you may hesitate to point out another hospitalist’s problem areas, keep in mind that it is constructive criticism.

“Physicians love to run things past colleagues,” says Kenneth G. Simone, DO, founder and president of Hospitalist and Practice Solutions, Veazie, Maine, and a consultant to hospital medicine groups. “Informal feedback can provide an unbiased and objective perspective, as opposed to [a formal peer review].”

Academic Physicians Get Motivated

According to a study published in Mayo Clinic Proceedings, motivating factors for physicians appear to be different for clinician-investigators than for clinician-educators—and different for male than for female physicians. Four hundred and eighty physician faculty members were surveyed regarding their occupational motivators, specifically self-expression, helping others, and extrinsic rewards.

Compared with clinician-educators, clinician-investigators were more motivated in their work by their ability to express themselves. Another difference researchers found was that, regardless of their work, female physicians were more likely than males to indicate that they were more motivated by helping others.

Source: Wright SM, Beasley BW. Motivating factors for academic physicians within departments of medicine. Mayo Clin Proc. 2004 Sep;79(9):1145-1150.

When to Offer Constructive Criticism

In some practices, or for some individuals, sharing constructive criticism with peers is part of the job. “Informal peer discussions should take place every day,” advises Dr. Rohr. “While handoffs pose a risk for losing vital information, they are also an opportunity to consider alternatives for diagnosis and treatment that may benefit patients greatly.”

If this seems like a natural thing to do within your hospital medicine group, follow Dr. Rohr’s advice: “These discussions should be frank but nonjudgmental. If someone has a problem discussing cases in this manner, then the group leader needs to get involved. If a life-threatening error is exposed, then the formal peer review system needs to be activated.”

Providing Peer Feedback

When there is no personal conflict, you may still consider offering constructive criticism if you feel it’s warranted. “I think [peer feedback] is extremely important—if it’s done correctly,” says Dr. Simone. “It provides a safe haven for discussion and can contribute to professional growth.”

According to Dr. Simone, appropriate topics to discuss regarding a colleague’s performance include logistical problems within the practice, such as a doctor who is chronically late for morning rounds; continuity issues, such as a physician who fails to provide detailed information when handing off patients; communication breakdowns, such as forgetting to check out the labs pending on a newly admitted unit-patient with chest pain; behavioral issues, such as a physician who’s verbally abusive to the nurses or disruptive at morning rounds; problems with work ethic, responsiveness, or availability, such as the doctor who never responds to his/her beeper (necessitating a call from nursing to an accommodating provider who’s always willing and available to help); and general team play.

Doctors Versus Nurses

A Canadian study of relationships and conflict between physicians and nurses has found that power imbalances are based more on gender than on professional hierarchy. A survey of 199 nurses reveals that when nurses and physicians are both female, the traditional inequalities in their relationship—such as nurses deferring to doctors and perceiving them as demanding—diminish.

Source: Zelek B, Phillips S. Gender and power: Nurses and doctors in Canada. International Journal for Equity in Health 2003. 2:1. Available at: www.equityhealthj.com/content/2/1/1. Last accessed January 13, 2007.

If you believe you need to address one of these topics regarding a colleague’s performance, plan the logistics of the discussion. “This is a conversation best held one on one—in private,” stresses Dr. Simone. “Don’t discuss these issues in front of colleagues, nurses, patients, families … and don’t do it at the end of a long, difficult day.

“Ideally, do it after hours and out of the workplace, though that can be difficult. Remove the person from the hospital floor or the office, and the emotions and adrenaline associated with work,” continues Dr. Simone. “If the environment is stressful, it will raise their defenses, making them more likely to be resistant and argumentative.”

Talking Points

When you offer constructive criticism, approach the topic carefully. “Take a non-confrontational approach,” says Dr. Simone. “Don’t raise your voice, and don’t take the discussion to a personal level. Use objective data as much as possible. Avoid saying ‘I feel that you’re …’ and instead use ‘Coming in 15 minutes late throws everyone’s schedule off.’ ”

Keep the conversation as casual and as light as possible. “This is not a peer review meeting,” Dr. Simone stresses. “Use a soft approach, and you might have greater success. Stay away from power words such as ‘you shouldn’t’ or ‘don’t.’ ”

Advice to Beat Burnout

One of the five “burnout beating behaviors” for physicians suggested by Abi Berger, science editor of the British Medical Journal, is “Remember the Tarzan rule: Don’t let go of one swinging branch before gripping the next.”

For the complete article on “Surviving (and Even Enjoying) Medicine,” visit www.studentbmj.com/ back_issues/0600/education/196.html

A Resource for Your Future

Hospitalists are typically young and busy—the perfect formula for ignoring financial planning. There are several resources to correct that, including a how-to book published in 2005.

Financial Planning Handbook for Physicians and Advisors, by David E. Marcinko, CMP, MBA, CFP, offers a personal financial planning program geared specifically to physicians. The book explains how to choose a knowledgeable financial advisor and develop a comprehensive personal financial plan, and the author also covers insurance and risk management, asset diversification and modern portfolio construction, income tax and retirement planning, and succession and estate planning.

The book is available on www.amazon.com and in bookstores.

Some phrases you might use include:

  • “I find it helpful if I … ”
  • “This has worked for me.”
  • “Have you considered … ?”

Even if you use careful wording, don’t be surprised if the other hospitalist doesn’t react well—at least initially. “Unless you’re seasoned at doing this, the individual may get defensive,” warns Dr. Simone. “If you’re consistent throughout the conversation, show support, and are astute enough to break down their defenses, you should be effective.”

Also, keep your cool: “Don’t respond to defensiveness in like [manner],” says Dr. Simone. Throughout the conversation, show your support. “Convey that your intent is to help the individual—not harm them. Ask if you can be of help, and offer to be a resource” to help them improve.

Also remember that your colleague is part of the conversation. “Allow responses,” adds Dr. Simone. “Give them a chance to express themselves.”

End the conversation with an offer to follow up or suggest a next step. “Offer your personal help or suggest a resource such as the employee assistance program,” advises Dr. Simone. “You can check in with them from time to time, but if you have an unwilling party this may be construed as meddlesome. You must consider the personality involved and if you think they’d be amenable to continued conversations.”

Even without a formal follow-up, be sure to voice your approval if you see their negative behavior change. “If you take the time to provide criticism, you should also offer positive feedback if warranted,” says Dr. Simone. “Tell them they’re doing a great job.”

One final piece of advice regarding informal peer feedback: “Avoid writing anything down,” says Dr. Simone. “This may make it discoverable in a court of law, and it’s not your place to put the discussion in writing. If the issue is that serious, take it to the powers that be.” TH

Jane Jerrard has written for The Hospitalist since 2005.

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