Teaching doctors the art of negotiation

Originally posted in HCPLive.com

by Jeff Brown, MD

When I am in a civilian situation and someone asks me what I do, if I am feeling whimsical, I sometimes answer “I’m in sales.”

Think about it – almost all of our professional interchanges can be seen as: 1) trying to talk someone out of doing something, like smoking, or 2) trying to talk someone into something, like exercising. Using a broader brush, you could argue that all human relationships are a form of negotiation, but my beat is docs dealing with things financial, and when it comes to negotiating, it’s another area (yet again) where we get no formal training.

Teaching doctors the art of negotiation To be fair, all Americans are unschooled, and therefore uncomfortable, in money-based negotiations. The unspoken rule is “Don’t argue, just shop somewhere else,” or worse, give in.

For those of you who have experienced any foreign travel, especially to countries economically down-rung, you can testify how minority this approach is. Ross Perot used to tell the story of the American adventurer who was in the Mideast and spotted a camel in a market that he might like to ride. “How much?” he asked the owner. “I couldn’t sell him,” said the owner, “He is my son’s pet.” As the American shrugged and walked away, the camel owner ran after him shouting “Wait! I thought you wanted to buy a camel?”

Whether you have had fun learning about haggling over souvenirs or not, giving some formal thought to the art of negotiation can be personally, professionally, and financially eye-opening.

There are many books and web sites on this subject, but I suspect that most of us are “too busy,” (i.e. uncomfortable) with the idea to pursue it. Me too. I’m always afraid that if I think too much about negotiating I will either botch it and feel worse or realize how the other person has even more advantage than I realize. This is a case in which a little knowledge strips you of the comfort of rationalization, so I’ll hit just a few key concepts so that none of us gets too uneasy.

The first principle is simply to prepare. Do your homework – get data. Docs love data and feel comfortable using it. Buying, selling, or persuading someone to change their behavior all benefit from a solid foundation of information.

Secondly, ask for what you want. Nine times out of 10, if you don’t tell the other person what you want, you won’t get it. People, you or they, aren’t mind readers, so don’t hint; be reasonable, be nice, and just ask. If they say no, ask what it is that they want.

Third, stifle your emotions. This is the hard part, where we always trip ourselves up. Learn to tolerate your temporary anxiety and remain calm. The other guy may get angry, say foolish things, roll the eyes, or whatever, but those are just tactics. You retain the upper hand as Mr./Ms. Cool. And remain optimistic and confident, if only for external consumption.

Fourth, you can’t control what the other party does, but you have control of your Ultimate Weapon, the word “No.” And sometimes just 30 seconds of silence, followed by a repetition of your request will eventually wear down the other guy first.

Next, it might be prudent to take the focus off of your primary goal, be it a number or whatever, so offer a compromise. Be creative. You know, a version of the time-tested “you can pick the price but I get to pick the terms.” Or vice versa.

It also helps if you have to determine ahead of time what you can live without and grudgingly give ground on that. Act strongest where you are weakest. The other side will consider it a victory for them while you go after your real goal. And it can be very useful if you can establish if the other person has some sort of deadline. Use it against them. They certainly will use it against you, if you let drop some deadline of yours.

Other ideas: always wait for them to make the first offer and then do not accept it, ignore their approval or disapproval – stay focused and unemotional and never feel guilty about any of this, it’s just business.

Now, clues to look for to tell you that you’re on your way; differences are narrowing, discussion shifts from differences to areas of agreement, the other side starts making notes and they start making personal references or looking to some social contact with you. Piece of cake, you’re on your way.

Two last thoughts: people can sense need, want, and weakness like blood in the water, so be prepared and remain confident. And secondly, sometimes success means just politely walking away. You can’t always win, but you can delay or go elsewhere gracefully, dignity intact, while you learned a lesson.

This process may seem contrived or stilted to some, but it is absolutely grounded in human nature. And we do negotiate daily, constantly, whether we are aware of it or not. But being unaware is a very expensive luxury that can hurt our practices, our business affairs and our personal finances. We didn’t explicitly learn this stuff at Medical U., sorry to say (curriculum committees please take note), but it’s not too late. The School of Hard Knocks is in session and we are all enrolled, like it or not. And you don’t want to earn a Phi Beta Coulda.

Jeff Brown is a family physician who blogs at Take As Needed.

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  • Doc99

    The ability for physicians to collectively negotiate should be on the table for Healthcare Reform.

  • Paul MD

    Three lawyers get together to talk about clients, strategies and fees and it is a tax deductible business lunch. Three doctors get together and discuss the same and it is colusion.

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