In my work as an academic medicine education specialist, and, perhaps more importantly, in my experience as a patient, I have observed time and time again a common scenario. I call it the grumpy physician trickle down scenario.
Here is how it plays out. A physician, likely good-hearted, well-intentioned, competent, and compassionate, develops frustration with system operations (scheduling, inefficiencies, miscommunication, the list goes on). The physician internalizes the frustration, perhaps believing (in error) that his or her professionalism is a stable trait that will be expressed, despite the mounting frustration.
However, the members of the care team begin to pick up the underlying frustration through changes in voice tone and volume, a stiffening body posture and quickening of gait, eye brows having slightly more furrow, deferred eye contact, and other very subtle cues. They wonder, “What’s wrong? Did I do something wrong?”
They shift their cognitive focus from patient care to reviewing the interactions they have engaged in with the “grumpy” physician. With this shift in cognition and a heightening of sympathetic activity, members of the care team adjust their behavior appropriately. They may “walk on eggshells,” scale back their level of engagement for the purpose of not making errors, and minimize their presence by avoiding asking pertinent questions, avoiding calling attention to errors or omissions in the care protocol, or refraining from suggesting a management alternative based on knowledge of the patient’s social situation—all because these behaviors might result in being scowled at or reprimanded by the grumpy doctor in front of the rest of the care team and the patient.
Quite unintentionally, through an unreflective choice, the physician has been the source of a less than optimum patient care experience.
Here is a three-step invitation for action for physicians who may wonder if this dynamic is currently playing out in their own patient care teams.
1. You, by virtue of your clinical knowledge and patient care responsibilities, are the team leader– whether you are intentional or not about it. Choose to get intentional about values-based leadership.
2. You (even those of you who don’t think you have one grumpy bone in your body) can benefit from creating a value-based feedback system within your teams. Let everyone on the team know, that in service of providing the highest quality of patient care, everyone on the team is responsible for sharing their observations about concerning and beneficial behaviors. Create and role model a light and respectful manner for sharing these observations. These observations can be shared without judgment by simply saying, “I’m observing a sharp tone and quick speech pattern today. What is up with that?” Let everyone on the team know that your goal is to have all team members focused on patient care and not distracted with wondering about someone else’s mood.
3. You, may need to address an errant belief system, by realizing that professionalism is not something that is acquired and then becomes a stable trait. Professionalism is a minute- by -minute choice. When frustration begins to mount, an intentional choice must be made to behave professionally or unprofessionally and that choice is in your court at all times.
If you accept this invitation, get ready for the benefit your teams and patients will experience. And get ready for the change in culture when your team is not calling you grumpy behind your back.
Patti M. Thorn is an education specialist and professional leadership coach who blogs at Living-In-Vision.