Consider a medical trainee, in the second year of her medical training, who has made it a point to always show up early to work no matter the situation. She often times stays beyond the end of her shift to help out either her co-residents or juniors. She is having a bad week and uncharacteristically shows up late for rounds in the ICU. As expected, she is castigated in front of the whole team for being late. She feels embarrassed and dejected. She feels as though she will now be defined by this episode of tardiness, and all her efforts prior to this, matter none.
There is a high expectation for residents, fellows, and even attending physicians to perform exceptionally as they practice medicine. From simple administrative duties to the very complex issue of dealing with death and terminal patients, a physician’s responsibilities vary in scope and detail. The physical and emotional toll of these responsibilities can often lead to burnout; therefore, there is a strong need to use positive reinforcement to foster those responsibilities.
I couldn’t help but notice during my medical training that doctors were very quickly reprimanded for medical errors, near misses, and unprofessionalism – and rightfully so. However, we need a culture that fosters positive reinforcement rather than punishment. I believe most doctors get things right more often than not. But how can we make ourselves feel better about the work we do? How can we make our work environment a friendlier place to be? How can we make one another go the extra mile in an already demanding job? We can achieve this by simply creating an environment that recognizes and validates good behavior. It’s an easy way to build confidence, and it impels people to do more. Let us recognize and commend our coworkers and juniors on a daily basis. Yes, let us commend each other on the 99 percent of things we do right, even though it is expected of us or in our job description. Let us say “thank you” and “well done” more often. Let us reinforce immediately when we see a coworker do something right; let us be genuine and sincere about the compliments we pay. Let us do it every day. It is necessary for us to do this because the effect of not doing so is quite potent; it leads to feelings of unappreciation, which turns into apathy for the job being done.
There are many ways for us to do this on a daily basis. For instance, “I have noticed you are always on time, that’s impressive,” “Thank you for spending time with that family and addressing their concerns,” “You put in a lot of work into making that presentation, thank you,” “I noticed how hard you worked during this rotation, well done keep up the good work,” “Thank you for drawing that blood work so quickly.”
Compliments like these instill confidence and are more likely to make a young medical professional go the extra mile. Several studies have come to similar conclusions, including a study done by Dr. Jooa Julia Lee and her colleagues from Harvard. Lack of reinforcement leads to apathy and job dissatisfaction. The physician, cited at the beginning of the essay, would certainly have felt more valued if all her concerted efforts to be on time were recognized, she would likely want to maintain her high standards. Now she probably wants to do the bare minimum to avoid criticism.
We need to bring back the feel-good factor to medicine and keep it. I have seen very good physicians get reprimanded for honest mistakes they have made without any recognition for all the good work they had done. Such a manner of reprimanding physicians can be very devastating and damaging. Multiple studies have shown that employees are much more productive when they feel good about the work they do. Let us do what we can to slowly change the culture of medicine.
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