Reversing common, adverse ophthalmologist behaviors

Although most surgeons set high personal standards and are admired by staff and patients, there is room for improvement.

Issue: August 10, 2008

ByJohn B. Pinto

John B. Pinto

Most ophthalmologists behave in a way that pleases their staff and patients and honors their teachers and their profession. They work extremely hard, set high personal standards and do the right thing irrespective of the economic consequences. They relish team building and will readily admit when they need to improve. They are widely admired.

I am sure this applies to most of you reading this column.

But even the most virtuous eye surgeon is often plagued by a cluster of human frailties that seem to be particularly common in the profession. The most self-aware ophthalmologist will readily confess to a number of attributes and behaviors that they are not so happy about and are working to improve.

Abstracting from tens of thousands of staff and provider interviews, here is a short list of common, adverse behaviors along with a few pearls to reverse these, whether you are one of the surgeons in question or working with them.

Only trusting yourself

This is a perfectly understandable way to behave if you have been trained as a surgeon. In most work settings, you are the smartest and best-trained person in the room. The patient is bonded to you and trusts your experience. And most of all, you are going to take all of the heat if there is a misadventure. But there is a lot more going on in your business and clinical world than your brain and your hands treating your patient. To be simultaneously effective as a practice owner and at ease as a provider, you have to learn to select, inspire and, ultimately, trust others to do their part.

Making mostly solo decisions

This is a behavior related to only trusting yourself, of course. Sometimes, you should be the only one making a critical decision. But you will better endear yourself to others if you let them get involved. This involves both staff and patients. Even if you have made a final, binding practice policy decision, write it up and circulate it among your team as a “draft for comment.” And even if you know your patient needs a procedure, ask them, “What do you think?”

Being malcontented: ‘Nothing is ever good enough’

You are probably a great physician, in part, because you obsess over the smallest details. People want this trait in their microsurgeons. But the same malcontentedness applied to far less critical parts of the practice will drive your staff and partners nuts. Does it really matter which chairs your office manager picks out for the waiting room, the color of a form or what is ordered for lunch? Try to be more contented and appreciative.

Indecisive

Because the standard of care in medicine is “slow and perfect,” it can be extremely frustrating for surgeons to operate in the business world in which the standard is closer to “brisk and good enough for now.” You may freeze up trying to make perfect decisions in an imperfect environment. As a practice owner, you have to flip back and forth several times a week, stepping out of “doctor mode” and plunging into the much crisper, lower stakes world of business.

Defensive

It may sound odd, but even among the most talented surgeons in America, insecurity is common. How can that be? If you think about it, that is the way our society picks its professionals: Start with a really smart kid who wants to please his or her parents and is always on edge about whether they are living up to everyone’s expectations. “Perfect” becomes the only acceptable standard. But even if you are very smart, it is a lot of work and worry to nail perfect in every class. Fast forward about 20 years, and out the far end of the educational tube pops an ophthalmologist. So at least a little durable insecurity is to be expected. In turn, defensiveness is just one coping behavior if you are feeling a little insecure. The best cure for this is awareness, combined with one simple phrase that you can probably use every day. When an unhappy patient or staff member is getting after you with a complaint about something you have done (or failed to do), simply say, “You know, you may be right.” Not only will you disarm your assailant, but you will be open to learning something helpful from whatever they have to say next.

Disproportionate response to stimulus

This trait, along with defensiveness, also comes with being a surgeon. By the nature of your work, you are conditioned to be very cautious. A small negative stimulus in the operating room or clinic (such as a case that is not going especially well) leads to a sometimes massive response — beads of sweat, a curse or thrown instruments. You do not come across many surgeons who are laid back, proportionate responders to stimulus. In fact, a disproportional response to stimulus may be the key to success in any profession. But taken too far and applied to nonclinical areas of your practice, this trait will actually reduce your standing as a leader and your effectiveness as a provider.

Narcissism: ‘What am I feeling?’

I am not referring here to the lay use of the word, which connotes vanity, but to its clinical context: a diminished ability to have empathy for the feelings of others. This is obviously a tremendous disability for someone who has to relate to thousands of patients and numerous staff members. As you can imagine, people — in their role as your customers or employees — are going to be most attracted to you if they know that you genuinely care about them and their perspectives. Simply being aware of this tendency and witnessing it in yourself is often enough to reverse the perception of others that you are self-absorbed.

A lack of proportionality: ‘In my book, you’re a hero or a zero’

Eye surgeons of my acquaintance will often be thrilled with a new staff member. They will imbue the worker with unrealistically high skills, saying, “Molly is a 10-plus.” Not uncommonly, these same surgeons will report a few months later, “Molly is worthless. She’s a 2.” Obviously, it is probably unlikely that “Molly” is either a 10 or a 2 but a nuanced, ever-changing 7 or 8 or 9, like the rest of us.

Lay staff are servants, here to serve us doctors

This is a delicate point, one sometimes lost on younger or less sensitive providers. Yes, there is clearly a chain of command. “You” are the leader and “they” are the followers. But at a very practical level, your lay support staff are vital partners in your joint success. If you treat your staff as lowly servants, they will commonly perform down to your expectations. Treat them like fellow teammates and they may just exceed your wildest dreams.

‘Put this great idea of mine in place now!’

This impatient, non-collaborative behavioral style gets a lot fewer results than saying, “I have an idea. Maybe it is a good one, maybe not. What do you think?” Collaboration with others (even when you know your idea is perfect) will ultimately speed up implementation and increase acceptance for unpopular policies.

An aggressive, confrontational style

Safe, appropriate, respectful confrontation is a good thing. It is the stuff of effective organizations and leaders. But perhaps that is not your style. In the words of one doctor, “I don’t know why, but there’s just something I kind of like about stirring up trouble. I think people listen and perform better when they’re uncomfortable.” The truth is that they do not. Instead, they freeze up. In the worst cases, they will simply leave you for an employer who helps them feel comfortable, competent and willing to make a few mistakes on the way to improving their skills.

‘Flame-mail,’ angry voice mail

Technology has made communication much more efficient but at the same time potentially far coarser. Some surgeons, in a zeal for efficiency (or a desire to avoid interpersonal conflicts), replace nuanced two-way phone calls and live meetings with asynchronous communication. They often do so without thinking and end up saying things in e-mails or voice messages that they would never say in person. In the worst cases, they will call and leave a voice mail message when they know the recipient will not be picking up the phone. The most difficult topics should always be handled face to face.

Saying, ‘We lost, and it’s your fault’

Would you like to be admired — even adored — by your staff and colleagues? It is simple, really. As a leader in your practice, when things go wrong, accept 100% of the responsibility. And when things go right? Tell everyone the team did it. And give away 100% of the credit. They will still be talking about you for years after you retire as “the best doctor I ever worked for.”

For more information:

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees and The Women of Ophthalmology. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.