Don’t be cruel

While none of us are eager to admit it, many of us have witnessed bullying in the healthcare environment. Sometimes it’s senior physician versus junior physician or medical student. Sometimes it’s physician versus nurse. Almost invariably it involved the presence of a power differential, someone who is advantaged versus someone who is not.

This past week, this podcast was released as part of the JAMA Podcast series.  If you’re not familiar with the JAMA Podcasts, they are pretty terrific.  In this one, Ed Livingston cites much of the data about the prevalence and impact of abuse/ bullying, with a particular focus in this podcast on medical students. If you want background reading for the podcast, the original case and discussion are here.  I want to highlight the importance of ignoring behavior like that described in the podcast (as do Dr. Lucey and Dr. Livingston)- if we ignore this behavior, we’re implying that this is okay.  Note: I am particularly heartbroken by the surgeons who were so terrible to the medical student- I promise we don’t eat our young. Also, if you’re in training as a student or resident and have someone in a position of power who is bullying you, it’s likely not just you they are picking on…find someone safe to report it to who can hold them accountable.

Interesting timing of course means that during the same week something came across my email talking about how to overcome bullies at work.  An important point that he makes is at the very end: If you’re surrounded with jerks, you’re at higher risk to become one.  Choose your environment wisely. (((Related but unrelated: some of you have heard me talk about Eric Barker’s blog in the past, and this piece is no exception to his usual brilliance.  I try to subscribe wisely to things, and his weekly blog is a highlight in my email inbox on Sundays.)))

And what if this isn’t about a power differential, but is more about a peer who is a jerk when they aren’t being watched? Remember not to get hooked, and that it’s really not about you.  Then refer back to the prior piece.





Gratitude: It’s good for your team AND it’s good for you

Let’s start with a question.

How did you feel the last time someone provided you with a sincere thank you or kudos for something you did?

If I’m a good judge of human nature , I suspect it made you feel pretty good.  Perhaps your body generated a nice surge of dopamine. I would also suspect that it generated some good will towards the person who said the nice thing about you. You felt seen, and valued- two of the things that we know are so important to developing a sense of empowerment and belonging. And, of course, empowerment and belonging result in loyalty.

Gratitude is an important, and sometimes underestimated, leadership skill. Let me be clear about one thing before you decide to just go around saying, “Thank you” to everyone in sight.  That won’t get it.  Appreciation needs to be personalized, and if you can be creative in how you show appreciation, all the better. Personally, one of the best acknowledgements I’ve received recently was from a friend and sorority sister whom I work closely with. Last weekend I couldn’t run my planned half marathon because of illness.  And the text I got from her….well, it knocked my socks off.  It was a well-timed reminder that I can do hard things, I just couldn’t do them last Sunday morning.  And that’s okay.  She is someone with an incredible gift of gratitude and appreciation, and it makes her FUN to work on big projects with.  It also makes her a wonderful friend.

Appreciative Leadership has a summary table of 7 reasons to be generous with appreciation. Taken from Table 6-1  in the book, the list is as follows:

  1. Recognition lets people know they are on the right track
  2. Appreciation communicates and reinforces your values
  3. Compliments foster a positive emotional environment
  4. Gratitude is a verbal immune boost; it is good for your health (we’ll come back to this one shortly)
  5. Praise is good for the health of those you honor
  6. Acknowledgement creates a sense of safety (SO important in teaching and learning environments!)
  7. Gratitude encourages risk-taking and experimentation

The reality is that a culture of gratitude helps to promote high performance by teams.

Here’s the thing: While appreciation is the right thing to do for your team, it’s also the right thing to do for yourself. Many individual-level benefits of practicing gratitude are becoming increasingly clear: it improves both physical and psychological health, enhances empathy, improves sleep, enhances resiliency…the list goes on. If you look at that list closely and if you follow the literature on burnout, you immediately recognize that gratitude might just be one of the cornerstones in combating burnout.  Again, from personal experience I know that on days when I am feeling particularly frustrated and as if I’m tilting at windmills, the best thing I can do is pause and think about something I’m grateful for.  On bad days, it might be that I’m only on call for 4 more hours.  On less bad days, the list is typically much more robust.

Weekend homework, friends. Before you go to bed tonight, tomorrow, and Sunday night, write down (yes, write it down with pen or pencil on paper- it does imprint better that way!) three things you are grateful for.  I’m helping you to kickstart your personal gratitude practice.  Next week see if you can extend sincere appreciation to people you work with.  I’m willing to bet you’ll make someone’s day and make them want to do an even better job the next time you work on something together.

Resolved: We need to be able to have dialogues and debates

With my recent post encouraging us to seek the Other, it seems like an important time to dive into debate and dialogue as tools we use in communication. One of these is, by definition, a better way to deeply listen to someone with a different viewpoint.

Quick question for you: What comes to mind with dialogue?

I personally tend to think of open mindedness, seeking common ground, and a willingness to change in belief or action based upon what one hears.  I see dialogue as not being zero-sum.

What about debate?

It feels more confrontational, critical, difference-based, focused on winning and losing.  Debate is usually VERY zero-sum.

We know that one of these things is the place we should go when we’re dealing with people and ideas who are different from us.  But dialogue requires a lot of work. And energy. And attention.

Is debate inherently “bad”? Definitely not, and it can be used very effectively.  If you’ve been given the opportunity to argue a side in a pro/con that you don’t agree with, you know how much you learned (and that you possibly changed your mind afterwards!)

Fostering dialogue within a group, however, improves inclusion.  It helps us make better collective decisions. In the most dramatic situations, it helps foster peace.

Clearly this is the extreme, idealized version of deep listening.

However, if I think about the times when I have sincerely tried to listen like Thay describes, I have learned so much about myself, about others, about the world.

From a more business-based perspective, it is possible to foster deep dialogue among team members using a collection of tools.

And if you’re wondering, yes, one of my 2017 goals is to work on my deep listening.  I would challenge you to join me. I would also challenge you to help keep me accountable on the days when I’m struggling.




Not the usual suspects

As I mentioned in this week’s reading round-up, I am completely enamored right now with the book Appreciative Leadership. I recognize that some view my tendency to skew positive as a leader as a shortcoming, and what I most value about this book is that it takes that it’s giving me great ideas to take that positive skew and convert it into positive power.

Last week I was reading the chapter entitled “The Genius of Inclusion,” which has sections on improbable pairs and and a section encouraging us to reach out to the “Other” as an act of inclusion. The take-home message from these sections centers around the importance of truly listening to someone who is different from us; it helps us learn what we have in common with people (which may not be at all obvious on first pass) and it also helps us to build trust and foster respect. The authors encourage the fostering of improbable pairs within our teams, in which team members choose a partner whom they believe to be greatly different from them and then do a 20-30 minute appreciative interview.

Let’s extend that idea of the improbable pair further out of our comfort zone since used within a team there’s at least one thing we have in common with the other person.  What about the Other, as the authors refer to it? We all have an Other- a person or group of people whom we like or don’t trust.  American politics this year has proven just how relevant this idea of Other has become, particularly in the face of a lack of willingness to listen to ANY opposing viewpoints (which, for the record, is behavior I’ve seen at both ends of the political spectrum).

So, an exercise for you this week, friends, that I’ll admit I straight up stole about half of from the book.

  • Who are your Others? How did you learn to see them this way?  We all have them, and if you say you don’t, you’re not being honest with yourself or others.
  • What might you be missing out on by excluding them?
  • How can you reach out to an Other to learn about them? I bet you know at least one whom you can have a conversation with, and whom you might even be able to build a bridge with.  Go do that.

I know this isn’t an easy exercise, and that in some ways it’s downright scary because it challenges a core belief about your Other. But what do you have to lose? And think of what all you have to gain if you discover that while your Other is quite different from you and you have common ground with them.  You might just change your life and theirs.

Wisdom and leaving the mind alone: The Buddha Walks into the OR Part 6

After a GLORIOUS two week hiatus (seriously, glorious and completely wild and disconnected for 10 days), I’m back and ready to tilt at more windmills, tie up some lose ends, and finish our review of the paramitas for the OR. So, here were are at Paramita #6, wisdom or transcendent knowledge.

If you review our other 5 paramitas, you find that wisdom contains each of them. Practice of wisdom requires us to use all of the other paramitas; each of them provides a necessary but not independently sufficient foundation for wisdom.

Ouch. That’s hard.

Here’s the even trickier part: prajna paramita is based upon knowing that is beyond subject and object, and is definitely beyond ego. This wisdom has at its core, the idea of omniscience- a way of knowing that transcends all knowing.

That’s very meta, right?

So what’s a surgeon to do with this squishy concept that even those well-versed in Buddhism can’t readily explain (I was so grateful when Susan Piver mentioned that in a dharma talk- it wasn’t just me!)?

Quite simply, leave it alone.

According to Tilopa, the approach to wisdom requires only a few things:

Don’t recall.
Don’t imagine.
Don’t think.
Don’t examine.
Don’t control.

Apparently in Tibetan merely 6 words cover that list.

Or, as Rinpoche has advised us, the way in is just to be with things as they are.

It seems to me that wisdom is Paramita #6 because it is incredibly challenging both conceptually and practically. My goal is simply to make you aware of approaches to wisdom because I am absolutely not qualified to make suggestions about achieving it.

But that doesn’t mean I won’t try to get there…




Conflict/ Opportunity


Did you squirm a bit when  you read that word?  Truth is that most of us probably do; when we think of conflict we think of  it in a destructive framework.  We think of how conflict at some point within a relationship or a group ultimately resulted in unworkable divisions.  It’s easy to forget those times that conflict, when sagely managed, resulted in an outcome better than the sum of its parts.  Yet, when used wisely, conflict can be constructive and provides a catalyst for change.  As hard as it may be to consider, conflict can serve as an asset to a group or organization.

Understanding the role and utility of conflict is a key leadership principle, and one that we spent several hours on last week at the AAMC Women’s Mid-Career Professional Development Course.  I’ll confess that I immediately had a bit of a visceral reaction to spending the better part of an afternoon discussing conflict.  Our homework for this session was to complete the Thomas-Killmann Conflict Mode Instrument (TKI) to measure behavior in conflict situations.  The TKI places people on two spectrums- one about assertiveness, and another about cooperativeness.  While I knew from the outset that I would not end up in the “competing” corner of the matrix (high assertiveness, low cooperativeness), I was dismayed to end up in the “avoiding” corner (low assertiveness, low cooperativeness).  That’s not how I see myself, and I hope that’s not how I am generally seen by those I work around the most often.

I responded to the TKI based upon one of the many settings I am expected to function in, and it’s one that I honestly consider dysfunctional.  It’s an environment in which I have, to use another phrase from the course, been “seen but not heard, or heard but dismissed” on a routine basis.  It’s tough to engage when you’re convinced that your thoughts will be immediately devalued, right?  Fortunately, I had a teammate who was listening generously when I described the environment and my choice to essentially not participate by being avoidant.  Jennifer wisely honed in on my description and simply asked, “Do you think that you behave the same in other settings where you have leadership roles?”  She then also suggested that I re-take the TKI based upon another of my settings.

Voilá.  I moved immediately from the unassertive/ uncooperative corner of the matrix to the corner that I view as “win-win” (collaborating- low on assertion, high on cooperation).  When I’m not in that mode, I tend to be a compromiser, with a rare tendency to pull out my bossy-pants and become competitive.  In truth, it’s only right that sometimes I do go into competitive mode as a surgeon-  when it’s a life-or-death matter it’s incumbent upon us to be assertive and steer the ship.

So, kudos to my wise teammate for pointing out to me the possibility that conflict style may be a combination of personal predisposition + situation.  I was also gratified to find that tidbit of wisdom on an Overview of the TKI.  I’m also trying to make people aware that you may deal with conflict differently based upon environment; I’m a clear example of trying to simply get by in one and trying to thrive in another.  I’m not sure it’s the “right” answer in the greater scheme of things, but it’s the one that keeps me sane.

What are your thoughts on conflict in the workplace?  How to you manage conflict with colleagues or team members?  Have you taken an instrument like the TKI, and if so, what did you learn from it?

Oh, and for those who celebrate…Frohe Weihnachten!

Some timely follow-up from the HBR blog