Medical Practice Staff Should Respect, Not Fear, Physicians

Physicians regularly tell me that it is good for staff to be a little afraid of them. There are three problems with that conviction:

1. Fear is binary. Staff members either fear the physician or they do not. If a staff person is even a little afraid, the threat of punishment, a tirade, or embarrassment is present in every interaction. Her guard is always up, and her primary attention is never fully focused on the task at hand.

2. Fear is an instinctive response to a perceived threat. Fear has its virtues. When options are limited to fight or flight, the physiological responses to fear promote survival. When more complex decision making is required, the diminished flow of blood to the brain becomes an issue.

Physicians actively defend themselves against making a fearful response, because they know fearful responses do not correlate positively with high quality decisions. It is illogical for them to consciously promote a fear-based response from others, especially when a subordinate's perception of threat is likely to be more severe than was intended.

3. A single destructive interaction can do serious, long-lasting, damage to a professional relationship between folks of disparate stature. Think of the physician/staff relationship as a checking account, where deposits/withdrawals correspond to constructive/destructive interactions. Two noteworthy features of the account are that withdrawals are recorded at twenty times face value and no overdraft protection is provided. It takes time and consistency to build a nest egg of trust; the balance can go negative in the blink of an eye; and it is very difficult to recover from a serious overdraft.

NOTE: Negative messages can be delivered constructively. There is no intent here to promote constant, mindless praise and avoidance of real issues.

What do physicians mean when they say it is a good thing for staff to be a little afraid? My best guess is that they want staff to comply with instructions immediately, particularly in a stressful situation. The physicians see a little bit of fear as an expeditious way to achieve that outcome.

Fear of the physician in any clinical environment, however, is counter-productive. It can be immediately efficient, but that is its only benefit. Staff fear, even a little bit, leads to distraction, lack of initiative, and disengagement. Those are with you all day, every day.

What is more effective than fear?
Encourage staff to share what they know or have noticed with the physician. This is consistent with the important manager/subordinate principle: "Don't let me do anything stupid."  The encouragement includes specific rules about how to share the information appropriately.

Once a staff member has appropriately expressed a thought or piece of information, she needs to be quiet. There must never be a question about the physician's ultimate responsibility and authority. Any staff member that lacks this understanding needs to leave the practice sooner rather than later.

Staff must trust the physician to take appropriate care of the patient, even when it seems to be outside of standard office protocols. At the same time, it helps if the physician acknowledges he has chosen to operate outside of the standard protocols.

Allowing staff input takes little or no additional time, but the payoffs are large in terms of information potentially missed and the benefits of an engaged staff.

If you who disagree with my premise, please respond and tell me where I am wrong. The arguments will help me understand why I have not made more real world converts. I hope you will help me out.