Saturday, November 28, 2015

Don't get angry . . . and don't get even.

Watching the recent angry back-and-forth between Russian President Putin and Turkish President Erdogan has caused many of my friends in the medical world to wonder: Why do high ranking national officials stoop to apparently immature approaches in their disputes, approaches that might lead to an expansion of a conflict to something that neither party wants?

And then I remind them of behavior they have witnessed between senior doctors in their hospitals' operating rooms, intensive care units, and treatment floors. Sheepish looks quickly follow.

There is a school of thought that suggests that your effectiveness as a negotiator is enhanced when you display anger. Professor Alison Wood Brooks at Harvard Business School presents the alternative view in a recent HBR article:

[T]here’s a body of research . . . that documents the consequences of feeling angry while negotiating. This research shows that anger often harms the process by escalating conflict, biasing perceptions, and making impasses more likely. It also reduces joint gains, decreases cooperation, intensifies competitive behavior, and increases the rate at which offers are rejected. Angry negotiators are less accurate than neutral negotiators both in recalling their own interests and in judging other parties’ interests. And angry negotiators may seek to harm or retaliate against their counterparts, even though a more cooperative approach might increase the value that both sides can claim from the negotiation.

Or, as Lucius Annaeus Seneca put it:

Anger: an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.

In her article, Brooks offers some strategies that can be employed to help people tamp down unproductive anger, both in themselves and in their negotiation counterparties.  Most of her advice relies on a party's emotional intelligence.

Coincidentally, Dr. Gene Lindsey devotes a portion of his most recent weekly newsletter to this issue of emotional intelligence in the health professions. His focus is on the importance of this attribute in enhancing the value proposition for health care delivery, but the topic is also relevant in simple face-to-face clinical relationships.

Many of the points seem self-evident.  For example:

Emotional intelligence — plays a significant role in determining how effectively physicians communicate and establish relationships with patients, as well as with their colleagues.

Effectively leveraging emotional intelligence requires an understanding of how emotional intelligence manifests itself, as well as tools to help understand an individual's emotional intelligence in a healthcare context.

Emotional intelligence has four components: self-awareness, social awareness, self-management and relationship management. EQ is the ability to perceive, evaluate, understand, respond to and influence emotions. 

Having spent many hours in offering negotiation training to residents and medical students over the past four years, I have seen first hand how often these latter four components are missing. Even in classroom simulation exercises, I've seen anger and its close ego-driven relatives--stubbornness, aggressiveness, and passive aggressiveness--employed as negotiation strategies.

More sadly, while working in the medical field, I found myself mediating and moderating such behavior among highly experienced attending physicians.

Linda Pololi, in Changing the Culture of Academic Medicine, explores the environment in medical schools and finds precursor behavior among the faculty that likely influences medical students, to wit, "feelings of dehumanization [and] erosion of trust . . . within an environment where competitive individualism was rewarded and collaboration undervalued."  If their teachers present such an example, is there any wonder why young doctors carry it along through residency and beyond?

But there is hope. As educators we can create a safe learning environment to help young professionals develop aspects of self-awareness, social awareness, self-management and relationship management.

Here's a story from two students who learned some key lessons during a simple negotiation game in one of my classes at Telluride. Derek summarizes what he learned: "The frantic pace of a situation [can] overwhelm you into making irrational decisions.  Once we’ve jumped to a diagnosis, and confidently shared it with others, we are too prone to cling to it beyond rationality. Our ego gets in the way of us re-evaluating, asking what we may have missed, and being open to different opinions."

Note, too, Sam's comment: "I’m not going to lie – my ego still stings a little bit, but what a great lesson, and what a good way to learn it. I hope that stings stays with me so that I don’t make the same mistake again when it matters, when it can affect a patient."

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