Be Nice or Leave! Manners Matter in Medicine

In the early 2000s, we noted that working in healthcare seemed analogous to standing in the middle of a congested intersection and dodging traffic throughout your shift. Many would say that things have worsened progressively over the past 20-plus years. The wear and tear that come with working in a toxic environment has brought thousands of physicians to our doorstep in search of resilience training, which many interpreted to mean "learning how to bleed less." This was not our intention! "Bleeding less" is not the same as resilience. Simply teaching health professionals endurance strategies borders on blaming the victim. The implication is that the medical professional and his or her family should be impervious to their extraordinarily stressful circumstances. Hard-wiring physician resilience will require ongoing revamping of the healthcare workplace. Put another way, healthcare leaders must find creative ways to "redirect the traffic," to make the work of medicine more doable.

In the Meantime...Culture Matters

You may have limited immediate influence on the structural aspects of your workplace (eg, your productivity expectations, EMR system, team composition, physical facility). But you do have considerable power to shape a crucial ingredient in your overall formula for well-being: your workplace emotional culture. Culture is shaped by what you say to each other, about each other, and about your organization. And make no mistake: Your workplace emotional culture (ie, how it feels to work here) matters — much! In fact, our research has shown that the quality of your workplace relationships will be one of the most powerful predictors of your overall career satisfaction, which will correlate robustly with the quality of your family life.

What Are You Spreading and Tolerating?

In The Power of Full Engagement, authors Jim Loehr and Tony Schwartz noted that when it comes to coping energy, you've got four categorical choices. In The Thriving Physician, Gary Simonds and I issued The Resilience Challenge: "Even if they are 90% of your problem, what 10% are you willing to own?" Mix these concepts with the fact that your emotions and attitudes are contagious, and you get two questions regarding your workplace culture that are worth considering:

What are you "spreading" and
What are you tolerating from others?
- Are you contributing to and/or tolerating a high-negative workplace emotional culture characterized by fear, anxiety, anger, defensiveness, resentments, stress, and tension?
- If so, you probably vacillate between that form of misery and low-negative energy and interactions, those that focus on burnout, exhaustion, hopelessness, fatigue, lethargy, sadness, learned helplessness, and hostile dependency.

High-performing teams, on the other hand, are fueled by oscillation between two variants of positive energy/emotion:

High-positive cultures are created and sustained by open displays and discussions of excitement about your work, engagement, invigoration, pride of affiliation, belief in your team, enthusiasm about your day, and moments of joy.
To sustain high performance, these individuals and teams pause regularly to enjoy low-positive energy and emotional states, those moments of calm, peace, pride about the work that has been done thus far, and "rest" before re-engaging, with high-positive renewal.

Take Responsibility

Champion performers at work and home make a discipline out of showing up and fluctuating between high-positive and low-positive energy and attitudes. And they do not tolerate others who "contaminate" their workplace with their low-energy misery and moans.

Taking responsibility for your workplace emotional culture requires two things: intentionality and courage. Be intentional about your attitude and behaviors (ie, "I do have choices about what I focus on today and how I feel about my work, even if the workplace is not a perfect place").

And be brave. Driving accountability in peers regarding their workplace behaviors takes courage. More about this in future blogs. For now, I'll close with the message conveyed on a sign I once saw hanging on the front door of a dive bar on Bourbon Street: "Be nice or leave."

I'm interested in your input and experiences. What do you find to be helpful in shaping positive emotional workplace cultures?

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About Dr Wayne Sotile

For more than 30 years, clinical psychologist Wayne M. Sotile, PhD, has studied resilience and work-life issues for high-performing health professionals. He has authored 10 books, including The Thriving Physician (2018) and Thriving in Healthcare (2019), both with Gary Simonds, MD. Wayne founded the Center for Physician Resilience, in Davidson, North Carolina. A sought-after keynote speaker, Wayne has delivered more than 6000 invited addresses to corporate and medical audiences interested in resilience and optimal performance. For more information, visit his website.

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