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Up front and personal.

There are many formal approaches to sharing one's personal self with one's business colleagues. One is through memos distributed from time to time to colleagues. Another is through the use of retreats set up specifically for the purpose of sharing oneself and removing barriers to communication. Finally, the peer-performance appraisal may be a very valuable tool for sharing. While this article will focus on personal sharing in a group of practicing emergency physicians, these ideas can be applied to any organisation.

How we share of ourselves affects our efficancy and our effectiveness. When we are aware of others' values, goals, dreams, sense of purpose, and problems, we have a more commonk basis upon which to bond with them. We are often faced with a colleague who makes decisions that we might not understand. We find it very easy to make judgments about that individual, why he or she made that choice. We may take it a crucial step further and make a judgment about the character of the individual. When one understands the basis behind the decision, even though it may run contrary to one's own thinking, one is less likely to make a value judgment about the individual. One is therefore more likely to maintain a collaborative relationship with that individual. In the long run, this open approach is probably the best one to take in managing organizations, particularly closely held ones.

At Idaho Emergency Physicians (IEP), we perform work on shifts that are scheduled in a geometric progression through the month such that any one individual is always passing the same individuals on changes of shift. Furthermore, we generally work solo in the emergency department. While we see one another at the change of shift, that time is frequently busy and stressful. The off-going physician is tired and wants to leave. The on-coming physician usually feels a sense of anxiety and stress because the department may be busy and he or she must rapidly review all the patients and any medical issues at hand rather than socializing with his or her colleagues.

Numerous meetings punctuate the schedule of the emergency physician. A monthly emergency services meeting is held at one hospital; there is a monthly corporate board meeting of IEP; and there is an IEP quarterly staff meeting for nonboard members. Individuals not on the board of directors do not receive automatic shift coverage for attending any of these meetings; unless one is off-shift, attendance may not be possible. Board meeting are scheduled such that board members can attend more easily, although nonboard members are invited.

Individuals with IEP tend to socialize outside of the group functions, based on common social values, comforts, age, and family size and composition. This is a rather selective process. Further, as individuals change and mature, personal values and family and social circumstances change and there is frequently a very definite reexamination of one's personal goals and values. This phenomenon has been well discussed by Levinson, * who spends a large portion of his writing on the mid-life transition within individuals. He describes several sets of polarities that need resolution at mid-life, including (1) youth vs. age, (2) destruction vs. creation, (3) masculinity vs, femininity, and (4) attachment vs. separateness. All of these polarities exist during the entire life cycle and can never be fully resolved, but they seem to operate at the mid-life phase with a special force. All of this leads to a redefinition of the individual with respect to himself and his group, and a potential for distancing certainly exists. There is increased potential for conflict and a potential for the group to lose participation and attendance of individuals who have been with the organization the longest.

Organizational values tend to parallel the values of individuals drawn into the organization. Physicians have a very hard time looking at themselves in terms of personal issues and genuinely sharing personal matters with others. The commonality that most of us have can lead to bonding, but this may well be ineffective in physicians. Many underlying mechanisms have been theorized for these behaviors. Physicians are socialized in a very rigorous environment, through medical school and internship, where they are taught to be independent. They are taught that they can control their environment and can have outcomes that are predictable and based on their own abilities. In many ways, physicians are set up for failures in the overall social system because of some very unrealistic self-expectations. In addition, physicians tend to have high standards for themselves and others; are often dominant, verbal, and perfectionistic; and tend to be nonpsychological in relationships with both peers and subordinates. They have very strong needs for attention, achievement, and approval.

It may be forgotten that personal support systems--people in the work situation who are friends, allies, advisors, and mentors--are needed by everyone. A lack of social support for the professional person is a major stress, particularly in medical practice. The most obvious example of stress and isolation carried to a maximum degree is burn-out. Symptoms include decline in performance, decreased commitment to professional and organizational goals, and a feeling of failure.

Another source of stress for independent professionals relates to the lack of regular performance appraisal. Many physicians do not have or do not create opportunities for evaluation and discussion of their work. They not only lose chances to correct and improve their performance, but, just as important, they miss praise and support for the high quality and dedication so often shown in their work. Closely related to this is another symptom of burn-out: Work becomes experienced as "routine." According to Jerry Johnson, MPA, a member of the faculty at the Menninger Center for Applied Behavioral Sciences, Topeka, Kan., there are three characteristics of professional burnout: (1) A personality type characterized as having excess expectations and very perfectionist ideals; (2) one or more related stressors, such as too much work, unclear communications, etc.; and (3) lack of a collegial support system, with no opportunity to ventilate, conspire, and test reality with others. Thus, there are some very important reasons to socialize and support one another, along with performing appraisals of individual performance within the practice of medicine.

I suggest that a balance of three approaches be implemented for improving sharing communications:

* Personal memos.

* Performance appraisals.

* Day-long meeting retreats.

The personal memo has some definite advantages. It can be dictated easily by any physician using current office telephone communications systems. An example of one I have used is shown in the photo on page 33. To date, feedback on memos has been positive.

The performance appraisal is a valuable tool. It should be done regularly and openly and should address not only issues of patient care but also some of the softer issues, such as communication and participation. This process has been avoided in physician groups because physicians find it difficult to be confrontational with one another. They also find it hard to separate actual behaviors (performance) from personalities. Appraisals should occur at least yearly for all group members.

A retreat is more complex. A proposal should be developed and presented to the entire group, suggesting development/improvement/implementation of a program to increase support, collegiality, and communications among the members of the group. This is necessary to fully enlist group support through what may be a very difficult and somewhat uncomfortable approach initially to sharing ideas and feelings. A professional, such as a counselor or psychologist, can assist in the development and implementation of this program. An agenda would be developed, ground rules would be agreed to, and a comfortable facility with adequate refreshments would be obtained.

This program should probably be repeated every 6 to 12 months on a regular basis with a similar agenda and professional assistance. One might well consider having a session involving physicians and spouses, although this could add another degree of complexity to an already complex problem. Nonetheless, it should not be automatically dismissed at the outset for reasons of difficulty or inappropriateness.

There are some significant reasons why physicians in a medical practice tend to have difficulties with one another and some of the reasons are definitely psychological. The persistent stress designed into our systems essentially sets up physicians for problems. I believe that many of these stresses can be handled early on and that, through programs of mutual sharing and support along with honest confrontation over issues of performance and behavior, long-term effectiveness can be improved and levels of happiness and satisfaction may well be increased.

* Levinson, D. The Seasons of a Man's Life. New York, N.Y.: Ballantine Books, 1978.

Lawrence Vickman, MD, is an emergency physician practicing in Boise, Idaho. This paper on which this article is based was written as a required assignment for Organizational Theory, a class in the Executive Masters in Health Administration Program at the University of Colorado, Denver.
COPYRIGHT 1991 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:personal communication in a professional group
Author:Vickman, Lawrence
Publication:Physician Executive
Date:Jul 1, 1991
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