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Practicing in a large organization requires skills you may not have needed in independent practice.

Fam Pract Manag. 2012;19(1):18-19

Dr. Gillette is a retired family physician and teacher of family medicine in Poland, Ohio, and a former member of the Family Practice Management Board of Editors. Author disclosure: no relevant financial affiliations disclosed.

Stewart Stonewall, MD, a star surgeon, stormed into the OR dressing room, threw his surgical cap and mask in the general direction of the trash container, and sputtered, “Dammit! I told them I'd need a resident to help with that case, but no! Dominie said they all had more important things to do. She's sure Miss High-and-Mighty since they made her residency director. I'm going to go tell Masters a thing or two right now.” Still wearing his scrubs, he headed straight for the office of the hospital's CEO.

“Hi, sweetie,” he said to the CEO's receptionist, “I need to talk to Freddy boy, if he's not too busy counting profits to listen to one of the guys who's keeping this place afloat.”

“Mr. Masters is in a meeting,” she replied coolly, “but I'll tell him you're here.” She picked up the telephone and announced the surgeon's presence.

The CEO was doing paperwork that could have waited, but he chose not to see Dr. Stonewall. For years, he had kept his composure in the face of the surgeon's repeated undiplomatic reminders of how important a busy operating suite was to the hospital's bottom line. Now, with surgeons in oversupply and the surgical facility downsized, he no longer felt obliged to be deferential; there being no bond of mutual respect between them, he saw no reason to listen to Dr. Stonewall at all.

The moral of the story

The story is apocryphal, of course, but for many of us Dr. Stonewall is an all-too-familiar character. His errors are obvious and plenty, and we might even be tempted to think that, as family physicians, we are so people oriented we could never make such mistakes. However, now that family physicians again find themselves moving more and more into contractual and employee relationships with hospitals and other large organizations, understanding and practicing effective interpersonal and communication skills has become crucial to professional success. The age of the lone wolf physician is gone, and trying to do things the old way is an exercise in futility. Success in today's medical arena demands that we work as harmoniously as possible with everyone. Dr. Stonewall, like many physicians today, would do well to consider the following tips for getting along and communicating well within an organization:

Learn to negotiate. Starting an argument will never be as effective as negotiating, even if you dislike a particular individual or do not approve of the way the organization is operating. In the face of disagreement, ask yourself whether you're looking for a fight or truly seeking constructive solutions. The strategies will be different – as will the outcomes. If you really are looking for a fight, don't expect to find solutions as well. Problem-solving in modern institutions must start with common, or at least compatible objectives. Try to understand the problem from the perspective of the other players. Making demands or giving orders to professionals is often counterproductive. It's much more effective to negotiate actions that make sense to all parties and that will be pursued willingly. Pick your battles; some issues are not important enough to justify the cost in terms of personal grief and expenditure of political capital. And never make an enemy needlessly. Don't break any more eggs than your omelet requires.

Go to the right source. One major problem within organizations is that people often address their problems to the wrong person. Sometimes, we ignore the chain of command, going to someone's supervisor when we should have worked it out with the person most directly involved. Or we tell the whole office about our trouble with so-and-so but never try to work things out directly with that person. At other times, we shoot too low, asking for a decision from someone who is not in a position to make it. Going to the wrong source wastes everyone's time and often creates ill feelings.

When you find that you cannot solve a problem on your own, ask yourself, “Who needs to know? Who can make the decision?” Go to that person first. Remember that the right source for a given problem might not be the person with the most authority. The individual with the answers you need may in fact be a clerk, a secretary, or a nurse.

Focus on the individual. People at all levels want to be known and respected. Use their names. Listen to them. Say thank you. Build up people publicly. When you must criticize, do so privately. Assess the people you work with: their personal strengths and weaknesses, mindset, intellectual horizons, ego needs, ambitions, anxieties, trustworthiness, ability to trust, prejudices, and actual and perceived power. Especially when it comes time to negotiate, you will want to understand what the other person's real needs are and what is motivating him or her.

In managing others, a major challenge can be to find ways to get extraordinary performance out of ordinary people. This may involve personal coaching, sending people out for training, restructuring the work, or reassigning individuals to positions that best use their strong points, whatever those may be. Getting rid of non-performers becomes more difficult as organizations grow in size, and it's often wiser to help people succeed than to try to dismiss them. One additional point: If two people in succession fail in a position, look for the problem in the job itself, rather than the individuals assigned to fill it.

Don't forget yourself. While we're on the subject of looking at people's characters, why not take a good, long look at your own? You need to develop strengths that will help you function effectively in an organization: reliability, respect for others, the ability to keep your mouth closed, patience, perseverance, loyalty to the institution and its leadership, and the ability to keep cool under pressure.

Successful people are trained – or learn through experience – to be very selective in letting their feelings show. If you do something that gives offense, however unintentionally, the other party may conceal the hurt for now but find a way to get revenge later. This puts a premium on two skills: not giving offense in the first place and being able to detect subtle clues that it has happened in order to defuse the situation. Conversely, learn to keep your own feelings in check. Don't return anger for anger. Give priority to understanding the reasons for the other person's actions, and also to resolving the issue in ways that minimize pain at the present time and open the way to better interaction in the future.

Be constructive and useful. The boss wants solutions, not problems. When you must present a problem, try to offer two or three possible solutions. And don't try to frighten or intimidate the boss when you present your ideas. Make it easy for others to support you.

Being useful to the institution is a great way to build job security, whatever that means today. One part of this is learning to understand the organization's vision, missions, problems, and external pressures. In other words, look at the big picture, not just your small corner of it. Ask, “How did we get where we are? Where do we need to go? How will the future be different?” At the same time, don't get lost in retrospection and planning. Explore your ideas, test them (cautiously) against the viewpoints of others, and act on good ideas – get something accomplished!

And finally, don't waste everyone's time. One of the biggest complaints people have about administrators is that they take up everyone's time and get nothing accomplished. Don't model that behavior. Lengthy emails, hours of meetings, and long-winded discussions are seldom effective in solving problems and promoting ideas. If you really want to get your point across clearly, write shorter emails and make your phone calls brief and to the point. Don't call a meeting unless it is absolutely necessary. And when you are in a meeting, don't waste time with chitchat or arguing; stick to the agenda, then get out. If you follow these principles, people may come to expect that you are not going to waste their time when you speak, write, or call, and that you actually have a point they should listen to.

Working within an organization presents special stresses and challenges for physicians, but those who understand how to get along and communicate well with others will have a head start toward success.

Editor's note: To enrich our online archive with some particularly useful “pre-web” articles, we are publishing updated versions of them. This article first appeared in 1997.

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