Physician Health

Why physicians should ask their health care colleagues for feedback

Sara Berg, MS , News Editor

When was the last time you actively sought feedback from someone who is regularly affected by your leadership or work? It’s probably been a while, especially with everyone being in a survival mode for the past year, said Mark Greenawald, MD, during an AMA webinar on seeking feedback. But it’s hard, he noted, for physicians to recognize their impact on others without regular, useful feedback.  

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“As leaders, part of our responsibility is to say, ‘How do I make sure that I'm understanding as many perspectives as possible, particularly for those people who were impacted by my leadership?’” said Dr. Greenawald. “We too often have a gap between the reality of what’s really going on for those impacted by our leadership and the perception of what we think is going on and often that’s because we’re living in a feedback vacuum.”   

“The purpose of seeking feedback is for improved performance, so we need for it to be personal. It’s up to us to decide what to do with it and to process emotions that are elicited as we look to close the gaps between where we are and where we want to be or where they would like for us to be,” he added. “People are hesitant to give substantive feedback to us when we ask for the same that we are often hesitant to provide it for others—because, as the messenger, they don’t want to metaphorically be killed.” 

“Yet without that feedback, we can never know if we’re really on target with the impact that we want to have,” said Dr. Greenawald. “We have to create conditions that make it feel safe for others to provide such feedback without fear of retribution or of being the target of our reactive emotions.” 

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To seek such feedback, “the first thing I do is thoughtfully plan, and this is perhaps the most overlooked part of feedback,” he said, adding that “when seeking feedback, the more you can answer the who, what, why, when, where and how of your intentions prior to approaching someone, the greater the likelihood that you will be able to create psychological safety for them to provide useful information.”    

Part of that planning is recognizing “that there’s certain people who are going to be able to give me better information than others, and I need to make sure that I’m mining those people who would have the best information to be able to help me,” said Dr. Greenawald. 

After planning, comes implementation of the mnemonic IACT, which Dr. Greenawald recommends following when seeking feedback as it provides structure and “boundaries” for the process:  It stands for: 

  • Invite someone to share feedback. 
  • Attend to what they have to say. Listen carefully.   
  • Clarify what was said without becoming defensive or challenging their perspective 
  • Thank the person for sharing. 

Here’s more detail on each element of the IACT mnemonic for seeking feedback. 

“That passive model of the open-door policy—for most people doesn’t work,” said Dr. Greenawald. Instead, “I need to go out and take an active role to seek the feedback that I need.” 

It is important to know “that there are some things that I’m likely going to hear that are not familiar to me,” he said, adding that “this will happen, particularly if you have people in your life who you’ve never really asked for feedback from before.” 

“Feedback should be—at its best—very personal because it should be very unique to you,” said Dr. Greenawald. “Unfortunately, because it is personal, it can make us feel vulnerable or exposed, and that can often cause our amygdala to start firing.”   

“That’s the equivalent of you having an emotional explosion,” he added, noting that “whether that’s your fight, flight or flee reaction, we internally—or sometimes externally—freak out, and that’s not helpful.” 

If a person does react emotionally and become defensive or challenging,  “you have now shut that person down and the feedback that you’re going to get is going to be very minimal and they’re not coming back again,” said Dr. Greenawald, adding that to prevent that from happening, it is important to be open and listen intently and attentively to what they are saying.    

That means “I listen and I resist the one temptation I have,” which is to respond “as soon as they say something that I disagree with, or I think they have the wrong perspective about,” he said. Instead, “I just close my mouth, open my ears and listen.” 

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“When I finally do open my mouth … it's only for one reason: it's to clarify,” said Dr. Greenawald. “And the words that I like to use are words such as, ‘Help me understand this a little bit better.’” 

“I have to be very careful with my tone of voice because I could just as easily say ‘help me understand’ with an angry or annoyed tone and the same words take on a very threatening context,” he said. “Again, as soon as I do that, I'm going to chase that person away and shut them down.” 

The final thing to do is to say thanks, and that is important for two reasons.  

“I thank them, first of all, because it takes great courage to give any kind of feedback to someone,” he said. “And secondly, I thank them because often they’ve given me some very important gems of information.”  

“Now it's my responsibility to go and do something about that” feedback, said Dr. Greenawald. “And I do that by reflecting on the feedback, responding through follow-up and action, and then repeating the I ACT, or I ACTion, cycle again.”  

“Once that cycle starts, particularly when you form a ‘feedback network,’ that’s when the real growth begins,” he said.    

Learn more from the AMA STEPS Forward™ webinar series, which focuses on physician well-being, practice redesign and implementing telehealth during COVID-19.