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Right–Those Wrong First
Impressions
When you’ve gotten off on the wrong foot—whether with a supervisor, a co-worker, or a patient, it’s both important and possible to get the relationship back on track. Simple steps to patching things up and moving forward.  

By marilyn haddrill     Unique Opportunities  July/August 2008
Early in his medical career, pathologist Ronnie Garner, MD, was working at a medical facility where he observed blood bank procedures that he was convinced needed to be changed immediately.
Garner, Ronnie, MD
But instead of welcoming Garner’s well-intentioned suggestions, the manager of the facility seemed to feel threatened and reacted badly.
Now with the insights gained from years of experience—including as a supervisor—Garner realizes the situation could have been handled far differently, not only to correct any unfavorable first impressions, but to avoid them in the first place.
“When you go into a new job, you don’t make random changes,” says Garner, who is the medical director of the Presbyterian Infusion Center in Albuquerque, New Mexico. “You learn the personnel. They learn you. You get trust.”
Garner says he should have waited about six months to take time and assess the work environment. Then he could have asked the manager for opinions related to any proposed changes. The idea, he says, is to enlist support from others—not alienate them by implying that their way of doing things is inferior.
“When you first come out of training, this may be a mistake that all physicians make,” Garner says. “I had been at some of the top places in the country, and I probably was very cocky about what I knew. I should have understood that there is such a thing as tradition.”

Awareness is key
Medical office environments, in fact, can be a prime source of festering employee unhappiness that can even carry over into patient relationships, says Tina Rowe of Denver. Rowe is a trainer and consultant in organizational and professional management who also provides internet counseling at www.workplacedoctors.com.
Rowe describes the physician stereotype of someone strictly focused on the clinical aspects of the practice, while perhaps lacking interpersonal and leadership skills. Unfortunately, this personality type is the very one likely to make a bad first impression on colleagues, supervisors, and patients alike.
“As a new physician, you have a real opportunity to be different from that stereotype,” Rowe says. “To start things out right, be aware of your impact.”
Rowe recommends combining confidence with humility. Be a strong physical presence and be direct, she says, but also convey the idea that you still have a lot to learn, and that you are open to those new learning experiences.
First impressions can occur within seconds. One study found that the impressions interviewers had of job applicants within 30 seconds matched those of interviewers who spent 20 minutes talking to the same individuals.
“It takes 30 seconds to make a reputation and the rest of your career to live it down,” Rowe says.
If a bad first impression has been made, Rowe says it is possible to correct if you talk openly about what happened and work at resolving any lingering issues. Even if you feel
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Ronnie Garner MD, Medical Director of the Presbyterian Infusion Center in Albuquerque, New Mexico.   ©Eric Swanson
three scenarios – 
How would you handle
these workplace conflicts?  

Scenario One:     Physician – Patient
Dr. Waters meets for the first time with a new patient, a 52-year-old woman named Sarah. He is still laughing about a joke he just heard. He repeats the joke to the nurse just as he is getting ready to examine Sarah. But instead of laughing with them, Sarah seems hostile. After examining Sarah, Dr. Waters finds out that his patient is in a lot of pain. The doctor realizes he has made a bad first impression only when he hears Sarah makes an unflattering remark about him as he leaves the room.
Garner: You have to plan to spend more time with the patient, and make every effort to listen so that the patient knows the focus is on them and not you. Spend time to build the relationship. That by itself will hopefully negate any initial first impression. Once you have the sense that there is some hesitancy on the part of the patient, you have to relax and get the patient to relax.
Because my patients are usually very sick and very complex, I use a certain amount of humor not directed at them but directed at the situation to try to get them to relax. If the patient relaxes and trusts me, they will give me the information I need to make the diagnosis. Patients will always tell you if you listen. The problem is that physicians are always stressed for time. If the patient senses that you are interested in them and what they are trying to tell you, then you will have a rapport and a relationship.
Montgomery: My suggestion would be that the physician call the patient and say: “I want to discuss the session with you. I want to apologize. I didn’t handle the situation as I wish I had. I would like for you to revisit so that we can get off to a better start.”
The physician should take responsibility for his or her behavior and give the patient a chance to speak.
Rowe: Be aware of your impact. If you had any discernment at all or if you cared at all, you would have picked up on the fact that the patient was offended or irritated. It shows self absorption when a physician is more impressed with what he is doing rather than what I [as the patient] am doing. The best way to rebuild a relationship is to act like you care.
Gorden: I assume he would be meeting with the patient for a second occasion. Even before that, if he feels he has made a bad impression, he might write a note and...pledge his commitment to give the best service possible. I don’t know that he should mention having left a bad impression.
Pho: First off, have the patient explain what is bothering them and why they are offended. Get the story from the patient’s point-of-view. Listening to them is really the key. An apology may be in order.
There has to be a certain comfort level before you make jokes or light conversation. This comes with experience and learning who the patients are. There is a wide spectrum of patient personalities, and you have to adapt the encounter to each one.

Scenario Two:     Physician – Colleague
Dr. Tyler has just been hired at a medical facility, where he hasn’t had the chance yet to meet one of his colleagues who was on a three-week vacation. During that time, a few of his colleague’s patients have liked the new young Dr. Tyler so much that they decide to switch permanently to him. The receptionist, meanwhile, makes a few snide remarks to Dr. Tyler about “stealing” patients. After the colleague returns from vacation, he walks through the back entrance just in time to hear Dr. Tyler make an insulting remark about the receptionist. This is when Dr. Tyler learns that the receptionist just happens to be the colleague’s beloved niece. Later, Dr. Tyler hears through the grapevine that his colleague is upset about the “poached” patients.
Rowe: First, I think we ought to live our lives as though people are overhearing us. That would probably keep most of us straightened out. When we feel sensitive and awkward about something, we tend to not talk about it. But we need to get it right out there that this has happened, even if someone feels resentful or irritated or frustrated. Just get it out  in the open. It makes everything so much better.
Pho: The most important thing is the patient. Unfortunately, the patient’s choice is much more important than hurt feelings from the colleague.


Gorden: If you wanted to try and do this in a direct way, you would ask for a time to talk this over with them. Ask them if, indeed, they do feel ill will toward you. Acknowledge that these things did occur. I’m not sure that you can always remedy something like this. But you can always apologize.
Garner: My approach is to immediately start asking input from the other physician. The biggest mistake I used to make and that I see other people make is going and giving your opinion. That’s the worst thing you can do. Just say: “What do you think about this?”
Montgomery: Act professionally. Your first criterion is to manage yourself and manage your own reactions. Think something through before you just blurt it out. But it’s important for the physician to try to discuss what happened.
If the patient wants to switch, maybe go to the colleague and talk about what the policy will be and how to handle it. What is your feeling? Are you comfortable with this? Ask the patient to talk to the physician [colleague] first.
I’m big on dealing with things as they come up, rather than just letting them lie and fester. You need to have crucial conversations up front before there’s a huge backlog of resentment.

Scenario Three:     Physician – Supervisor
In her final rotation as a resident, Dr. Castillo is looking forward to finishing her training. The new attending is a stickler for punctuality and still a believer in the “old-boy network” of medicine of yesteryear. Dr Castillo was up all night with her sick baby and overslept by 30 minutes. She arrives late for rounds, only to suffer the attending physician’s wrath about being late AND a crack about how females can’t be counted on to be reliable physicians, once they have children. Now what?
Gorden: Not to inquire about something first, and instead criticize, sounds like a mistake. So often, those who are in charge of something and those who aren’t don’t talk about the rules of talk and about what should and shouldn’t be said. There needs to be an understanding about those rules, but also with the understanding that there also needs to be some flexibility.
She should say: “Your criticism about my irresponsibility certainly is [understood], and I don’t want to be defensive about it. But I hope we can have a clear understanding about any events like this in the future. If I didn’t call, I should have called to alert you to the problem. If I’m going to be late in the future, I will try to do that.”
Montgomery: First off, she should cool down and give herself perhaps 24 hours. I’m sure with that kind of attack, she will be in a reactive mode. And when we are reactive, we literally can’t think straight. It’s like we go off line in terms of being able to think clearly and manage ourselves.
She should think about what she wants to say, and then address the problem. It’s important to stand up for yourself and be assertive. Say that you are uncomfortable with the way you were addressed and uncomfortable with the way you were handled, and that you do not appreciate being attacked. Say: “I do want you to know I’m not willing to be treated this way.”
Also, if there is someone available that she can seek advice from—such as another attending—she can ask: “How should I handle this? What is your recommendation?”
It’s always helpful to get another perspective. The bottom line is that this is not the kind of thing that should be let go. She should gather her thoughts and approach the supervisor in a collaborative rather than adversarial way.
Garner: Don’t immediately respond back. Say nothing, and then make an appointment later to talk about it in private. Say: “I understand your viewpoint, but do you mind telling me this [sort of thing] in private? Then I could have told you I had serious family problems with a sick baby.”
Do not create an argument or elevate contention by going back and forth.
Rowe: People doing training sometimes feel that part of their job is make life a living hell for trainees. I don’t agree with that, but it seems to be part of the culture.
I’ve gone through that as a trainee, and I take it as a chance to rebuild in such a way that the supervisor later has to say: “I was wrong about her.” Make yourself the model for how people are supposed to act.
Pho: This is a fairly common scenario, as you can imagine. Any individual problems or individual issues should be communicated to the supervisor to see if they can be resolved. Again, communication is the key. If the supervisor is not empathetic or makes inappropriate comments, then most residency programs have ways to deal with this.
She should communicate about problems to see if they can be solved and [relate] concerns about inappropriate comments. After going to the supervisor, then she should see some type of physician support service. The bottom line, really, is that no one should just “take it.” This definitely needs to be addressed.  ~