One of my favorite residents asked me this as we talked on the phone recently. She wondered how she’d be able to balance all the expectations she herself and everyone else might place on her in the future. It’s a good question, and I’m sure I’ll only scratch the surface of this complex topic. But to be honest, my first reaction was, “Nice? That’s what she’s worried about?” As a physician, she’ll soon be in charge of getting things done, as efficiently and safely as possible. So how is she supposed to manage that degree of responsibility, manage people, and… be nice? Well, it might sound harsh, but being nice isn’t always my highest priority. These are my thoughts on being nice as a boss lady.
While you want to be nice enough in any situation, I strive for polite. As a physician leader, I consider it a good day if my staff and I didn’t offend anyone. That’s because patients are so different, and they’re usually struggling with health issues when I see them. They’re not at their best. Add to that the family dynamics that enter our department, or the expectation that we answer for something that was said or a cancer that was not diagnosed by someone else, even if it was months or years ago. As physicians, we are expected to handle all these situations with as much patience and empathy as possible, at all times. Sometimes it’s relatively easy. Things go smoothly, and the patients are sweet, respectful, and grateful.
Other times, the interpersonal aspect of doctoring can be more demanding. You could find yourself repeating yourself, or rephrasing, hoping for another shot at understanding one another. The work of translating medicine for patients can involve drawing pictures. Or it might be followed by several phone calls to distant relatives around the country, as you realize your patient isn’t sure what you mean, and maybe never will be. This is all part of being nice as a doctor. It is what we do every day, and it’s really just part of the job. All of these personal touches are on top of the core work of actually diagnosing and treating your patients. And most doctors do this for between 50 and 100 hours per week. Compassion fatigue, anyone?
Because of the demands on doctors I mentioned above, it’s incumbent on you to get help from the people around you. It might not seem “nice” asking someone else to do things for you, but as a doctor, delegation isn’t optional- it’s a necessity. If you don’t delegate, you’ll scurry about, spending bandwidth on tasks that could’ve been handled by someone else. And you will still have the doctoring to do. No one can do that but you. There’s a reason they call it a healthcare “team,” and if you’re handling stuff the support staff could handle, there’s an opportunity cost to that.
In a healthcare environment, it’s up to everyone to operate “at the top of their license.” And as the doctor on the team, it’s up to you to ensure everyone else is working in their scope, with an appropriate degree of autonomy. Most people thrive when they have a degree of ownership and independence in their work, and the ability to make their own decisions. When I give more responsibility to technologists, nurses, and schedulers, they’re often eager to learn and help me within their role. When you empower people to do what they’re trained to do, they end up more fulfilled. And, you’ll strengthen your skills as a leader at the same time!
As a byproduct, the more you delegate, the safer and better a doctor you can be. You have more time to double-check those pre-op labs, look up the next patient consult, or work on a hospital safety initiative. And when you delegate well, you’re more likely to have time to enjoy pleasantries with patients and staff, or even FaceTime with your family for a minute! In the end, a doctor who delegates is nicer.
People who take the time to engage in small talk are often seen as nice. But as a busy doctor, you have an agenda. Even if you grew up the person who cared about everyone and everything all the time, it’s hard to maintain that as you take on doctoring and all its accompanying responsibilities. And sometimes, people misunderstand and think you’re less nice when you need to move quickly or get to the point. But it’s not you, it’s the role its attendant responsibilities.
You are there to diagnose and treat, then move on to the next person who needs help. So when there’s less time for small talk, you might run the risk of coming across as less than “nice.” But don’t worry. If you can’t find extra time for hand-holding, sometimes a smile or solid eye contact is enough.
When there’s time, it can be fun to chat with the people around you. This can make work more enjoyable. Side conversations are a great way to deepen rapport with your co-workers, as long as they don’t get in the way of patient care. For some people, it’s a fine line, and as the leader of the team, it can be your job to re-direct people, and remind them of their responsibilities. I might need to call for a dose of IV analgesia in the middle of someone else’s conversation. Is that nice? For the patient, it is.
In another way, in the procedure suite, small talk can be a useful tool. We call it “social anesthesia.” Since we do most of our work with local anesthesia and moderate sedation, a bit of social anesthesia can go a long way to ease a patient’s nerves. A bit of therapeutic distraction by the sedation nurse can help bridge the gap as the sedation takes effect. It can help redirect a patient’s attention from their fear to their happy place, usually some tropical paradise without fluorescent lights. In this way, small talk is a kind act of generosity. It often has a reciprocal effect, putting everyone else in the room at ease. The best nurses do this automatically, but as the boss lady, you can chime in or remind them, as in, “A bit of social anesthesia please!”
The problem with “nice” sometimes, is the expectation that it should always be a priority for women. But when you’re in a healthcare environment, or leading a team, being nice isn’t always the first priority, to be frank. At worst, trying to maintain this standard can be distracting, or even dangerous, when you’re a doctor. People’s health is in your hands, and that comes first.
Long-term, the expectation of “nice” can trap you in an exhausting cycle of people-pleasing. And while pleasing people sounds good, you really can’t please everyone, so you definitely shouldn’t base your success on it. If you do, you’ll always fail somehow! My goals are more realistic. In my most challenging moments, I try to curse as quietly as possible, and I generally avoid anything that could get me fired.
Because of societal expectations, women in power, including female physicians, are still expected to do things men aren’t. They have to bend over backward, manage relationships first, and pad their statements with niceties, or risk social backlash. But it’s too much to ask. And it holds us back, in my opinion. Over time, as people come to know you as a leader, it gets easier. Once you’ve built a track record of doing the right thing for patients every time, people will understand and trust your intentions. They’ll empathize with your frustrations, rather than demonizing you. And hopefully, they’ll understand when you bark an order, it’s to resuscitate a crashing patient, not because you’re a “B- word” (not boss… the other one).
Unfortunately, lady bosses can be called expletives for behavior that would be praise-worthy in a man. When we take charge or heaven forbid, correct someone, people misinterpret this as “she is upset.” I think “upset” is a booby trap for all female leaders. It minimizes and de-legitimizes concerns as emotional rather than rational. So sometimes it helps to clarify, “I wasn’t upset, but I needed to make sure you understood the dose wasn’t documented correctly,” or “I wanted you to call me prior to discharging that patient.”
So from my perspective, as a mid-career physician and department leader, I’d be careful with striving for “nice.” It can distract or deplete you with its demands. Personally, I don’t make it the top priority. Don’t get me wrong, being nice is pleasant… like a luxury. But it’s less likely to save your life than the lady who takes charge and knows her priorities.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.