Hearing feedback can sometimes be painful, but it is always useful, says Professor Michael Fasher
Hearing feedback can sometimes be painful, but it is always useful
I am not wise. But I am wiser than I was yesterday, wiser than last week and last month. That is thanks to feedback.
But in singing the praises of feedback, it is easy to gloss over the fact that it can be painful.
When we encourage young colleagues to become teachers, we usually don’t ask for informed consent; we don’t tell them the journey may involve pain, and even some humiliation.
I regularly give a talk about febrile pre-schoolers going to the doctor. These days it is always received well by medical students, registrars or peers.
Less-experienced colleagues hear the applause and some of them wonder why they can’t extract the same warmth from the same audience.
What they don’t see is that it took decades to get that talk into a shape that is now reliably successful. Feedback over decades has often been negative and not easy to hear.
Jerry Seinfeld understands this. After finishing his TV series, he prepared a solo stand-up show. Once the new show was drafted, he took it around the backblocks of America for a year.
So he had a lot of feedback before “opening” on Broadway. By opening night, he had perfected each pause … he knew exactly when and how long his audience would laugh. The critics in New York praised his “natural” talent.
Negative feedback
A long time ago I was seeing my last patient for the morning, a new patient. This child and her parents had been kept waiting. I was running late for a tutorial at the hospital, so my medical students were also waiting. But the consult seemed to go well. I dashed off to my tutorial.
Several weeks later, I received a closely typed three-page letter of complaint from the parents – the father was a solicitor and the mother a health academic.
The letter was scarifying and personal. It included passages such as, “you think you are so superior sitting over there in your bow tie”.
As I said, hearing feedback is not always easy.
After quite a lot of thinking, I wrote a letter in response. I apologised for the fact that the consultation had not met their needs. I thanked them for taking the time and trouble to write. I wrote that without their feedback I would have missed the opportunity to improve – improvement that was clearly needed.
It dawned on me that my behaviour and body language during that consultation had been affected by my pre-occupation with the impending tutorial and the fact that I was running late.
Those parents had no idea that there was a tutorial or that I was anxious about it. So, they had no option but to mind-read and I reckon that they read my body language and behaviour as disrespectful.
Since then, if I have something on my mind that is not central to the patient’s concerns I declare it. I might say, “I’ve just got this rotten headache, please excuse me if I seem to lose focus”, or “I’m really worried about a patient I saw earlier today, forgive me if I seem distracted”, or “I’ve got to be on a plane to the Gold Coast in two hours …”
The angry feedback in that letter opened my eyes and improved my consulting skills. It was a gift.
Ironically, the tutorial that prompted the negative feedback was on communication skills!
Positive feedback
I had just finished a consultation with a young couple who had recently arrived from India. They had come concerned about their baby, who cried a lot. In taking their leave the father said: “Today we have met more than a doctor.”
Fast forward a few weeks, and I was consulting with another mother, with a medical student was sitting in. This mother had been a successful manager, she was used to being in charge – and then she had her first baby. The baby and the family were distressed. Just the set of problems I thought for “a more than doctor”. All seemed to go well.
You’ve guessed it! Some days later the practice manager told me that the mother had rung to complain about the consultation. Among several complaints was that Dr Fasher had been theatrical and “over the top” in addressing the issue of attaching the baby to the breast.
I discussed this feedback with the student: he thought the consultation had gone well. Critical reflection led me to several conclusions.
The delightful feedback from the Indian dad had seeped into my subconscious.
At some level I now believed I was “a more than doctor”. Over-confidence and arrogance is a perfect precondition for failing in the patient-centred clinical method.
As well, my “over-the-top theatricality” was likely to have been me showing off my consulting skills to the student rather than being totally available to this mother.
A few days later, I overcame my reluctance and called the mother. I said something like: “Thank you so much for the feedback. I am sorry I was not helpful. I am so grateful that you rang, without that I would not have a reason to work on the improvements that are clearly needed.”
She responded with something like: “Thank you so much for ringing. I believe in feedback. I’m happy it has been useful.”
The cortex and the primitive brain
Let us consider a different kind of feedback.
I ducked into the treatment room, with the same medical student. The practice nurse was checking a baby’s growth and development prior to routine vaccination. The mother was explaining she had a commitment to almond milk, and feared the hormones in soymilk. My primitive brain heard this, and in less than a trillionth of a millisecond it triggered irritable body language.
Thankfully, my cerebral cortex noted this and took control. Thanks to my cortical activity, calm and empathy prevailed.
Delayed feedback
Earlier this year, I performed an external clinical visit that in my mind went really well. I was confirmed in that judgement by a happy conversation with the registrar when I ran into her at a local café.
You guessed it! A month or so later, the practice principal drew me aside and told me the registrar had found the experience totally overwhelming. I had made her run late … she had found it all too much.
Since then I have been careful to rein-in my enthusiasm. I cultivate being quiet, and in the moment. Subsequent registrars have benefited from this feedback, delayed and fortuitous as it was.
Ian Corliss, a senior manager at WentWest, has a collection of pithy and instructive stories. So let me conclude with one of them.
A professor was part of a departmental meeting at which student feedback was being discussed. On discovering the feedback was critical of his lectures, the professor stormed out raging: “I am not going to be judged by a bunch of undergraduates … and anyway, I’m sick of hearing the same feedback year in, year out.”
This is a summary of a talk delivered by Professor Fasher at the recent GPTEC 2016 at The Gold Coast
