How To Give Feedback. Or Not.

I saw this article on feedback today and thought I would practice the suggestions here in this blog. Are you with me? Good.



1. When giving feedback it's important to focus on an employee's specific behavior, not the impression you had of it.

"I noticed you didn't read the journal article I chose for journal club this week and as a result, could not effectively contribute to the conversation. I will presume your perceived disinterest is not a reflection of me, but a result of something unrelated to work."



2. Feedback that is generic and vague is also useless. Be specific.

"You could have been more effective as a leader had you put forth the effort to support me in what you know is an undertaking of mine to bring more scholarship into our work as pediatricians."



3. Whenever possible, request to give feedback.

"I'd like to give you some feedback on how your actions, or lack thereof, affect not only my morale but the group's as well, especially when they see a person in a leadership position fail to complete what was billed as a mandatory activity."



4. Preface with the positive. Point out what the employee is doing well before delving into areas for improvement.

"I respect your knowledge and experience and was hoping you would bring some purposeful, focused advice to enhance our level of comfort in analyzing and understanding medical literature."



5. Try to look at your employees' work through their eyes and try to understand their approach to their work.

"Tell me, what was your understanding of you asking me to reschedule my journal club a week earlier on short notice because you were going out of town and wanted to be there? My understanding was that you wanted to be there in support and to provide valuable insight and experience. Oh wait, that's why I wanted you to be there. So, thanks for showing up. Maybe next time you could read the article? That way we both win.

Tuesday Morning Quarterback

Coming up on my 6 month anniversary at my new job, I've realized that I am slowly but surely gaining confidence in my clinical judgement. Here's how I know. Last night I admitted a child with a complaint of limping and leg pain. The story was suspicious for infection, hence the reason for admission. However, when the residents examined him his pain was gone and he was well and playing. He's already admitted at this point, it's late at night, and the seed has been planted that this child may have a bone or joint infection that needs to be evaluated. So, I did what any self respecting physician would do. Nothing. I am a firm believer in these two ideas:

1. Don't just do something, stand there.

2. A child will declare themselves when the time is right.

I figured I'd give the child the benefit of observation overnight knowing that time would tell me what I needed to know...whether or not I should pursue a workup. I explained that to the daytime hospitalist this morning, feeling a little bit silly in the light of day that I admitted a child and then did nothing, but she seemed to understand and agree.

I ran into her at the end of the day and asked about the boy. Turns out, he remained well and did not have any leg pain throughout the day so she sent him home. Here's the rub. His labs suggested a high level of inflammation going on but that did not fit the way he looked. This brings me to a third idea I hold dear.

3. Treat the patient, not the lab values.

Unfortunately for her, another physician heard about the case and clearly does not believe in the three ideas I've listed above because he felt that more should have been done and that the child was sent home in error. Despite the fact that he looked like a peach from the minute he arrived on the floor. Then this other physician asked the dreaded "Who staffed this patient last night?!" Now, 6 months ago had I heard this story I would have turned red, my stomach would have dropped and I would not have been able to let that comment go without picking it apart, losing sleep and berating myself for missing something. But today, 6 months later? I just thought, "Huh. That's funny." And let it go. I will not lose sleep over this tonight. I will not let his Tuesday morning quarterbacking make me feel less than. And I will continue to practice by those 3 ideas, because that is what I feel is best for my patients. And I am their doctor.

Plug for PLA

You’ve finished residency and are embarking on your career as a pediatrician. Maybe you are deep into fellowship and enjoying the challenge of academic life. Maybe you are comfortably settled into a group practice and building relationships with your patients and their families. Maybe you are trying to find your passion and traveling around as a locum tenens physician. And maybe, despite feeling accomplished and relieved that you are finally out of training, you ask yourself “What now?”

After finding myself in that exact position in 2007, I came across an advertisement for the Pediatric Leadership Alliance (PLA). At the time, I was struggling with how to make a name for myself in academic pediatrics as a young physician. I was intrigued by the opportunity to network with leaders in the field of pediatrics in such an informal environment and to be able to practice leadership skills in a practical, hands-on format. After attending the PLA, I possessed a renewed sense of confidence and felt part of a larger community of pediatricians who had the same values and drive to succeed. More importantly, I had the tools to channel my energy into a productive and exciting career path.

Over 3,000 pediatric professionals have attended the PLA and 79% of PLA alumni advanced into greater leadership roles within the Academy (including myself!), as well as in hospital, medical association, government and corporate environments following their training. Another PLA session is being offered March 23-25^th, immediately before the Annual Leadership Forum (ALF) at the Schaumburg Renaissance in Schaumburg Illinois. The PLA is specifically designed to provide real-life scenarios in order to practice skills and learn from one’s colleagues. Sessions include “Strategy Development: Charting Your Course” and “Dynamics of Change: Moving People & Culture”. A dynamic keynote speaker, Dr Lewis First, (Editor-in-Chief, Pediatrics) will describe his leadership journey and how leadership skills learned were embedded in advancing into more key roles in the profession of pediatrics. To promote networking among participants, the PLA has dedicated time for casual conversation during the reception, dinner and workshop meals. It was during this “downtime” that I was able to really form relationships with the other participants and facilitators. More than enjoying the company of my colleagues, I was inspired by the different people I met and by the work that they were doing.

In addition to the foundation for leadership formed at the conference, the participants will be encouraged to sustain their development through long term follow up and goal setting. Although a critical component of the workshop, the follow up is entirely personalized and voluntary – the support is provided by the PLA staff and the AAP as a whole but it is up to the individual to follow through on the goals set during the conference. This was the most difficult part for me personally, sustaining the momentum I gained at the PLA, but I was able to refer back to the PLA website and workshop materials including the book The Leadership Challenge by Kouzes and Posner. A full 13 hours of CME credit can be earned by attending this influential conference. Early registration (before Jan 30, 2011) is $395. Housing at the Schaumburg Renaissance is approximately $300 total for both nights. For more information visit www.aap.org/moc/members/PLA/ or email PLA@aap.org.

Please challenge yourself to answer the question “What now?” Consider sharpening your leadership skills with a group who pledges to “enable pediatricians to become effective learners and leaders to advance their profession, and to care and advocate for children”.

My Hero

Let's be honest. There are a lot of topics that I avoid writing about in this blog because I don't believe it is the forum for my political opinions or to inflame anyone else's opinions. However, in light of the weekend's events in Tucson, I must comment. It has been surprisingly hard and very personal to see my hometown splashed all over the news. Glimpsing the sandwich shop my husband I ate at in November in the foreground of footage of the crime scene is surreal. Seeing the hospital where I did both my medical school and residency training as the backdrop for the neurosurgeons' press conferences is chilling. The flowers and candlelit vigils at various spots around town make me ache with sorrow, homesickness and pride, all at once.

However, I can't stop thinking of the little girl, Christina, who lost her life that day. She had just been elected to student council and was thinking about a future in politics. A neighbor thought it would be fun to take her to meet the Congresswoman Gabrielle Giffords. What a gift, for that little girl to have her dreams so supported. Do you remember what it was like to be 9 years old? The world was spread out before you and you had an infinite number of choices, each one more exciting than the next. The only problem was finding enough hours in the day to explore all the things you wanted to explore. When I was young, I wanted to be a writer, so I wrote. Then I wanted to be a lawyer, so I read. Then I wanted to be a doctor, so I went to medical school. I was blessed to have a family who supported those dreams, however lofty they seemed, and made me feel like I could do whatever I wanted. And here I am, tremendously satisfied with the life that I have chosen.

We'll never know if Christina would have gone on to be a successful politician. But, given what I've read of her and her family, I believe she would have gone on to be successful at whatever she chose because her dreams were valued. She is my hero because she died following the thread of a passion without fear of failing. I only wish that was as easy at 35 as it was at 9.

I hope you will honor Christina and all the victims of this vicious attack by pursuing your own thread of passion or by nurturing a child's dreams and allowing them to believe in themselves and the endless possibilities the world has to offer. Rest in Peace.