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Right those wrong first impressions

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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.
Ronnie Garner, MD Medical Director of the Presbyterian Infusion Center in Albuquerque, New Mexico.

Ronnie Garner, MD Medical Director of the Presbyterian Infusion Center in Albuquerque, New Mexico.

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.”

Take time to assess your work environment

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 the bad first impression was unfair or resulted from circumstances beyond your control, you still need to conduct yourself professionally at all times. Think about the impression you want to create.

“If I were being videotaped right now and they were going to use me in medical school as an example of how to deal with challenges in my intern program, how would I want to present myself?” Rowe says. “You don’t want to sulk. You don’t want to run around and tell everyone how you’ve been mistreated. You don’t want to say you are broken down with lack of confidence.”

Above all, Rowe says, having staff at all levels enmeshed in hurt feelings and “wrongs” in the workplace ultimately may result in the patient being deprived of the best care possible.

“Rather than putting the focus on you, you may need to get outside of that and put it on the patient,” Rowe says. Even disciplined physicians, however – who do everything they can to maintain professionalism and focus in the workplace – can still inadvertently make a bad first impression on patients.

Fixing bad first impressions with patients

When dealing with patients, Columbia, South Carolina, psychologist and executive coach Bonnie Montgomery, PhD, says prevention may be the most effective way for physicians to avoid unfavorable first impressions.
“It’s all about communicating and taking responsibility for what one does, even if the patient does not always have the capability,” Montgomery says.
She recommends these steps to help mitigate or avoid unfavorable first impressions with patients:
• Strive to be present for the patient, beyond personal feelings of tiredness or stress.
• Be emotionally intelligent, in that you make thoughtful overtures to achieve empathy.
• Take responsibility if a bad first impression has been made. If the patient misunderstands something that was said or done, take the time to explain your original intent or wording.
“Getting well can be significantly affected by the doctor-patient relationship—whether or not the patient is going to follow the doctor’s advice or follow through with procedures,” Montgomery says. “If something has gone off track, pretending that there is no problem is not going to get it back on track.”
After an unfavorable first impression of one physician, some patients may announce that they want to switch to another doctor within the medical practice. If so, should the physician try to win back the patient?

There is disagreement on this point. One physician who says letting things go is better is Dr. Kevin Pho of Nashua, New Hampshire. Pho is an internal medicine specialist and also writes a blog. According to Pho, in certain cases, it may be best simply to find a good patient-physician fit rather than attempt to try changing the patient’s unfavorable first impression.
Pho says he has experienced the situation both ways—patients who preferred his personal punctual style and patients who did not.
“There are a wide variety of physician practice styles,” Pho says. “Some physicians stay on schedule and stay on time. In order to do so, they may not be able to spend as much time as they would like with a patient. Other physicians may spend endless amounts of time with patients but stay off schedule.”
Patients are equally different. Some people are very busy themselves and want to get into and out of the doctor’s office as quickly as possible. These types of patients hate to be kept waiting and thus appreciate a doctor who sticks to a schedule and appointed time. But others don’t mind waiting as long as they receive more time with the doctor when it is their turn, Pho says.
“When it comes to conflict, communication really is the key,” Pho says.
Pho says studies show that immediate first impressions of the physician often define an entire relationship with patients.
“Physician attire and professional appearance are all very, very important,” he says. “In a relationship, it’s much easier to make a good first impression than it is to correct a bad one. Professionalism can be conveyed immediately and makes a lasting impression. Patients who trust a physician with their lives have to have trust.”
But first impressions, even if negative, don’t necessarily have to set the tone for how a relationship will continue, says workplace team builder William Gorden, PhD. Gorden is retired from Ohio’s Kent State University, where he taught 25 years in the school of communication studies.
“All interpersonal relationships are wrapped on trying to think of how another person would react, and to realize that first impressions are never complete,” Gorden says. “It takes time to explore and get to know another person in a more effective way. It usually moves from simple demographics to eventually understanding that person’s character and values.”
 
Marilyn Haddill has been a freelance writer for more than 35 years. For the past 10 years, she has specialized in medical writing with an emphasis on eye care and vision correction. She currently is the editor of All About Vision, which provides eye care information for consumers.
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Marilyn Haddrill

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