In movies, villains establish how evil they are by treating their henchmen with disdain. In real life, it is a bad move to abuse someone and then turn your back on them. The same holds true in a medical practice. Think about it.

                 Traditional medical training is built on a foundation of ‘pimping,’ of aggressively getting in the face of your underlings (there’s always someone in the hierarchy below you) and aggressively drilling them with questions until inevitably the answer is not known. When that point is reached, rather than praise for what is known, or a gentle prompt to read more, a harrumph of “these young studs don’t know a thing” is the only response.

                 And those of us trained in this fashion did learn…how to pick on those smaller than us.

                 The modern health-care office is stressful enough. Increased patient loads, new regulations, and reduced staffs have strained many practices to the breaking point. It stands that anything, anything, that can improve efficiency should be employed.

                 So here’s the eye-opener – you can get a lot more effort out of people if you keep them happy, and the easiest way to make them happy is to show honest gratitude for their efforts.

                 Early in the 1900s, behavioral scientists found that if you caused an animal pain it would change its behavior to avoid more of the same. This is negative reinforcement, and our own medical training is full of examples. Edward L. Thorndike, in 1911, found that the power of positive reinforcement is much stronger than the negative. Thorndike’s Law of Effect states simply: “Behavior which is rewarded is likely to be repeated.” Our mama, and perhaps yours too, said something similar: “You can catch more flies with honey than with vinegar.”

                 We are not saying that you should hand out bonuses every time a patient’s file is fetched. What we are saying is that a kind word or acknowledgement gives people confidence in their actions, and confident people work hard. The person you thank today might be the same person who comes in over the weekend to help clear your file, billing, or transcription backlog. Who helps you shift a large patient in bed. Who handles an irate caller.

                 And what are you giving them when you compliment them on good work? Nothing short of their due. Take a moment to think about that.

Have you been displaying an attitude of gratitude to your staff and partners, or have you been accepting their hard work as “your due,” or as “they should be grateful that they have a job at all.” Tsk, Tsk…we’ll need to work on that, won’t we?

THE EXERCISE:

                 Tomorrow, place five dimes (or Monopoly ^TM hotels, or paper clips, or whatever) into the right pocket of your lab coat. As you go through your day, take a moment to look for good work and extra effort. When you see it, be it an office receptionist handling a cranky patient, a nurse soothing or educating, or even a patient exhibiting good behavior, compliment them on their specific action.

                 It doesn’t have to be an ovation or anything. Just note that they did well. It’s even better if said in front of an audience…more bang for your buck that way.

                 Then, surreptitiously, move one of your tokens from your right to your left pocket.

                 The goal of this is to move them all by the end of the day.

                 It will likely prove surprisingly hard the first day…we don’t tend to be as complimentary as we think we are. You should find that this gets easier and easier. If it gets too easy, then go to ten then even fifteen tokens. After fifteen tokens becomes easy, the game is over for now. You see, people have come to expect that you will recognize good behavior; they perform it automatically not for a raise, but for praise. They relish your acknowledgement. As you give out respect, you will find that the world around you gets a little better. Your staff begins to compliment one another, and you’re not even necessary anymore.

                 The neat thing is, with the positive reinforcement of great patient care, negative actions will become more rare as your staff desires to perform well for strokes alone. You’ll get the positive behavior that you were bitching, moaning, and complaining for.

                 Those with real gamesmanship will keep at this exercise, making sure they can get through every day with their five expressions of gratitude. Try it at home as well…spouses and children respond well to recognition and gratitude.

                 And who knows – maybe someone will thank you in return!

Patricia Raymond MD FACP FACG is a Virginia gastroenterologist who takes the personnel hemorrhage in medicine seriously, and herself lightly. Formerly fried by compassion fatigue, and a frankly cranky caregiver, Dr.Raymond writes and speaks on helping physicians and nurses to play nicely in the sandbox of medicine.

Her books, “Don’t Jettison Medicine” and the cult comedy anthology “Colonoscopy: It’ll Crack u Up” are available at www.RxForSanity.com, or you can hear her on streaming audio each Friday from 12-1 EST as she hosts NPR’s Housecalls challenging patients to step up and accept responsibility for their ow