I use a coach myself and strongly advocate coaching to improve the performance and well being of my own staff so I guess you could say that I am a convert. Having said that I am but a recent one. It would not have occurred to me to use such a service as a doctor - indeed the thought, let alone the subject, never arose during the clinical phase of my career. In retrospect this probably says something about the medical profession and their opinion or even awareness of such 'new management' ideas.
Firstly - a quick definition. Coaching (if done correctly) is a very specific skill that differs from other forms of teaching. Rather than traditional didactic and rote learning methods familiar to anyone that has survived medical school, coaching is about observation, judgement and guidance. The key is objectivity - the ability of the coach to see performance from the outside and to help the coachee arrive at their own insights and revelations. Subject expertise is not essential but it helps – it is hard to see how Pavarotti’s voice coach could help Federer with his backhand beyond a certain point.
So, why would doctors, ambitious and perfectionist as they so often are, not see the value in such an approach to performance improvement? I put forward a few explanations which I hope on reading come across as easily surmountable.
Self-reliant Culture - doctors are taught to be self-reliant from the very earliest stages of their academic careers. A herculean work ethic, long hours and constant moving from job to job do little to encourage the idea that a doctor needs or deserves support during their career.
Ego - doctors often see failure as unacceptable and shameful - coaching taps into the heart of this fear and exposure can seem like a genuine threat to the ego.
Insight - doctors often lead sheltered lives. From high school to the top of their profession they are cocooned in the world of healthcare and can go the whole way largely unchallenged by those around them. It takes a major shift in paradigm for a senior clinician to suddenly invite feedback and criticism, however constructive it might be.
Management Style - doctors, sadly, still seem to miss out on much of what contemporary HR best practice has to offer. Structured feedback for doctors seems to be the exception rather than the rule, except when it comes to scrutiny of their clinical outcome metrics - good to know what you should have achieved but some help in getting there would be useful. Furthermore, there is often a perception that feedback is for under-performers rather than for those at the top of their game.
Professional Risk - doctors are increasingly guarded about exposure to medico-legal risk and could be concerned that their coach’s notes might look somewhat similar to a prosecution lawyers in cases where things go wrong. Who knows who, or what, can be subpoenaed in those circumstances?
Invincibility - doctors usually see themselves as helping others but not necessarily in need of outside help themselves. It seems that when a doctor gets 'help' it is often thrust upon them by an employer or medical registration body. The idea, of course, that doctors never need support is belied by the alarming incidence of depression, alcoholism and suicide in the profession.
Time - doctors are notoriously time-poor and coaching may be seen as another demand on this precious commodity. Of course it all comes down to priority - perhaps nine holes instead of eighteen?
Whatever the reason it is clear that the use of a coach for the purpose of improving clinical skills is still not common practice. Perhaps it is just a matter of time before it becomes a widely accepted idea with the medical profession. I was certainly encouraged by Gawande’s personal and very detailed account of how a coach helped him improve his operative skills and I strongly recommend that you read it - if only because, in typical New Yorker fashion, the cartoons are funny.
Dr John Bethell
Director, Wavelength International
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