Emotional Intelligence For Physicians
Some years ago Daniel Goleman popularized the notion of emotional intelligence as the key to success in many areas of business. This has set off a landslide of articles focusing on the notion—both expanding and arguing with some of his statements. He has recently published a new article which represents an updated summary of his views.
He begins by noting many people use narrow definitions of emotional intelligence, such as sociability, sensitivity, or likeability. He suggests emotional intelligence be defined as comprising four domains: self-awareness, self-management, social awareness, and relationship management. Self-management is further sub-divided into emotional self-control, adaptability, achievement orientation, and positive outlooks. Social awareness is sub-divided into empathy and organizational awareness. Relationship management is subdivided into influence, coaching and mentoring, conflict management, teamwork, and inspirational leadership. So how do physicians as a group stack up on these 12 domains?
Most physicians are generally self-aware. We can all think of glaring exceptions, but the process of medical education and learning to be a physician places a great deal of emphasis on our own personal skills (and knowledge.)
Of the four domains in self-management, physicians have to develop emotional self-control. The ability to compartmentalize is necessary to survive and be effective in stressful emergency situations, and all physicians learn to do this. In fact, emotional self-control is so important to physicians, they may cut themselves off from recognition of the role it plays in the therapeutic relationship. Physicians are generally adaptable. Hospital managers might disagree, but all physicians learn to adjust their practices based on local realities, new medical data, and “progress.” True, doctors may be skeptical about what constitutes progress, but this attitude sometimes protects patients from unintended harms. Achievement orientation is a universal attribute—getting into medical school in the first place selects for this trait. On the other hand, positive outlooks are not universal. Most physicians are not positive about the trends in the daily practice of medicine, but most tend to think the therapy they recommend works, even when the odds are low. This is the one aspect of self-management that has not been stressed in medical training and is one of the keys behind organizational efforts to address widespread physician burnout.
Social awareness—empathy and organizational awareness—can be issues. I have addressed the issue of empathy separately. Up until recently, organizational awareness was not considered necessary for physicians or by physicians. I suspect much of the current tension in medical practice is two way—physicians are not generally organizationally aware, and organizations are frequently not aware of what makes physicians different from other groups.
The five domains of relationship management are also less universal for physicians. In most medical organizations, physicians have led through influence and occasionally by inspirational leadership. These are the preferred domains of physician leaders and ones I try to emphasize with notions such as the clinical microsystem. We do less well in the coaching and mentoring category—most physicians are too busy coaching and mentoring patients to have much time to do the same for their colleagues. And their colleagues are often not receptive to efforts to coach or mentor.
This brings us to teamwork. Physicians don’t do formal teams well, but, in fact, use informal teams daily, usually without thinking about it as a team. An attending physician calls in two other physicians as consultants to help management a patient’s illness. All three are part of a team caring for the patient, but may not ever see each other face-to-face during an episode of care. The surgeon who takes a patient to the operating room has a team of people to care for the patient prior to, during, and after surgery, but he may not interact directly with more than a handful of these people during any procedure. When managers think of teams, they imagine a roomful of people interacting directly. When doctors think of teams, they have a much looser definition—and they usually imagine themselves in charge.
Lastly we have conflict management. This is the one most physicians are terrible at handling. So much of what physicians do depends on establishing a cooperative relationship with the patient and family that failure do to so usually provokes a desire to end the relationship for fear of bad results, lawsuits, etc. Since conflict in organizations is inevitable, life in organizations necessarily provokes avoidance behaviors on the part of physicians, even when there is not really a threat. I am not optimistic this competency can be learned by physicians as a group—this is one that is going to have to be dealt with by others.
Years ago I sat on an airplane next to a British anesthetist. We got to comparing war stories and it turns out he, too, had served in the Middle East, in his case during the Suez Crisis in 1957. He said he was having trouble with the Bedouins breaking into the water mains to steal water and in the process creating sanitation issues for him. He tried installing taps to let them take the water they needed, but this did not work, so he made an appointment with the Regimental Commanding Officer. He reported his problem to the Colonel, who listened and then turned to the Regimental Sergeant-Major (RSM) and said: “Sergeant-Major, Doctor has a problem. Do you have a recommendation?”
The RSM replied: “Sir, I’d shoot a couple of the blighters.”
The anesthetist said he must have flinched, because the C. O. said: “Sergeant-Major, I don’t think Doctor wants to do that.”
At which point the RSM said: “Sir, I’ll see to it.”
Medical organizations are going to need people to “see to it” if doctors are going to be emotionally intelligent leaders, as they are going to find it difficult to do themselves.
27 February 2017
 Goleman, Daniel. Emotional Intelligence: Why It Can Matter More Than IQ. (New York: Bantam Books, 1995.)
 Goleman D, Boyatzis RE. Emotional Intelligence Has 12 Elements: Which Do You Need to Work On? Harvard Business Review, 6 February 2017. Accessed 6 February 2017 at https://hbr.org/2017/02/emotional-intelligence-has-12-elements-which-do-you-need-to-work-on.
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