Managing Status in the Medical Community

I once attended a gathering to celebrate the opening of a new, expensive university facility. Since I had been affiliated with the organization for several years, I decided to introduce myself to one of the senior leaders whom I had not met. We spoke briefly, but the moment he realized I was not a wealthy donor, he immediately diverted his gaze and walked off to talk with someone else.

I felt discarded, even soiled. This shouldn’t be surprising though, as we know from brain science research that people who feel socially excluded experience a reaction so similar to physical pain that you can actually reduce their pain by giving them Tylenol.

I do a lot of work in the pharmaceutical industry, primarily executive coaching and regulatory communication consulting for FDA advisory committee meetings. This has often put me in a room with global scientific and medical leaders, including a large number of MDs. One of the dynamics I have observed in these contexts is the meticulous way in which doctors manage status and inclusion. Many physicians, especially high-level global leaders, give each other status in various ways, for example:

  • Using each other’s titles in public settings “I appreciate what Dr. Smith said…,” even if they are close colleagues
  • Avoiding blunt critical language and instead raising criticism diplomatically and only after praise or recognition
  • Taking a strong personal interest in each others’ backgrounds, training, work and life
  • Complimenting each other’s contributions and research
  • Making requests using the polite language of a colleague

Indeed, watching a global medical leader in action can be a real lesson in how to give a feeling of status to others. Many are extraordinarily skilled—and it gives them a great deal of influence. It feels good to gain status, and we tend to like people who give us that feeling.

There can be a downside however. While doctors often provide each other a high level of status, some fail to attend to the status of non-MDs. For example, some may give orders to nurses instead of making requests, or criticize administrative staff using unnecessarily abrupt, undiplomatic language. Or they may simply ignore or undervalue some non-MDs and their contributions.

Personally I believe these behaviors happen not because of a meanness of spirit, but more out of cultural habit or early training. I wonder if in some sense these doctors “use up” their status-giving capacity in interacting with each other, and so don’t have much left over.  They may also be driven by efficiency—it takes a lot more effort to treat everyone with the kind of deference we might provide to a close colleague.  To be fair, there are also many MD’s who are highly supportive and respectful towards everyone.

Whatever the cause, a culture that differentiates status too much is not conducive to peak performance, because for an organization to be its best, every person needs to feel included and important.

What’s the answer?

Medical organizations are most effective when their leaders, including physicians and others with high influence, model status-increasing behaviors with everyone. The sense of having medical “insiders and outsiders” needs to dissolve so that all stakeholders feel they are part of something very special—public health.  The path to achieving this kind of atmosphere involves the hard, intentional work of changing organizational culture.  This often begins by defining and articulating organizational values and behaviors; and it blossoms through a long, intentional campaign of modeling and rewarding these behaviors.

Short of an organization-wide initiative, individual leaders can do a lot right where they are. Something as simple as acknowledging a colleague, taking an interest in them personally, and expressing genuine appreciation for their work can be a good start.  Ask yourself–do you use the same level of respectful language with everyone at work?

Some medical organizations have no doubt worked very hard to build this kind of uniformly positive culture. Where is yours?