NEW ORLEANS—After performing an otoscopy and writing a diagnosis of “obvious middle ear effusion,” Ellen M. Friedman, MD, had a wake-up call when the referring physician called her condescending. “He told me on the phone that perhaps it was obvious to me because I had been at Harvard, but it wasn’t so obvious to him,” said Dr. Friedman, professor of otolaryngology-head and neck surgery and director of the Center for Professionalism at Baylor College of Medicine in Houston. The referring physician added that if Dr. Friedman hadn’t been quite so condescending, he would have sent her a lot more patients.
While taken aback by the experience (she had been writing this diagnosis in the way her mentors had taught her to write it), Dr. Friedman took this physician’s feedback and dropped the word “obvious” from her written diagnoses from that point forward.
Her lecture, “IQ Got You Here. EQ Can Get You There,” presented at the Women in Otolaryngology luncheon as part of the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) 2019 Meeting, held September 15-18 in New Orleans, discussed the importance of high emotional intelligence (EQ) in a work setting and how communication skills, including thoughtful word selection, can play a part in building or undermining relationships with colleagues and patients.
Dr. Friedman defined IQ, or intelligence quotient, as a number used to express the apparent relative intelligence of a person, adding that IQ is innate. She defined EQ as the skill to feel, communicate, recognize, manage, and understand emotions. Whether you are born with a high EQ or not, she said, it’s something that can be changed. And it’s not something that goes hand in hand with the high IQ that may have landed a person in medical school, an otolaryngology residency, or a fellowship.
“Some of the most brilliant people we know have a lot of emotional intelligence problems,” Dr. Friedman said. “EQ is not really on the same gene as IQ. The good news is, whereas IQ is innate, EQ can be learned.”
Emotional intelligence is also something that can make or break a physician’s practice.
Emotional Intelligence Focuses on Careful Communication
According to Dr. Friedman’s presentation, miscommunication among medical staff contributed to 80% of serious medical errors, and the average 500-bed U.S. hospital loses $4 million a year specifically as a result of communication inefficiencies. Miscommunication can even cost residents and physicians their jobs when they share misplaced humor or political opinions.
Dr. Friedman spoke of an incident in which the Cleveland Clinic fired one of its residents this year after discovering a series of anti-Semitic tweets she had posted as an undergraduate, including one joking about her intention to purposely give Jewish patients the wrong medicines. She shared another case about a Texas hospital resident who’d had an especially challenging shift in the ER. “He sent an email to several friends saying, ‘This ER is horrible and I’ll give anyone $2,000 to blow the place up,’” she said. What the resident thought was a joke was taken as a legitimate terrorist threat, which triggered an FBI investigation and nearly cost him his residency.
Communication comes in three forms: face to face, via telephone, or electronic (email, private message, or text). In face-to-face communication, Dr. Friedman said, the words we speak comprise approximately 7% of our communication efforts, whereas tone of voice comprises 35%; the rest is nonverbal, expressed in our body language. In other words, how we stand, sit, gesture with our hands, and express feelings on our faces says more than our words.
When we yawn, stretch, and roll our eyes—either purposely or subconsciously—a person with a low EQ does not pay attention to those visual cues and simply plods along. Someone with a high EQ, on the other hand, understands when you are bored, annoyed, or otherwise disengaged and likely pauses and considers how to regain your attention. “If you have a low EQ, you ignore the visuals,” said Dr. Friedman.
When physicians say, ‘Thank you for waiting,’ the patients are much happier than if they say, ‘I’m sorry for being late.’ —Ellen Friedman, MD
The words themselves are also important, so Dr. Friedman advises choosing them wisely and considering their implications. She pointed to a study that showed physicians responding in one of two ways when they were late to an appointment with a patient. “When physicians say, ‘Thank you for waiting,’” she said, “the patients are much happier than if they say, ‘I’m sorry for being late.’”
The implication of apologizing for being late seemed to be that the physician had more important things to do in another room. When they were thanked for waiting, the patients felt the statement acknowledged that the physician understood that they too have important things to do. “Saying ‘Thank you for waiting’ can be almost like magic,” Dr. Friedman added.
Be Mindful of Tone
Tone of voice is another important aspect of communication, according to Dr. Friedman, particularly when speaking by phone, with no visual cues to support what you think someone is saying. Simply placing the emphasis on different words in a simple sentence can change its meaning in a variety of ways. For example, there are many implications for the simple sentence “I didn’t steal her money,” as follows:
- I didn’t steal her money. (Maybe someone else stole her money.)
- I didn’t steal her money. (I definitely didn’t do it.)
- I didn’t steal her money. (She loaned or gave it to me. Or I found it).
- I didn’t steal her money. (I stole someone else’s money.)
- I didn’t steal her money. (I stole something else of hers.)
“When you have a high EQ, you use a neutral tone of voice,” Dr. Friedman said. She also pointed to a study that showed that when researchers put dogs in an MRI machine and said nice things to them in a harsh or sarcastic tone, the aggression centers in their brains lit up. “Sarcasm isn’t lost even on a dog,” she said.
Beware the Email Gaffe
Because digital communication relies entirely on words, Dr. Friedman said it’s important to be mindful of what you put into an email, as it is easy to make a mistake that can haunt you later. Additionally, there’s no opportunity for immediate clarification if something is confusing or misunderstood. She also warned against forwarding an entire thread and advised physicians to double check the recipients of an email before pressing send.
“Use email only for sharing facts and data,” Dr. Friedman said, warning that email should never be used for anything controversial, political, or humorous; nor should it be used to resolve conflict, express emotions, or avoid face-to-face communication. “Don’t ever write an email when you’re angry,” she said. “When you have an emotion other than happiness or joy, do not put that in an email.”
Stay Positive and Express Sincere Appreciation
Negative remarks—both casual and not so casual—can set the tone for a negative atmosphere in your practice and can also affect a medical team’s performance. Dr. Friedman mentioned a study that rated a medical team’s performance during a simulation activity when an actor who had been identified as an international expert made negative comments. “Things unraveled and fell apart,” she said. Then they repeated the drill with the actor complimenting the team on what they’d done right.
“When the ‘expert’ was saying positive things,” she said, “they did better than average and beat their own personal best as a team.” While we may think expressing gratitude will be awkward, according to Dr. Friedman, we usually overestimate that and underestimate how surprised and happy the recipient of our gratitude will be.
Dr. Friedman also advised going out of your way to be pleasant to colleagues, saying good morning to everyone at the front desk and in the O.R. She also spoke about regional differences and adapting to the culture in which you work. “I’m from the northeast, and now I work in Houston,” she said. “A nurse once asked me if I was having a good day, and I said the last time I had a good day was 1967.” Dr. Friedman had been kidding but later learned that the nurses thought she was serious. “It was a big cultural revelation that not everybody got me,” she said, adding that some physicians might ask, Why should I be the one who has to change? “You don’t have to,” she said, “but then you won’t get along with everybody.”
Emotional Intelligence Relies on Empathy
Empathy is an important factor in emotional intelligence. In response to a complaint, people with a low EQ will talk about their own experiences, hijacking the conversation and making it about themselves. “Never use the phrase, “I know exactly how you feel,” Dr. Friedman said, “because it trivializes the other person’s feelings.” Instead, she suggested saying, “I can only imagine how you feel about this.”
Dr. Friedman added that kindness is an important skill for physicians to work into their careers, and that those with a high EQ understand that everyone they encounter has a backstory. In fact, according to one survey, 72% of patients were willing to pay more for a kind physician; 88% were willing to travel farther to see a kind physician, and 90% would switch physicians after receiving unkind treatment.
“You don’t know what’s going on in anyone’s life. You don’t know their backstory,” Dr. Friedman said. “We have the opportunity to be kind and elevate people or to squash them. I want to be an elevator, not a squasher.”
Renée Bacher is a freelance medical writer based in Louisiana.