The Hardest Part of Your Job That Nobody Warned You About

The most challenging aspect of my job, at times, has nothing to do with patient care. There are occasions that I would rather listen, take the heat, and apologize to an upset patient for something I didn’t even do… than give another provider or intern “constructive” feedback. I don’t want to give the impression that it’s always awful, you know? I suppose it depends on the individual’s personality and how they could have done a better job. Oh, and I can always hope to avoid the conversation, crossing my fingers that the same incident won’t happen again. Or if it does, the outcome will magically improve. Don’t do that, by the way; I don’t support the latter as an effective strategy. My role has slowly morphed over the last 5 years from a clinical role to a supervisory position. I consistently oversee 4 clinical instructors at a time as well as 8 DPT interns; giving feedback is essentially non-stop!

I’ve read conflicting information about the effectiveness of the compliment sandwich. And there is another method for providing 5 positives for every negative, but 5 positives sound like so many! Are we supposed to give that feedback all at once like a larger compliment sandwich? Gottman el al. is well known for this research in these 1994 and 1998 resources. They were looking at how couples in a marriage interacted with each other, determined if they were in a stable, unstable, happy, or unhappy marriage, and then wanted to see how well they could predict divorce. Their findings suggest that couples who provide positive to negative feedback in a 5:1 ratio have happier marriages and are less likely to get divorced. The theory is that this can be translated over into the workforce with supervisors, coworkers, employees, etc.

It’s easy to see from the graphics and numbers in the study that there is a correlation between the feedback ratio and marriage satisfaction/success, but is there a causation? Maybe the happy couples say nice things to each other because of the obvious: they love each other. Are we confident that the unhappy marriages would improve if the couple switched from the compliment sandwich to the compliment “Royale with Cheese”? Well, I’m not sure, but I don’t think it would be detrimental. As an instructor, I strive to keep my mindset on the students’ strengths and areas for improvement; however, I believe that I fail to express the positives as often or consistently as I could.

A mentor once told me, I think the feedback you gave was appropriate, but do you think it will motivate them? This really struck a chord in me and got me to reflect on my interactions with just about everyone. How are my words interpreted? Am I encouraging growth and improvement? Am I instilling a sense of self-efficacy? Our goal should be for the receiver to look forward to the conversations and even seek timely feedback. Harvard Business Review gives a brief example of how this dialogue can flow, interestingly enough, with a physical therapist. The conversation starts off between the physical therapist and her supervisor, but ends up with an HR representative. The supervisor creates a hostile, one-sided discussion, yet the HR rep creates an open, welcoming environment while incorporating the PT in the process and guiding her toward solutions – like a coach.

This could be a good opportunity for us to think back on a situation in which we gave a co-worker, student, or patient feedback. Did we go into the conversation ready to listen with an open mind? Were we creating a hostile environment that spawned the receiver’s defensiveness? How can we develop a strategy to become more effective at communicating and feedback?


6 responses to “The Hardest Part of Your Job That Nobody Warned You About

  1. I find that students and staff PTs respond very well to the concepts of reflective listening and motivational interviewing. As an added bonus…….so do patients. Studying these concepts via staff meetings helps with both team building and patient care. To me,trying to find five positives to the one negative is what some would call a “left-handed compliment” and these have never worked well in my experience.

    1. Jacob Melnick says:

      Hi James,

      Thank you for the comment. I appreciate the life experience regarding the 5:1 feedback model. Even though this concept has been around for over 20 years, it was recently brought to my attention at a work meeting. I have yet to fully implement this strategy because it feels like I’m really reaching to find that many positives to give at one time. My assumption, though, is that this process isn’t strictly 5:1 positives to negatives in one meeting, but over time. The idea that some managers/supervisors may only be giving feedback or comments when the job is not being done well is what we are striving to prevent. This 5:1 process can be related to telling your significant other how pretty you think they are when it isn’t a date night, or buying them flowers on a random Thursday. So, when the feedback comes, the individual still has a sense of value and appreciation.

      Thanks again! I hope this clarifies my thought process a bit.


    2. Dr. Pete Zepelak says:

      Dr. Glinn,
      Where can I find more information about reflective listening and motivational interviewing?
      -Pete Zepelak PT DPT

  2. Paul Potter says:

    Jacob, let me give you some feedback-great post. Thanks for reminding us to verbize what we see and hear.

    1. Jacob Melnick says:

      Thank you, Paul! I searched the blog archives for posts about this topic and didn’t see too many. This truly is something I work on everyday, so I hope others are able to take something from this and put it into practice regularly.


  3. Great references for Motivational interviewing and Reflective listening include the work of Miller and Rollnick.

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