Friendly Competition: An Exercise in Re-framing

Eric Postal, MD

Instead of concentrating on mis-steps and failures, focus on the opportunities they create.

It’s an extremely common while-working pastime: Griping, via internal monologue or to colleagues, about what a lousy job the folks around you are doing. How that holds you back from doing your potential best. And/or how much time and effort you waste, cleaning up others’ messes.

We denizens of diagnostic imaging are no exception. Common topics include referrers providing lousy or no clinical reasons for exam, ordering the wrong studies, or poorly informing the patients they send to us. The patients themselves being bad historians or non-compliant. Radiologists complain about bad technique or documentation from the techs. Techs complain about the direction they receive from the rads…too little, or excessively demanding and overbearing.

Some of this is in the guise of wishing for a better, more efficient occupational milieu, but if I had to assign a number, I’d say 99.9 percent of it is simply venting, without an expectation that the grousing will bring about any change whatsoever.

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There’s more than a little bit of literature out there about the psychology of venting, and how much it helps/hinders. Having done some studying in that field beyond what gets covered in med school “behavioral science” courses, and via personal experience, I’m not a big fan. I don’t find such venting to be at all helpful to my performance or my mood. I also suspect that, if and when I do indulge, whoever’s listening to me might not be wowed by my amazing professionalism and positive attitude.

A recent notion that might be of use to others who want to cut back on such behavior: try re-framing the situations which provoke your fault-finding moods.

Re-framing, for those unfamiliar, is another tidbit from the psychological/cognitive-scientific world in which I dabble. It also has a significant presence in the studies of persuasion and negotiation that I’ve been enjoying for much of the past year. Simply put, it means looking at a situation in a different way—or helping someone else to do so.

As a metaphor-man, allow me to illustrate: Someone shows you a picture of a kid running along outside on a sunny day. Oh, how nice. Now they enlarge the “frame” around the picture to show a larger field of view…and you can see he’s fleeing a burning house. This has gone from idyllic to tragic. Now the frame gets moved once again and you can see, behind him near the house, he left a pile of gasoline-cans and rags. Hey, that’s not tragic, he’s a rotten little arsonist!

Re-framing happens all the time, as we gather new information or see things from other perspectives. A radiologist might, for instance, think he has a pretty sweet gig because he’s making $X per case, per hour, per year, etc. But, if he finds out someone else in a similar position is getting two-to-three times that, he might reconsider his appraisal.

Without such new info, adjusting one’s attitudes via re-framing can take a little more effort, since we tend to cling to our preconceived notions (see “anchoring” in my last column). Unless the new perspective is the result of a “Eureka!” moment, it’ll probably take some time and practice with the new way of thinking before it “sticks” and over-writes the old.

Still, I offer a moment from a recent workday in which I was playing sympathetic ear. A colleague was reading a case for which the referrer’s “reason for exam” completely omitted the most important bit of clinical information. If not for the technologist jotting down this key piece of info, my colleague might have read the case disastrously wrong. What a careless idiot that referrer was!

I found myself re-framing the scenario to myself: What a conscientious, day-saving individual that tech was. He took a potential medical snafu and upgraded it into a nothing-wrong-here, standard piece of the radiological workflow. The patient, and, indeed, the referrer, would probably never know that there had even been a problem.

The tech might or might not have realized the impact he was having. If he did, perhaps he thought just as negatively of the referrer as did my colleague.

But what if, I thought, the tech re-framed the situation himself? Instead of “look at these turkeys I work with,” what if he considered it a sort of friendly competition? What if, every time that tech finds himself doing the referrers’ work for them, he registers it as another point he’s scored? Evidence that he’s doing a better overall job, something in which to take pride.

We’re all theoretically on the same team, right? Why not consider every time you right someone else’s wrong as a point in your favor, a time you’ve proven yourself more of an MVP?

Someone missed a pulmonary nodule on a previous case, but you’re seeing it (and, thank heaven, it’s stable)? Don’t aggravate about whether the other guy might be a dangerous quack; instead, enjoy the iota of evidence he’s given that you might be a superior rad.

Same goes for having to talk with referrers about cases other rads have read, but they’re not answering their phone or are otherwise unavailable: Points for you, as you forge/strengthen the reputation of someone the referrers (and, thus, your group) can rely on.

Why dwell on others who fail to prove their value? If they had done a better job, you wouldn’t have the chance to show yourself off by comparison. Don’t jump on every opportunity to resent them and wish them ill; remember, they’re on your side. If and when they do better, it’s no skin off your nose; this is not a zero-sum game.

But, in the meantime, enjoy winning the friendly competition when they make it easy for you.

Follow Editorial Board member Eric Postal, M.D., on Twitter: @EricPostal_MD