Giving Positive Feedback

Early in my residency training, one of the attending radiologists called attention to a CTA we were reading. He approvingly referred to the contrast enhancement and lack of patient motion as “excellent,” and dictated this into his report.

I think his point was somewhat lost on those of us who, at that early stage of our careers, could count on one hand the number of CTAs we had thus far seen. We have gone on to report innumerable cases in which we have carefully described technical factor deficiencies of all sorts. “Suboptimal” is a much-used term. We’re somewhat less eager to point out when we find things to be of particularly good quality.

One can imagine several reasons why this is the case. In general, medicine is a field which accentuates the negative. The focus is almost invariably on pathology - that is, things not being the way they should be - or at least factors predisposing to future pathology. At our most positive, we’re saying that organs are “normal,” or that things which were previously pathological have now improved.

Can you recall ever seeing a report on a superb liver? Or a magnificent spleen?

Inundated with such negativity, the field has developed its own upside-down lingo, where a “positive” finding is actually something bad/negative, and a “pertinent negative” is a grudging admission of normality, rather than a ringing endorsement of good news. Indeed, a completely normal report on anything more detailed than an X-ray can raise suspicions that the reader must have missed something.

Such a bias breeds ancillary negative attitudes, as well. Even without a generalized pessimism about the sociopolitical state of health care. On a spectrum from misery to euphoria, moods seem to hit a ceiling somewhere around the level of “OK,” or “no news is good news.” Audits and site inspections’ best possible outcomes tend to be a stay of execution until the next visit, and peer review’s highest accolade is “agree with interpretation.” When’s the last time you saw an M&M that focused on a brilliant pickup as opposed to a parade of misses?

I find it a refreshing change of pace to buck the trend when I can. We’re all very familiar with receiving lousy or downright inaccurate clinical histories for imaging studies, and orchestrating a manhunt for the one clinician who can give us more detail - or else muddling through cases after failing to find such individuals and liberally peppering our reports with less-than-crowd-pleasing recommendations for clinical correlation.

So, when I get a case with a clinical history that’s particularly thorough (even if not entirely pertinent), I make a point of sending positive feedback. If not to the individual who gave me the good history, then at least to his department. When the clinician’s history is “pain” but the CT tech adds a note that the patient had right lower quadrant discomfort for a week that suddenly got worse today and there is now fever with nausea and vomiting, I make sure the CT tech gets some kudos.

Even if the powers that be don’t notice and reward a good egg as a result of my actions, most folks derive satisfaction from having their efforts noticed. If every other aspect of their health care workday has been doom and gloom, at least they’ll know they were appreciated by somebody in the mix. It certainly can’t hurt their chances of making additional such efforts in the future.

On the other hand, if you go above and beyond the call of duty and nobody says a word to you, you might not bother next time.

Another ancillary benefit: Psychological research has demonstrated that positive (or negative) comments from a person impact impressions of that person from witnesses in the area. For instance, if I tell some radiology techs what an incompetent SOB their coworker in MRI is, the techs come away from the discussion with a diminished opinion of me (at least one psych experiment showed that they’ll specifically have an increased likelihood to consider me an incompetent SOB). But if I tell the same techs how much the guy in MRI cares about his patients, the techs generally wind up with an improved opinion of me in the process.

Pretty good dividends to receive in exchange for spreading a little sunshine around.