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During the week of  9/30-10/4, Dr. Foster will be checking in here to answer your questions about professionalism. Double-click anywhere on the blog to begin.

How Does it Work?
1. Post your professionalism questions or concerns between 9/30-10/4
2. Jody will reflect on your questions and post responses here
3. Return and read Jody's replies

>>>Blog Guidelines, Purposes, and Intentions
>>>Review the last Just Ask Jody session
>>>Learn more about Jody Foster, MD, MBA, Assistant Dean of Professionalism

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Dear Jody, I work with someone who is challenging to get along with. Sometimes she seems incredibly confident, and other times she seems insulted by the tiniest slight. I really admire her and most of the time I appreciate how much I can learn from her, but I’m also tired of living through her tirades.

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Dear Jody, I work with someone who is challenging to get along with. Sometimes she seems incredibly confident, and other times she seems insulted by the tiniest slight. I really admire her and most of the time I appreciate how much I can learn from her, but I’m also tired of living through her tirades.

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Jody's Response

Might I suggest this short, fun video about Some Features of Egotistical Personalities (in under 5 minutes) More about this topic to come. Jody.

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Dear Jody, I am confused. I manage several junior faculty and have listened carefully to you when you have encouraged direct feedback as issues arise. Recently, I gave feedback to someone about his behavior. I sat with him for close to an hour, listened to his side of the issue and gave him lots of pointers about how the situation was perceived and how he might approach it differently the next time it arose. It seemed to go well, or so I thought, but by the next day he raged back at me. He twisted pretty much everything I said into me “just misunderstanding everything,” taking everyone else’s side, and said I was “out to get” him. This could not be farther from the truth. What happened?

Jody's Response
Thanks so much for writing. This is common. Getting feedback can be uncomfortable for the individuals on the receiving end, but giving it can be uncomfortable for us, too. Sometimes, in our discomfort, we dance around issues because just giving direct feedback in a few words seems harsh or unkind. And sometimes we also get into extended conversations about how the feedback makes the receivers feel, because it seems unempathic to leave them to process it themselves. Unfortunately, though, these extended conversations often serve to give receivers more “fodder” to ruminate about later, and misunderstandings or new interpretations develop.

Keeping feedback concise and direct, and circumscribing the engagement, is actually most often the best way to handle these situations. Tell the individual exactly what you need to, with clear terminology, then allow them time on their own to absorb it. For example, you might say, “It seems that when you become frustrated, you tend to look angry and raise your voice. This makes some of the people around you feel unsafe and uncomfortable.” There’s not much room for interpretation here, and later on, when this person thinks about what you said, it’s clear what behavior is causing concern and where to focus effort to make change. If the behavior continues or escalates, the next conversation might include suggestions for intervention and/or consequences.

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Dear Jody, I work with someone who was a peer and is now my division director. Her moods are labile and she is hard to read. We all feel like we are walking on eggshells around her and it makes for significant communication challenges. She is selective about when/and whom she chooses to respond to emails and is difficult to approach in person because her body language and tone suggest that she is being bothered or inconvenienced somehow, even when a very legitimate, objective concern is being raised. She makes it difficult to schedule anything because she does not respond to email requests in a timely manner, or ignores them altogether. She is a brilliant clinician and we all admire her clinically, but her attitude and body language are off putting.  It is a difficult work environment to be in because we don't know which version of her we are getting that day. It also makes it challenging to schedule anything and adds a level of anxiety and stress that seems unnecessary. How does one navigate these types of waters ?

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Dear Jody, I work with someone who was a peer and is now my division director. Her moods are labile and she is hard to read. We all feel like we are walking on eggshells around her and it makes for significant communication challenges. She is selective about when/and whom she chooses to respond to emails and is difficult to approach in person because her body language and tone suggest that she is being bothered or inconvenienced somehow, even when a very legitimate, objective concern is being raised. She makes it difficult to schedule anything because she does not respond to email requests in a timely manner, or ignores them altogether. She is a brilliant clinician and we all admire her clinically, but her attitude and body language are off putting.  It is a difficult work environment to be in because we don't know which version of her we are getting that day. It also makes it challenging to schedule anything and adds a level of anxiety and stress that seems unnecessary. How does one navigate these types of waters ?

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Jody's Response
Hi, thanks for writing! It’s unclear to me from your question whether this is a new position for her or not. If it’s new, she certainly may be anxious or stressed as she adjusts, and it might be contributing to her lability. She may be struggling with time management and might feel overwhelmed. All that said, regardless of her length of time in the role, it’s essential to communicate with one’s team and avoidance of that will eventually impact the division negatively. So I would suggest that communication gets built in as a standard as opposed to something requested as an “add-on.” The faculty, together or individually (I don’t know the size of the division at hand here), might empathically note to the division director that she is clearly very busy but that there must be a mode of communication for day-to-day and/or more pressing issues to maintain the division’s overall health. Suggestion of regular 1:1s and/or staff meetings to keep conversation open will circumscribe the “ask” and allow her to be more available and present for the faculty without feeling like she’s being pulled away from other tasks or duties. Presumably this should make her, and you, feel better. If this is put into place and she becomes more secure in the role, etc., but people still feel that they are walking on eggshells, fearing her moods or the like--then the situation should be escalated to leadership, likely the Vice Chair for Faculty Affairs in your department. These individuals can be helpful resources in managing difficult situations.

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I work with a more senior colleague (associate level) who is continuously passive aggressive and appears to feel extremely threatened by junior colleagues! This makes working together extremely challenging and it is starting to result in avoidance behavior by many. Any advice?

Jody's Response

Thanks for your question. Passive aggressive behavior is particularly hard to manage because, in its passivity, its specific features are often hard to identify. Sometimes all we have to go on is the way an interaction made us feel afterward, without necessarily understanding why exactly we felt that way. And some people are so adept at being passive aggressive that it can take hours or days after an interaction to even realize that it made us feel bad. When I advise people about intervening with difficult behavior, one of the first steps is always to “name the beast,” that is, identify exactly what the person is doing or saying that is making the interaction difficult for us--and it’s that much harder in these cases.

I also believe that people do not have malicious intent (in general) when they behave badly, and for many people, the passive aggression is not conscious. But a person who is consciously passive aggressive with regularity makes me question that belief. In any case, the intervention is the same. Whether someone is being aggressive and doesn’t realize it, or is quietly and purposefully acting out, the only way to dispel it is to bring it out into the open. This is not easy; but, in the moment, to call out a specific passive aggressive action and essentially say, “You may not realize this, but here is what I’m seeing and here’s how it makes me feel,” can be incredibly effective. For the person acting unconsciously, it offers awareness. For the knowingly passive aggressive person, it “blows their cover” and feels humiliating. You will not likely get anything but a blank stare in return, or an “I have no idea what you’re talking about.” But trust that this person will think twice before being passive with you again. And by dispelling the passive aggression, you may then have a chance to view the driver of the anger more clearly, and hopefully have a productive discussion at some point as to why, as in this case, the individual feels so threatened. Good luck!

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Dear Jody, I am planning on addressing an issue with a colleague in my department, and would like to see what you think. I’m in my 6th year on faculty and my colleague is a full professor. However, he is a great guy, so I think I can get my message across. My colleague is enthusiastic and has a long history of effectiveness with trainees. Having said that, I think his mannerisms are inappropriate. He is known to put an arm around younger faculty as to say “atta boy” or put an arm around a trainee in a friendly way while we chat. It’s pretty inappropriate -especially now. I was planning on saying something like, “hey, you gotta cut that out. Things are different now. You’re gonna get us all in trouble.” What do you think?

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Dear Jody, I am planning on addressing an issue with a colleague in my department, and would like to see what you think. I’m in my 6th year on faculty and my colleague is a full professor. However, he is a great guy, so I think I can get my message across. My colleague is enthusiastic and has a long history of effectiveness with trainees. Having said that, I think his mannerisms are inappropriate. He is known to put an arm around younger faculty as to say “atta boy” or put an arm around a trainee in a friendly way while we chat. It’s pretty inappropriate -especially now. I was planning on saying something like, “hey, you gotta cut that out. Things are different now. You’re gonna get us all in trouble.” What do you think?

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Jody's Response

Hi, thanks for writing. I think that sounds fine, and if you’re comfortable doing it, great. I’m not sure that you need to add “You’re gonna get us all in trouble” unless you really feel his behavior reflects broadly on the Department. The culture has indeed changed in this regard and you are correct that if the Professor believes that these boundaries don’t apply to him, he is at risk for a rude awakening. Just be prepared for the potential of a defensive response, in which case you might simply remind him that you’re simply looking out for his best interests and trying to be helpful. It’s hard to argue with that.

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Like many of us in academia, I share a primary mentor with several other trainees and early-career faculty members. There can often be differential treatment of mentees, which one would expect to happen to some degree. However, this is functionally professionally accepted favoritism, in which mentees receive differing levels of enthusiasm, support, and sponsorship that are fully apparent to others. As you might imagine, this breeds resentment and competition among the trainees. How should we as mentees handle this and how should mentors approach this unavoidable but culturally challenging situation?

Jody's Response

Hello, you raise a ubiquitous issue for which there is no ideal answer. It immediately reminds me of the conundrum of the parent with multiple children—how does one avoid displaying favoritism and make every child feel loved and special? Most of us figure it out with our kids, so we should be able to figure it out here, too. As your question suggests, mentoring is a critically important component of academic development. As a school, we have identified a best mentoring practice that includes mentoring teams. This type of approach provides a leveling effect for mentoring that might mitigate some of what you are noting. Additionally, mentees should ideally be able to make mentors aware if they are overly investing in some people but not others. One would hope that this awareness would then impact behavior. Just as in any family, these inequities are likely to persist unless there’s clear communication on both sides about the deleterious effects. While not always easy, it’s essential.

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Dear Jody,

I work with a very accomplished colleague in a powerful position who appears to enjoy micromanaging. Whenever colleagues report news about an ongoing or new project to this person, he/she asks the most basic questions (figurative example: have you considered turning the computer on before logging in?) and provides the most basic recommendations (figurative example: I would considered letting anesthesia know how long the surgery will take). I have read that micromanagers have issues with trust and would like to know how we can tackle this ongoing issue to have more productive discussions. We are a very successful group of colleagues by Penn standards. Thanks.

Jody's Response

Hi, thanks for writing. I’m curious about your first sentence, where you wrote, “...who appears to enjoy micromanaging.” Micromanagers rarely “enjoy” exercising so much control but rather, need to do it to feel in control of their own environments. You might perceive some contentment from this person in the context of that control, but I’d be hard pressed to imagine it as joyful. If, however, he/she appears to actually enjoy the act of controlling others or minimizing their abilities—that sounds somewhat aggressive to me. In that scenario, questions as (figuratively) basic as ‘have you considered turning the computer on?’ sound designed to shame or humiliate.

In either case, we know that this individual feels that he/she has all the answers and feels compelled to make sure you hear them. If this is driven by terrible anxiety and a fear of losing control, then the crux of the conflict is this inability to trust, to which you allude. If he/she could only trust that you would approach projects as carefully and diligently he/she would, there would be no need to check. And I will advise that your consistently excellent, reliable work, your ownership of mistakes when you make them and your respect for his/her suggestions and corrections should lessen the intensity of the control over time. But the questions that seem basic or obvious will continue and are likely unconscious, delivered almost compulsively just to be sure they are stated, i.e., “box checked.” Confronting the individual with the way these questions make you feel may be useful, just to get it off your chest and to open the door to future reminders when they happen again, but the behavior will most likely rear itself again and again. In short, my best advice is to realize that the behavior is not about you, is driven by fear, and to ask you to find an empathic spot for it regardless how incredibly annoying and insulting it may feel. If you treat it as background noise you can try to move past it to the more productive parts of your conversations.

If instead it is driven by a need to denigrate you and to maintain superiority, that’s an entirely different dynamic that should be confronted head on. You can most definitely tell this person that you feel insulted by the assertion that you don’t know computers must be turned on to function and that you wonder why he/she would question that? The response you get, which may range from “I’m just kidding” to anger or jealousy, will hopefully open the door for a more substantive conversation geared toward improving overall communication.

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Is Penn Medicine really about "Wellness"?

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Is Penn Medicine really about "Wellness"?

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Jody - I was called on a weekend where I was with my family (which is not common) for a non-urgent patient transfer to the health system.  I have a unique skill set, but this was not a emergency and could have been managed on Monday.  Of note, the patient was a "VIP" and did not respect personal or professional boundaries and expected a certain level of doting / vigilence / hand-holding.  Despite all this effort on Wellness and Health, when it came down to it, there was a CLEAR expectation that I would come and manage the patient.  This came from and included high level folks with the health system.

So, Jody, is all this work that we talk about regarding personal well-being to be better clinicians - is this really the direction Penn Medicine is going?  And how do those of us in the trenches, who make regular sometimes daily sacrifices, live up to the "expectations" of those who are in the ivory tower?

Thank you.

Jody's Response

You’ve raised so many important issues here. There is the issue of inequity in access and treatment related to so-called VIPs and the issue around the reality of “protected” or “off-duty” time. VIP management is, in itself, worth full study and discussion but I will focus instead on the wellness aspect of the situation you’ve described. The unspoken expectation of omni-availability has only worsened as modes of communication have improved over time. It’s unhealthy. It’s almost impossible to disconnect fully, and to do so with a sense of permission and deserving seems even more impossible. Some corporate entities have strict rules around night, weekend and vacation time but we are, by the nature of our work, an operation that never sleeps. As an organization, we need to better define expectations for communication outside “on-duty” hours. This definition will always be a challenge for those in highly specialized, niche areas as it sounds like you are. Regardless, it is important to set boundaries, especially for vacation time. I might suggest that you do your best to identify someone in your practice who could cover your calls (forward your work phone to them and do not take it with you) and at least put another layer between you and such requests. As with most things, though, change takes time so keep bringing it up and keep it visible. Thank you for writing.