Practice Perfect 693
Legitimate Criticism

I am a relatively recent fan of mixed martial arts and enjoy some nice bonding moments with my 14-year-old son while watching the Ultimate Fighting Champion (UFC) on some weekends. A couple of weekends ago we watched a fight between two legends of the sport, Donald “Cowboy” Cerrone and Conor “Notorius” McGregor. This was a big fight with a lot of hype since McGregor was returning to the UFC after about a year away, and Cerrone was universally respected as a pioneer of MMA. Unfortunately for Cowboy, the fight ended in 40 seconds when McGregor used his shoulder – an unusual move in the UFC – to literally break Cerrone’s face (he suffered orbital and nasal fractures). As quickly as the fight ended, it seemed even faster for the armchair quarterbacks to criticize Cerrone for not fighting well. Specifically, ESPN commentator Steven A Smith, criticized Cerrone for giving up too soon. Anyone who has watched the UFC knows this was not the case.

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Listening to the internet discussion about Smith’s ignorant and uneducated comments started me thinking about how we provide criticism about various aspects of professional life. I’ve been involved in podiatry long enough to hear people at conferences criticizing each other, and it can get brutal. Why is that so few lecturers talk about their complications? Because you must be brave to put up your less proud moments for all to see. I’ve also received written criticisms over the years with this blog, from a variety of individuals from Internet trolls to legitimately caring individuals. I will admit publicly that, like most others, I too have roughly criticized folks in the past. I’m as guilty as everyone else.

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The one part of all this that is most frustrating is seeing a glint in the eye of someone doing the criticism, as if they’re enjoying tearing someone else down. I’ve witnessed this at conferences, case discussions, and heard from patients who’ve received this type of treatment from other doctors. As I self-reflect and try to improve my own behaviors, here are some rules of thumb to create a more cordial and less toxic environment of criticism.

  1. Walk the talk. If you’re going to criticize someone be sure you’re the correct person to criticize. Are you an expert in the topic of discussion? I am not trained to do total ankle replacements, and I have no experience in them, so I would be very hesitant to criticize the outcomes of someone else’s procedure.
  2. Would you say the same thing in front of that person? It’s easy to be rough on people when they’re not present to defend themselves, so when you’re about to criticize that poor result of another provider ask yourself if you would be as mean with them present. You’ll find the desire to modulate your speech comes naturally.
  3. Showing your outcomes takes courage but is necessary to learn. The only way for us to learn and improve is to focus on errors and deficiencies, not where things went well. We spend quite a bit of time at the Chino Valley Medical Center residency program analyzing the results of surgical cases as part of our academics. Many times, the results are excellent, sometimes they’re not great, but always there’s something that could have been done better. We must each be as open and honest as possible to teach and learn. Remembering this will make it easier to create environments where it is safe to show poor outcomes, errors, and have disagreements.
  4. Take the other’s perspective. If you were the other person what would you think of the tone and content of the criticism you’re hearing? Is what you’re saying potentially hurtful? Consider also that our individual perspectives are limited by never having the full story. We weren’t there in that operating room. We come to all situations with ingrained biases. There may be unknown factors that explain a situation. Putting yourself in others’ shoes is a sure-fire way to create awareness and caution with criticism.
  5. Seek to be constructive. Even when things are obviously bad, and you want to brutally disparage, there are always better ways to be constructive with your criticism. The best way is to be specific about the details of your analysis. For example, instead of saying, “that was a poor choice of incision placement for that surgery,” try instead, “identifying the anatomy of this area would have allowed an easier incision placement and dissection.” Focusing on the features rather than making a verbal judgment will always be better accepted and more productive.
  6. Patience and the golden rule are still virtues. They’re trite for a reason: they’re true. Being patient and speaking to others as you would want them to speak to you are tried, true, and very effective for good interpersonal communication.

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It all boils down to respect. If we can approach others with the benefit of the doubt we would like to be approached, communicating with others would be safe and beneficial.

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Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
jarrod@podiatry.com

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