Giving Feedback That Physicians Don't Want to Hear
The Feedback Nobody Wants to Give
There is a conversation sitting in your head right now. You have been composing it for weeks. Maybe months. It involves a colleague who is talented, productive, and genuinely difficult to work with. You know what needs to be said. You also know they are not going to like hearing it.
So you don't say it. And as a physician leader giving feedback that people don't want to hear, you are far from alone in that choice. But the cost of staying silent is higher than you think.
Why Physician Leaders Avoid the Hard Stuff
Most leaders I coach are not conflict-averse. They deliver devastating diagnoses to patients with composure. But difficult feedback to a peer is a different animal. There are specific reasons physician leaders avoid it:
- Reputation risk. Academic medicine is a small ecosystem. The person you confront today might review your grant next year.
- Identity threat. Physicians tie their professional identity to competence. Feedback that questions how someone leads, communicates, or collaborates can feel like an attack on who they are, not what they did.
- Ambiguity about authority. Many physician leaders occupy roles without clear positional power. You are a section chief, but the person you need to talk to is a tenured full professor. The org chart says you are in charge. The culture says it is complicated.
So you hint. You work around the person. You quietly reassign responsibilities. You absorb the dysfunction yourself.
What Happens When You Stay Silent
Here is the part that does not get discussed enough. When you avoid giving feedback, you are not maintaining peace. You are making a series of decisions that your team can see.
They notice that Dr. X dominates every meeting and nobody pushes back. They notice that the same person gets away with behavior that would get anyone else a talking-to. They notice that you, their leader, appear unable or unwilling to address it.
Research by James Detert and Ethan Burris, published in the Academy of Management Journal, found that employees are remarkably attuned to whether their leaders actually act on problems. When leaders stay silent on visible issues, it erodes trust across the entire team -- not just with the individual in question. Your silence is not neutral. It is a signal.
Four Principles for Giving Difficult Feedback in Academic Medicine
I have seen frameworks come and go. What works is not a script. It is a set of principles.
Be direct
Say the thing. Not a softened version. Not a question designed to lead them to the conclusion. "I need to talk to you about how you handled the discussion with the residents last week" is direct. "Have you thought about how some of your interactions might land?" is evasion dressed up as curiosity.
Kim Scott makes this case plainly in Radical Candor: caring personally while challenging directly is not rude. Withholding honest feedback because you want to be liked is actually the unkinder choice.
Be specific
Generalities invite denial. "You can be dismissive" gives the other person nothing to work with and everything to argue about. "In Tuesday's faculty meeting, you told Dr. Patel her idea was not worth discussing. She did not speak again for the rest of the hour." That is specific. That is observable. That is hard to wave away.
Be private
Never deliver hard feedback with an audience. Not in a meeting. Not on a group email. Not with a pointed comment that everyone in the room understands. Privacy is not just politeness. It creates the conditions where the other person might actually hear you instead of performing a defense.
Show that you care about them
This is the one that separates feedback that changes behavior from feedback that starts a war. Before you deliver the message, the other person needs to believe -- genuinely -- that you are on their side. That you want them to succeed. That this conversation is happening because you respect them enough to be honest.
If you cannot honestly say that, you are not ready to have the conversation yet.
Start With the Conversation You Have Been Avoiding
You know which one it is. You have probably rehearsed it twenty times in the shower. Here is what I want you to do this week: schedule the meeting. Keep it to fifteen minutes. Use the four principles. Be direct, specific, private, and caring.
It will not be comfortable. But another month of silence while your team watches and waits for you to lead -- that should not be normal either.
Learn about coaching for departments and how we help leadership teams build a culture where honest feedback is expected, not feared.
