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Dr. Campbell: The value of 'we' in health care

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RALEIGH, N.C. -

Have you ever taken note of how much you or a colleague says "I" versus other pronouns? The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader.  

Current research has indicated that the frequency at which an individual uses the pronoun "I" speaks volumes about their self-confidence, level of empathy and perceived status within an organization or group.  As physicians and members of teams of providers we function in groups in order to provide care to our patients on a daily basis.  How effectively we interact with patients, nurses, technicians and other providers may significantly impact the outcomes for our patients.  This research, which was published in Journal of Language and Social Psychology in the last month may provide important insight into how we can better function as physicians, team members and leaders in medicine.

The Wall Street Journal‘s Elizabeth Bernstein explored the potential impact of the newly published studies on pronoun use in her column just this week.  Researchers tested subjects in five separate studies and examined the way in which status or relative rank was reflected in the frequency at which subjects used the pronoun "I."

The findings were quite interesting — those who used the pronoun "I" often felt subordinate or less sure of themselves. In addition, those that used frequent "I's" were more introspective, self-conscious or in emotional or physical pain.  

Surprisingly, those that were "full of themselves" and even narcissistic did not use "I" nearly as much.  In contrast, those that were more self-assured, and possessed higher job status used the word "I" with much less frequency.  In a separate study, the use of the word "I" was also associated with those who were telling the truth – those who avoided using it were found to be less genuine and were often hiding something.  When resolving conflict, psychologists have often encouraged those in group therapy to use the pronoun "I" when discussing conflicts and feelings.  For years, marriage counselors have advocated the use of the word "I" rather than the word "you" during feedback sessions as "you" is often perceived as more accusatory.

Confusing?  "I" think so.  But, as study author Dr James Pennebaker mentions, there is an enormous misconception about the use of "I" –  those in power or positions of authority do not use it more. In fact, those that are in power were found to use it less because they seem to be more interested in looking out at the world and figuring out their next strategic move– while those in more subordinate positions were found to be  simply looking inward and trying to please others.

In today's medical world, the focus on care is on the team (the "We") rather than the "I."  A major shift in approach to patient care has occurred in the last decade  – individual disease states are managed by teams of caregivers composed of varying job titles, provider roles, and medical specialties.  Even physicians from varying specialties such as radiology and cardiology are working together to provide multidisciplinary approaches to disease management.  

Discussions of best practice and hybrid approaches across specialities are now commonplace and are resulting in improved outcomes.  For example, at the University of North Carolina at Chapel Hill, we have created a Heart and Vascular Center where radiologists, cardiologists, vascular surgeons, cardiothoracic surgeons and heart failure specialists see patients together and develop care plans in concert – no longer are different specialties competing for cases and arguing over alternative approaches to management.  In our institution, care is becoming more streamlined and through cooperation and academic discussions amongst providers, patients are receiving the best treatment options available essentially tailored to their particular clinical situation.

So what exactly do we as healthcare providers do with this information from the pronoun study?  Admittedly, much of it is confusing (except to the psychologists) but the bottom line is that we must pay careful attention to the pronouns that we use and how we may be perceived by both those we lead and those whom we follow.  As leaders and as team members, how we are perceived by others may be a critical factor in our ability to function most effectively and care for our patients at the highest levels.  High level, effective communication with patients, nurses and other healthcare providers is essential.  In addition, we must also take note of the ways in which others communicate in order to maximize everyone's contribution.

Pennebaker, the study author, recommends that we all try to use "I" a bit more.  According to his work, it makes you appear more humble as well as more genuine and more engaged.  Using "I" allows others on the team to see humanness and vulnerability in their respected leader – this fact alone may provide more connection and more inspiration among those with whom you work.

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