You’re in the OR. A colleague, maybe a resident, suggests a different approach. You’ve already considered it. Or maybe it’s not a great suggestion. Either way, it’s hard to hear. You feel your muscles tense and lean away from your colleague, avoiding eye contact. Defensiveness is a common and understandable dynamic.

A common dynamic

In the era of shared decision-making, physicians get all kinds of suggestions—not only from peers, but also from advanced practice providers and young residents. Many of the attending physicians I coach get frustrated and defensive, often because they already have a plan for the patient.

Why it’s hard

Here are some things my physician clients say about why suggestions can feel threatening:

• Hierarchy and power dynamics: “I’m the captain of the ship. Why should I listen to someone with less training?”
• Fear of malpractice: “I’m the one who gets sued if something goes wrong.”
• Evidence-based medicine: You’re trained to cite peer-reviewed articles and defend your position.
• Challenge to expertise: “It makes it seem like I don’t know what I’m doing.”
• Emotional immune response: Your brain senses a threat and goes into defense mode.
• Deviation from usual practice: “This has been done this way successfully for years.”
• Time pressure: “I don’t have time for a discussion in the middle of a case.”

What’s at stake

Often, it turns into a defensiveness debate. The attending seems dismissive. The staff member argues or shuts down. The attending doubles down or ignores the input completely. Later, that colleague might hesitate to speak up about near misses, patterns, or concerns.

Being open to suggestions isn’t just about being nice—it’s about patient safety, stronger teamwork, fewer complaints, and sometimes even better outcomes.

A reframe: suggestions as gifts

One way to shift your mindset is to treat suggestions like gifts. People feel like they’re giving you a present. And what do you say when someone gives you a present? At a minimum, you say thank you. You don’t say, “I hate it, I’d never use this.” You say thank you, and maybe repurpose it.

The apple and pear analogy

Being open to suggestions doesn’t mean following all of them. Let’s say you like apples, and you’re holding one in your hand. Someone offers you a pear.

You don’t have to switch, but you can acknowledge the offer with curiosity. “Thanks for the pear. Tell me why you like pears—what’s your experience with them?” Then you might say, “I see why you’d recommend pears. In this case, I’m sticking with the apple. But you gave me something valuable—I’ll keep the pear in my pocket and maybe use it later.”

An example

One physician I coach shared a story about a resident who suggested stopping a particular med in a complex ICU case. She felt the suggestion oversimplified things, but instead of shooting it down, she asked why. The resident shared a relevant article and a similar case he’d seen. She kept the med, but responded, “Thanks for raising that. I’ll read that article tonight.” Their relationship shifted from tense to collegial. That resident walked away feeling respected—and more likely to speak up again.

A step further: Be proactive

Some proactive approaches my physician clients have shared:

• Ask for input: “What’s your opinion?” (This doesn’t make you weak.)
• Practice active listening: Don’t just listen to respond—listen to understand.
• Create space for feedback: Use interprofessional rounds or dedicated case reviews.

When you treat suggestions as thoughtful contributions—even when they’re off-base—you build trust and encourage useful input. You make space for others to speak up when it really counts. And you model leadership that’s grounded in confidence, not defensiveness.

So the next time someone offers an idea—even if it’s a bit off—pause, nod, and say:

“Thanks for the pear.”

Mary Remón is a licensed counselor, certified coach, and certified employee assistance professional with over 20 years of experience in health care. She has coached physicians and leaders at hundreds of health care institutions across North America, including prominent academic medical centers. Previously, she managed employee assistance programs at two academic medical centers, supporting physicians, leaders, and frontline staff. Mary now provides individualized support to professionals and executives through her private practice. Her website, Mary Remón Coaching, provides more information about her services. She is also active on LinkedIn and Facebook. Her co-authored publication, “Academic and Corporate Cultures Contrasted: Implications for Employee Assistance Professionals,” appeared in the Journal of Workplace Behavioral Health.