Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Licensed counselor and certified coach Mary Remón discusses her article “How doctors can turn criticism into collaboration.” Mary explains why physicians often react defensively to suggestions from colleagues, citing hierarchy, malpractice fears, time pressures, and challenges to expertise. She reframes criticism as a “gift,” using analogies like apples and pears to show how doctors can acknowledge input without necessarily adopting it. Mary shares practical strategies such as proactively inviting opinions, practicing active listening, and creating structured spaces for feedback. Listeners will gain actionable tools to reduce defensiveness, strengthen interprofessional relationships, and improve patient safety and outcomes by fostering a culture of trust and collaboration.

Our presenting sponsor is Microsoft Dragon Copilot.

Want to streamline your clinical documentation and take advantage of customizations that put you in control? What about the ability to surface information right at the point of care or automate tasks with just a click? Now, you can.

Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Offering an extensible AI workspace and a single, integrated platform, Dragon Copilot can help you unlock new levels of efficiency. Plus, it’s backed by a proven track record and decades of clinical expertise, and it’s part of Microsoft Cloud for Healthcare, built on a foundation of trust.

Ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Mary Remón. She is a counselor and certified coach. Today’s KevinMD article is “How doctors can turn criticism into collaboration.” Mary, welcome to the show.

Mary Remón: Thank you so much for having me on the show.

Kevin Pho: All right, so briefly share your story and then talk about the KevinMD article that you shared with us today.

Mary Remón: Absolutely. I am a licensed mental health counselor and unexpectedly I got into health care. For the past 20 years, I have been working in health care. I used to manage the employee assistance programs, which are like counseling programs for employees on site at two academic medical centers. And then for the past nine years, I have been exclusively coaching physicians. So I learn a lot from the challenges they face and their unique ways of solving them.

Kevin Pho: All right. And what are the most common issues that these physicians come to you with?

Mary Remón: Burnout. A lot of times physicians do not need help with their communication skills; they just need rest. But also I help with communication skills, stress management, just how to be most effective in the environment that they are in. And one thing that I have noticed is that physicians, I have learned this, they get interrupted a lot and they get a lot of unsolicited suggestions and critique. And that can be challenging and really put them on the defense. Is that something you have noticed, Dr. Pho?

Kevin Pho: Sometimes. I could definitely connect with the interruption part, right? It is very difficult for physicians to have a continuous train of thought before getting interrupted, whether it is a phone call or a knock at the door. I think there are just so many concurrent things that are going on in a typical physician’s day right now. In your KevinMD article, “How doctors can turn criticism into collaboration,” you mentioned that physicians get a lot of unsolicited feedback. So tell us what your article is about for those who did not get a chance to read it.

Mary Remón: Absolutely. So physicians get a lot of unsolicited feedback and defensiveness is completely normal. Turning it into collaboration is extraordinary, and that is what the article is really about is how we can shift the mindset from defensiveness to openness. And that is not just about being nice. It can actually indirectly improve outcomes, patient safety, because when we are approachable, people are more likely to point out a near miss, ask an important question, maybe make a good suggestion that makes things better. So that is the main gist of it.

Kevin Pho: Now, from your experience and when you talk to physicians, who is giving them this unsolicited feedback, and what are some examples of some of that feedback that you have heard?

Mary Remón: Good question and good point, because they are getting suggestions from a lot of nurses, and it is shared decision making, right? And the nurses are encouraged to speak up and they are getting suggestions from young residents and they are getting suggestions and criticism from the family and people who have less or limited training, and they already have a plan for the patient.

And so, one example I can think of if it sort of brings it to light is there is a resident and an attending, they were dealing with a complex ICU case, and the resident suggested stopping a particular medication and the attending thought that that was premature. And instead of reacting defensively, she said, “Why do you recommend that?” And he explained that he just read a couple of research articles about it. He gave some case examples. The attending continued the medication. She said, “I am going to go home. If you send me the article, I am going to read it tonight.” And their relationship changed from tense to collaborative, and I love seeing those kind of shifts.

Kevin Pho: I love that story that you shared because instead of getting defensive, that attending approached that situation from a standpoint of curiosity. Right?

Mary Remón: Exactly.

Kevin Pho: And that turns that relationship, I am going to guess, into a more collaborative one.

Mary Remón: 100 percent. It is not always easy to do, but if you can make that shift, it is a wonderful thing. And so, in working with the physicians that I coach there is an analogy that I use that for whatever reason, many people have told me, “This is the main thing I remember from working with you.” And I am like, “Really?” So that is what inspired me to write the article is because I have a very simple analogy, but it sticks with people.

Kevin Pho: That is not always easy to do. Right. Because sometimes, you know, no one likes to hear negative feedback or criticism. Right. So when you coach physicians, how do you get them to lower their guard and make them less defensive or reactive and kind of approach that situation differently? How do you teach doctors to do that?

Mary Remón: Well lower their guard when they are working with me. First of all, I need to commiserate. Who am I? I have never practiced medicine and I have never walked a day in their shoes, so they need to tell me all the reasons why it is hard to take the suggestions, and those are valid reasons. And I need to validate that the defensiveness is normal. And that is how I get them to rant about it a little bit, and then we kind of take a shift and it is like, what is a different way? How do you think you might approach it next time? So in terms of the analogy, would you like me to share the analogy, Dr. Pho?

Kevin Pho: Sure, of course.

Mary Remón: So the general idea is to treat suggestions as gifts. Because I feel that when someone is giving a suggestion, they feel like they are giving you a present, even if it is not wanted, especially if it is not wanted, because that is when we are quick to toss it away in medicine. But if someone gives you, this is not my analogy yet, this is a different one, but if someone gives you, let us say an ugly sweater or something, are you going to say, “I hate it. I am never going to wear this. It is useless.”? No. What are you going to say?

Kevin Pho: You are going to of course show appreciation.

Mary Remón: Yeah. So, so in general with suggestions, start with appreciation. At a minimum, say thank you. Being open to suggestions is not the same thing as going with the suggestion, and I want to be really clear about that. And so this is the analogy. Imagine that I am holding an apple. On one hand, I really like apples and someone hands me a pear. The pear does not cancel the apple. The apple does not cancel the pear. They co-exist in that moment.

So if someone gives me a pear, that is a gift, right? If I do not like pears, it is a gift. And I say thank you. And then with the tone of curiosity, like an eager learner, I say, “Tell me more about pears. What is your experience with pears? Why are you recommending them?” You know, “And why are you recommending them?” And then at a minimum, listen, and you can say, “Well, I can see why you are recommending a pear. In this particular case, I am still going to go with an apple. But I am going to keep this pear in my pocket for later because I might be able to use that.” And so it is the whole apple and pear analogy that has just stuck with people.

Kevin Pho: So if physicians or clinicians continue to be defensive when receiving unsolicited feedback, tell me what that perpetuates. What are some of the consequences of that?

Mary Remón: That is an important question because I see that a lot. And worst case scenario is a medical error, I think. Second worst case would be being written up, which happens unfortunately too often. But it shuts down ultimately the collaborative environment. And so approachability is super important for patient safety. And like I said earlier, it is not just about being nice. The physicians I work with, they say when they are interrupted, for example, maybe 50 percent of the interruptions are valid and the other 50 percent are not.

And it is frustrating, but at the same time, they need that 50 percent that are valid, you know? So they realize that because you said worst case scenario, they miss out on the ones that are important, especially because they are not being approachable or open, and then people are not going to point out when they see something wrong necessarily. They might be afraid to ask something that they think is a stupid question, that is really a vital question. And so that is how it can affect patient safety. And also people are sensitive. You know, it is 2025 and depending on the way it is handled, unfortunately, physicians sometimes get written up for these interactions. So I help them prevent that or turn things around.

Kevin Pho: Do you have a success story that you could share? And of course, it does not have to be a real client, it could be an amalgamation of your previous clients where you have coached them to be more curious about feedback and talk about and do some of these approaches that we have talked about today, and what were they like after? Maybe give us a before-and-after picture after implementing some of these techniques that we have talked about today.

Mary Remón: I have someone in mind and I am not going to give too much information, but this person makes me smile. This person did not want to start working with me. He was actually kind of sent to work with me and was not too happy about it, which is understandable. And in general, I think he got in trouble for the way he was handling criticism or suggestions in the workplace. Yeah, so I think he was very misunderstood. All the physicians I work with are good people and they are speaking up about important things, and he is definitely a good person.

But what I, first of all, he is someone who really loved the analogy and said it just shifted things for him. And I know that when the physicians I am working with are happier and they tell me that they feel happier going to work and the people around them are happier and it is like a more positive environment that things have really shifted and clicked. And they tell me like once they start implementing these things regularly and it becomes a habit because it is a little uncomfortable at first. But when it becomes habitual, it is that overall happiness at work and more collaborative teamwork. And they tell me, it even spills into their personal lives, which is something that happened with this physician. So he is actually the person who inspired me to write the article and reach out to you.

Kevin Pho: So we have talked about, of course, this approach to better accepting feedback and turning it into a collaborative moment. Give me some red flags. What are some things that physicians absolutely cannot do when receiving feedback that causes them to get written up? For instance, what are some red flags, absolute things that physicians should not do?

Mary Remón: I mean, they may seem obvious, but you do not want to raise your voice. You do not want to say, “What do you know? You have not been trained.”

Kevin Pho: And that happens, right? Physicians really do say that, right?

Mary Remón: Yeah. Yeah. I mean, they are swearing. They are just obvious stuff. Right. This and or just like. Even just turning your back and ignoring the person, it is less than ideal. Some people will actually put their hand in the person’s face.

Kevin Pho: You have literally heard or seen a physician put their hand to a person’s face like that, that actually happened.

Mary Remón: I mean, give the hand like this. Not touching, but giving the hand. Yeah. Wow. And I have been given the hand too, so I know what it is like to be on the receiving end. So I think just, you know, some physicians actually touch people, you know, you push them away. But I think those are the rare cases. The more common case is just the human reaction, which I would have too, if I were getting criticized and I already had a plan, it is normal. And that reaction is usually just, you know, they feel their muscles tense and they lean away from the person and maybe they do not make eye contact. And it is not necessarily that they are doing anything wrong, but it is an opportunity to do something right. So it is less about getting in trouble or that sort of thing. It is more about how can I make this better? How can I turn this into something not defensive and more collaborative? And that is really extraordinary when people are able to do that. I admire their ability to do that. Not easy in medicine.

Kevin Pho: Now sometimes physicians are in a position where they are the ones having to give feedback.

Mary Remón: Yes.

Kevin Pho: What kind of tips do you have for these physicians to give feedback in a more collaborative way, and of course not raise any defensiveness at the recipient? What are some tips for that?

Mary Remón: Excellent question. Praise in public, criticize in private whenever possible. We cannot change the past, so rather than berating someone for something that happened in the past, try to state it in the future so there is future positive if then. “In the future, if you set up the instruments in advance and we look at the tray together, then we will have everything we need if something goes wrong, right?” That sounds much better than, “You did not have the instruments ready. You never have the instruments, right?”

So that sort of thing, phrasing it in the future can be helpful. And just saying that, you know, the expectation is, or we are expected, versus you avoiding the word you. You can say you if you are complimenting someone, but it is better to avoid if you are criticizing someone. So, also to make it kind of neutral. There is something called observation concern. Question observation is, I noticed that the last three cases started late. My concern is it sets us behind for the day and has a ripple effect. And then you ask an open-ended question, beginning with what or how, like, “What are your thoughts on how we can improve?” You know, and then help that person be part of the solution.

Kevin Pho: We are talking to Mary Remón. She is a counselor and certified coach. Today’s KevinMD article is “How doctors can turn criticism into collaboration.” Mary, let us end with some take-home messages that you want to leave with the KevinMD audience.

Mary Remón: Absolutely. So openness really encourages input and if someone gives you a suggestion, especially if you do not want it, smile, nod and say, “Thanks for the pear.”

Kevin Pho: Mary, thank you so much for sharing your perspective and insight and thanks again for coming on show.

Mary Remón: Thank you for having me.