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Pediatrician and certified coach Jessie Mahoney discusses her article “Dealing with physician negative feedback.” Jessie validates the pain that comes with criticism, noting that it hurts not because physicians are weak, but because they are human and deeply invested in their patients. The conversation explores the physiological response to negative reviews, suggesting practical mindfulness techniques like placing a hand on the heart to lower cortisol and signal safety. Jessie advises against the habit of rumination, encouraging doctors to instead create a “generous story” that frames the feedback through a lens of curiosity rather than shame. Discover why prioritizing integrity over being liked is essential for sustainable medical practice.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast today. Welcome back, Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Dealing with physician negative feedback.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much.

Kevin Pho: All right, so tell us what your latest article is about.

Jessie Mahoney: So this article is about the reaction that we have as physicians to negative feedback, which is usually quite a strong reaction. The criticism, and I would say any kind of criticism, feels huge and significant and stings a lot. It often lasts for a long time. I do a lot of coaching around people having feedback. Maybe it is a patient complaint or maybe it is feedback from a leader. We tend to just dive into rumination and self-doubt. It impacts things like sleep. Sometimes people even apply it to their ultimate career choice. They wonder if it was a mistake and if they are a decent doctor.

We can take these tiny bits of feedback and just blow them into huge things. So I thought the conversation around what we can do and how we can respond in a way that is less costly and more helpful to us is worth a discussion.

Kevin Pho: All right, so what is the typical physiological response that physicians get to negative feedback? I think this could apply to anybody because nobody likes negative feedback, right?

Jessie Mahoney: Yeah. Nobody does. We dislike it more than the average person because we are trained to think that if somebody doesn’t like us, something terrible will happen. It means something bad. That comes back to the root of our training. If you weren’t liked on rounds somewhere, then you wouldn’t get the next residency or the next fellowship. In my day and age, you would end up under a freeway overpass homeless because you couldn’t pay back your loans. That was the energy that came with it.

So we see feedback as a threat, and our nervous system goes into fight, flight, or freeze. The freeze is a bit of the rumination. So it is very common for people when they get some kind of negative feedback to lose nights of sleep over it and to not be able to get out of the spin. They then start to weave stories that are quite painful and much bigger than the initial comments. Sometimes they are not even meant to be critical comments, but sometimes they are. Our brain weaves these elaborate stories about them from the lens of trying to protect ourselves from harm, and yet we are causing ourselves harm in our reaction itself.

I think that is trained into us, and so it is very hard to untrain it. We also somewhere along the line have been taught to equate responding to feedback and taking it seriously as part of being a good doctor. Like if someone were to send a patient feedback, for example, we often have to respond to it. But we also feel like we have to take it very seriously, learn from it, and change things. And yet, very often our patients aren’t actually supposed to like us, despite what Press Ganey and other versions of getting patient scores suggest. I think that good doctors actually do get complaints. In pediatrics, we don’t always prescribe antibiotics. We shouldn’t always be prescribing pain meds, and we shouldn’t always be doing all the things that patients want because they are actually not trained in medicine. So good medicine actually results in disappointed patients. Most of us are so uncomfortable disappointing anyone. We equate it with danger.

Kevin Pho: So I think that I see this sometimes in the context of medical malpractice trials, right? Physicians who are on trial for a perceived mistake take it so personally. But then you have the defense and the plaintiff attorneys who argue so viciously in the courtroom, and then after the case they go out for dinner together. It is part of the job for them, but the physicians left are taking things so personally.

Jessie Mahoney: Oh my gosh, yes. My husband is actually an attorney. One of the things that I have learned about law is that being an attorney is about telling good stories. It is really about who can tell the better story. And yet we take it as facts and judgments about our care, our ability, and even how much we care.

Kevin Pho: And you wrote in your article that sometimes negative feedback even hurts the most seasoned physician. It doesn’t matter how long you have been in medicine. Whether you are a trainee or whether you have been practicing medicine for 30 or 40 years, negative feedback still hurts the physician.

Jessie Mahoney: Yeah, I don’t think it has anything to do with how long you have been practicing. We are actually, I believe, trained to think that any negative feedback is not OK. I often told people when I was a department chief that when we do our evaluations, we actually had a box where we had to put things that people could improve. That box, if you watch it, would trigger people’s nervous systems. But you couldn’t close the evaluation if you didn’t put something there.

So I think that for me it was always a challenge because I knew that anything you put there would be triggering. I don’t think it is that physicians don’t want to improve. I think we actually do want to improve. That is why understanding this nervous system response and figuring out how we can respond in a way where we can actually feel curious, calm, grounded, and ready to learn, rather than go into shame, blame, catastrophizing, and overwhelm, is actually useful. But it takes a lot of work.

Kevin Pho: All right, so let’s talk about some of that work. So how can we train physicians to accept negative feedback in a more helpful and healthy way?

Jessie Mahoney: Well, it is interesting because I think the first thing I was going to say was to work on your physiology. But the first thing is actually to notice how we personalize feedback and notice the thought patterns of catastrophizing and all of those things. If you can notice them before you notice your physiology, that is perfect. Sometimes our physiology is freaked out such that we can’t notice anything. We are just in this spin.

I think recognizing the fight, flight, or freeze response and taking a moment to regulate your nervous system to the best of your ability is key. That could, for some of us, just mean taking a few deep breaths. Sometimes it is putting your hand to your heart to shift those neurochemicals so you are not in a cortisol and norepinephrine bath. We know this in health care, but we don’t take the time to do it. So taking that pause and figuring out what you can do to settle is important.

I think in the case of negative feedback, acknowledge that it is really challenging. You will go in and out of these moments of regulation. Sometimes we need an even longer pause, especially if it is something like a malpractice suit, which we take as negative feedback. That can take a month of pause. But in these smaller instances, taking time to work on your nervous system helps. Working on it outside of negative feedback so you have access to what that feels like is good.

Figuring out tools that help you ground and get out of the physiologic and brain spin is essential. That involves a lot of mindfulness tools, and there are so many. Finding one that works for you is important. I think we think we have to be exceptional at meditating, and I don’t think a lot of physicians are, and that is OK. But can you just look at taking some intentional deep breaths? For some, it is one pose. Maybe it is doing a child’s pose and putting your head on the ground, or even putting your head on a desk or a yoga block to just shut your mind off from that spin.

You are essentially trying to interrupt the automatic physiologic response, and then you can get to what is true about this because there is always something true about it. I also like to point out what is true is that people will always complain. What is true is that you will always be upset when someone complains because we are all trying to do something good. Acknowledging those two things right upfront is helpful. People will complain and you will always be upset when someone complains, and nothing has gone wrong when either of those two things happen.

Then you can get onto other things like telling a neutral story, or what I call a generous story. This means telling a story that doesn’t make it worse. Tell a story that doesn’t flip you into more of a physiologic cortisol and sympathetic storm, and ensure it is a story that is also true. I think that patients have their own stories. They are coming from their own space of scarcity. A patient in pain of course wants some medication that is going to work even though they don’t understand the long-term consequence of it.

So tell a story that maybe you acted from a place of integrity. You acted from a place of good care, and not all patients would understand that. That is what I mean by a generous story, not a made-up story that nothing bad will come of it or that you shouldn’t be upset about it. Telling yourself you shouldn’t be upset is really being mean to yourself. Of course you are upset about it.

I also really like the strategy of asking better questions. Ask yourself what you can learn from this and what else could be true as your brain is offering scary stories. Another one I love is asking what if we were a mismatch. In pediatrics, you are not a match for every family. Surgeons are not a match for everyone. Your style might not be a match. So ask questions that sort of get you out of that negativity. Ask how this sheds light on your strengths. Maybe you actually practice very judicious antibiotic or pain medicine approaches, and not all patients will like that.

The other piece that I think is so helpful is focusing on what is in your control. That is not what they wrote, but how you respond to it or what you write in response, and how you choose to take care of yourself. Sometimes when people have gotten better at responding to negative feedback, one of the things they do is get mad at themselves for not handling it perfectly. I have done this a lot where I think: “Well, I know all these things, how come I am still upset?” Recognizing that we are human and all humans get upset means we can get better and better at it. No human loves negative feedback. They are just not going to. I think just recognizing that it is going to be painful and takes work is a process, and we will just get better and better. But so many people just get in that spin and struggle to get out.

Kevin Pho: So a lot of things that you just mentioned require actions that aren’t done impulsively. Again, we talk about the pause. We talk about not acting in the immediate aftermath of receiving that feedback because all the things that you just mentioned require some reflection. Not responding when you are emotionally dysregulated is key, right?

Jessie Mahoney: Yes. Yeah, and I am thinking actually we talked a bit ago about physicians who get called out or get in trouble. I think that usually comes when there is negative feedback and we respond in dysregulation. Recognizing that the long-term goal of having less negative feedback is actually learning to regulate and respond to it carefully is important.

A lot of this comes from caring. We care and we want to do a good job and we want to make a difference. So when we do get negative feedback, it gets at something that feels so integral to who we are and why we practice medicine that it feels like extra pain and extra judgment.

The other thing that comes to mind here is what we make it mean. This is where people can really spiral into negative thoughts about themselves, self-harm, thinking they need to leave the practice of medicine, and a lot of shame around negative feedback. Could we as a medical culture normalize that there is always going to be negative feedback?

Much of the negative feedback today comes from systemic issues and not us. But there is no other way to address them than sending in a complaint or a patient complaint that might not even be about you. This isn’t to dismiss it because there is always something we could do better. That is true of the human condition. It is just that we are perfectionists, so we don’t like that human condition.

I have had surgeons say they don’t want to be human. Humans make mistakes and humans get complaints, and it feels so threatening to us. So I think just recognizing how we feel threat physiologically and in our brains and asking if it is true that we are in danger is helpful.

Kevin Pho: And specifically in the context of patient satisfaction, like you alluded to, you don’t necessarily want to be that physician who receives universal acclaim. You don’t want to be the physician who acquiesces to every patient request, like for antibiotics or opioids, for instance. So sometimes in order to be a good physician, you have to expect negative feedback. Maybe reframing it and having that expectation that negative feedback is going to come your way means that sometimes you are doing a good job.

Jessie Mahoney: I think it can be a sign of doing a good job. It is bringing me back to the time when I was a department chief. We were expected to reward physicians who had the best scores. But someone who had a hundred percent score means that they are quite accommodating and usually people-pleasing. So maybe we should actually be rewarding scores that are 90 percent or recognizing that some percentage of people are going to be dissatisfied. Isn’t it interesting that our culture in medicine is that the perfect score is the way that we want to show up?

I think recognizing when you have this feedback means asking if you acted with integrity. Did you do the best that you could? Did you practice the medicine that you believe is the best care in the moment? That is another example of looping back to asking good questions. When we ask good questions, then we can get out of this spin of shame, blame, and guilt.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Dealing with physician negative feedback.” Jessie, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: One is to recognize that it is often not about you. It has to do with the person who is complaining and their nervous system and what is going on with them. Really name your response because we say name it to tame it. Notice what is happening.

I think it is absolutely worth creating and building a toolbox of ways to respond to negative feedback because that is part of being a human. Notice your defaults and begin to work on these things because we can change them. If we are to survive in the health care system as it is, and even in any future health care system, there will always be patients who aren’t pleased and someone always has room for improvement.

If we can view it as asking what we can learn from this and how we can grow, we realize that it isn’t a personal affront, a threat, or an assessment of your level of ability or your fit in a career of medicine. That is where we will be able to move through it in a way that is healthier and more sustainable.

Kevin Pho: Jessie, as always, thank you so much for your insight. Thanks again for coming back on the show.

Jessie Mahoney: My pleasure. Thanks for having me.