Dr. Campbell: The value of ‘we’ in health care

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

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
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

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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