Telling a Colleague the Hard Thing Without Wrecking the Partnership
Physicians are trained to critique cases, not each other. Here is a practical approach to peer feedback and conflict that protects patients, preserves trust, and keeps the conversation human.
You have noticed it for months. A partner leaves discharge summaries unsigned for days, and the nurses have started routing questions to you instead. You mention it to your spouse, to another partner, to yourself on the drive home. The one person you have not mentioned it to is the colleague who needs to hear it.
Medicine has a rich culture of case critique and a thin culture of peer feedback. We can dissect a missed diagnosis at morbidity and mortality conference with precision, then go silent when a colleague's behavior is the problem. The silence feels kind. It usually is not.
Separate the behavior from the verdict
Most avoided conversations are avoided because they feel like accusations. The way through is to describe what you observed, not what you have concluded about the person. "Three of your discharge summaries from last week were still open on Friday" is a fact your colleague can respond to. "You do not seem to care about follow through" is a judgment they will defend against.
Before the conversation, write down the specific observation, its effect on patients or the team, and what you would like to see instead. If you cannot fill in all three, you are not ready to talk yet.
- Choose a private setting and a moment that is not the end of a brutal shift.
- Ask for the conversation directly rather than ambushing someone in the hallway.
- Lead with curiosity. There may be a reason you do not know about.
Expect defensiveness and let it pass
Physicians often tie their professional identity closely to competence, so even mild feedback can land as a threat. The first response is frequently a counterexample, an explanation, or a complaint about someone else. Do not argue each point. Acknowledge what you heard, then return calmly to the specific observation and the request.
The goal is not to win the conversation. It is to make the next week go differently.
Sometimes the conversation reveals something bigger, such as a family crisis, a health problem, or burnout that has been building for a long time. When that happens, the feedback becomes a door. Offer support and, where appropriate, point toward confidential resources your organization provides. Staying in the role of colleague rather than therapist matters here.
Know when it is no longer yours to handle
Peer feedback works for patterns that are fixable and do not pose immediate risk. It is not the right tool when patient safety is in danger, when there is possible impairment, or when behavior crosses into harassment. Those situations belong in formal channels, and a good colleague uses them without delay.
For everything else, the most useful habit is to speak sooner. A small observation offered early is far easier to hear than a list of grievances delivered after a year of silence. This week, pick one thing you have been carrying about a colleague and decide whether it deserves a conversation. If it does, schedule it.
Dr. Lindqvist is a psychiatrist focused on clinician wellbeing, moral injury, and sustainable careers in medicine.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
