Using Status Behaviors Wisely as Clinicians

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Angrydoc copyThere is a fascinating discussion about status and human behavior in Keith Johnstone’s seminal book for actors, “Impro“.  He maintains that vying for high or low status positions in our relationships is going on constantly and that as audience members we find status differences and changes to be interesting to watch.  As such, mastering verbal and nonverbal expressions of status are important strategies for theatre direction and performance.

We also see it’s importance in military or police work where being in a high status role requires physical stance, facial expression, uniform, and perhaps a weapon that clearly state, “I’m in charge here!”.

stethoscope in handsStatus is one of those topics that the more you study it, the more fascinating it is. I wonder how it is connected to power, money, position in society or at work, physical size or strength, educational level, majority culture, etc.  I also wonder, when and how it contributes respectful relationships or those that embody fear and mistrust?   How is it related to responsible leadership and followership and when is it compromising psychological safety in teams and patient safety in teamwork? Although not her main theme, Suzanne Gordon’s recent blogpost, “More about Introductions and Acknowledgement” discusses important related behaviors.

Being aware of and facile with expressions of high and low status can help us to use them wisely in healthcare (and to not use them unwisely).

  • Doctor uses authoritative and directive tone in directing code team’s response to a patient’s cardiac arrest.  Wisely
  • Nurse uses assertive tone and body language demonstrates high status in raising concerns with a physician about a patient’s clinical status.  Wisely!
  • Nurse apologies frequently, mutters, and covers her mouth when speaking uses low status when raising concerns about a patient’s clinical status.  Unwisely!
  • Nurse’s assistant sits down next to patient with dementia while feeding him.  Wisely
  • Doctor uses dismissive and humiliating language to belittle a nurse who raised concerns about a patient’s clinical status.  Unwisely
  • Nurse Practitioner speaks softly and is mindful of his body posture in lowering his status to create psychological safety for an anxious patient.  Wisely!

Medical Improv is one way to learn more about status behaviors and their importance in therapeutic relationships, collaborative leadership, and interprofessional communication. Learn more about how it works in this video Medical Improv and Status Activities I did with National Association of Independent Medical Practices,

And/or check out these status-related posts:

Can Practicing Improv Make Hospitals Safe?

“Hi, I’m Doctor Salerno, but please call me Tony”!

The Status Game is Killing Us. Literally.

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9 Responses to Using Status Behaviors Wisely as Clinicians

  1. Pingback: Medical Improv is Relevant to Outcomes You Seek!

  2. Donna Carol Maheady says:

    So interesting Beth!
    Unwise use of status occurs in nursing education as well. For example, a new faculty member voices an opinion at a faculty meeting….the comment is dismissed by the group facilitator. Or a new faculty member (non-tenured) is serving as a thesis committee member….comments by the new faculty member are ignored by the faculty member with tenure.

    • Beth_Boynton_RN_MS says:

      Oh man, great examples, Donna. Ugh…how quickly creativity can be oppressed. And not a huge leap to vertical or horizontal violence. And sadly, I think everyone suffers as well as the system itself. I’m happy to defer to a higher status if there is some clinical reason….BUT as human beings I believe we’re all of equal value.

  3. Elizabeth Scala says:

    Great resources, Beth. I love how you share all of the books with us so that we can further look into this topic. I have been thinking about this as well, as I embark on a collaborative project myself with a physician colleague. It’s so interesting to me how the status is set up- when really, the patient ought to be the one ‘in charge’ of it all. After all, its that patient’s life we are all looking to help.

    I also enjoyed your examples of wisely used versus unwisely used statements. Great teaching, thank you!

    • Beth_Boynton_RN_MS says:

      Thanks, Elizabeth. Fascinating, isn’t it. It would be interesting to hear your colleague’s take. When I took the med improv Train the Trainer Course at Northwestern University Feinstein School of Medicine, we spent the 4th day teaching material and I paired up with a physician who was wonderful to work with. I had to really be intentional with my assertiveness and he certainly was intentional about listening. It was healing for me in way. And ironically we did some status games and had a great discussion about the topic. Keep me posted on your insights and experiences. It would be a fascinating conversation.

      • Elizabeth Scala says:

        Will do. We don’t even have our ‘formal’ signed agreement yet, but when we do and things move forward, I will certainly keep you posted. (I feel another great blog piece ahead, LOL.)

    • Donna Carol Maheady says:

      I like the use of wise and unwise as well!

What are your thoughts?