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Mirror Mirror


This blog post complements the talk I gave in the closing session of DFTB19. It has been recorded and will be released as FOAMed later in the year.

As part of my ongoing professional development, I volunteered for an experiment the Australasian College for Emergency Medicine was running. As a consultant, it is really hard to get feedback on how you are doing, both clinically and professionally. You could ask your colleagues face-to-face, but how honest an answer are you really going to get? So, I enrolled in a pilot multi-source feedback program. Unlike traditional peer feedback and yearly assessments, where you receive one-on-one feedback from the head of the department, this was something different.

I had to nominate 15 colleagues to complete an online survey about my professional behaviours. Anonymized to make sure that things would not be seen as personal. I chose colleagues from all levels of my work life – interns, registrars, peers, my immediate bosses and the Chief Medical Officer of the hospital. I chose doctors from specialities that I refer to on a regular basis, and I chose non-clinical staff, too. In order to increase the actual worth of the project, I included some people that I feel that I don’t get on with as well as I could (yes, they do exist!).

The findings were…interesting. There were the usual comments about drinking less coffee and learning to say no, both of which I fail at miserably on a regular basis. And then there was this one.

Now, clearly, this says more about the author than it does about me, but it did get me thinking about the impact we have in the workplace.

Emotional contagion

Human beings are social animals. We thrive in groups and, despite having had language for approximately 100,000 years, we rely on non-verbal communications to let members of our tribe know how we are feeling.

Charles Darwin, in his threequel to The Origin of the Species, wrote that, despite their fleeting nature, our emotions are written large on our faces, and this process is far beyond our control. But what is more fascinating is what happens when someone witnesses that unbidden display of emotions. Watch someone smile, genuinely smile, and mirror neurons light up in your brain. In a series of fMRI studies, Rizzolatti et al. showed that the same area of the brain fires up when you witness an emotional display as if you had experienced it yourself. This reflexive, sub-thalamic response is emotional contagion.

Whilst our emotions influence our physiological state, the reverse is also true. If I smile (more on that later), I feel happier. If I frown, I feel more sad. And if I cannot frown – perhaps I have succumbed and finally got some Botox to rid me of these troublesome wrinkles – then I will actually feel happier. Well, that is what some scientists have found.

Negative states

The problem is that negative states – fear, anger, boredom – are much more readily transmitted than positive ones – kindness, compassion, and calm. Perhaps because they often come unbidden and out-of-control, they are more likely to leak out before they can be contained.

This can cause major problems in the workplace as a doctor infects all those around them.

Our work has a high level of emotional labour, moving from high-intensity states, such as dealing with life-affecting resuscitations to low-intensity states of chronic constipation, without pause.

Some people are more susceptible to emotional contagion than others. Take a look at Docherty’s 15-part emotional contagion susceptibility scale and see where you might fall.

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154

And if you are the sort of person that finds themselves crying at the movies, then you are not alone. I’ve left a little something for you on our YouTube channel for the next time you want to cut loose.

There are some highly infectious people that we can find in any department.

We’ve all met the MAVERICK – the hotshot doctor that thinks they know everything. They don’t need to follow the guidelines because they know better. They can send home the febrile 28-day-old because they look fine to them. They can make the half-baked referrals because it’s the end of their shift, and they must get to their beach volleyball game. Besides, the team will sort it out.

They make us fearful, nervous, a little afraid. Their arrogance spreads as they achieve more success until…. They make a mistake. And they will.

So how can we help them? How can we protect ourselves and the department from their contagion? They need to be reminded, gently, that even Tom Cruise wears a safety harness. Guidelines are there for a reason. It’s okay not to agree with them, but you have to be able to defend your actions. If you want to go your own way, you need the evidence to back you up. Rather than ignore the MAVERICK and allow the worry to fester it’s important to head them off (whilst allowing them to save face). You set the tone!

What about the MOANER? You only have to go into the staff room of any department in the hospital to spot one of these creatures. They are the ones drawing everyone into their spiral of doom as they complain about so-and-so from X (insert particular out-group here). Before long, the rest of the group has been infected, but their particular brand of emotional catharsis and everyone begins to moan.

It’s easier to not become one of them than it is to change their mind. This is the time for herd immunity. The more positive people there are in the room, the better. Rather than joining in, it is time to point out the dangers of stereotypes and labels. And should the opportunity to moan about your lot at work arise, then it is time to take the higher ground. Remember, you set the tone!

And finally, there is the MAGNET. Years of bad experience has led to a degree of learned helplessness. The more times they have been crushed by the chaos of the system, the more they feel it is pointless to do something about it. At the mention of the Q word – the word-that-should-not-be-named – they predict an apocalypse worse than any Private Frazer could dream up. Equipment will fail, stock will be missing or fall apart, and nobody will be around to help at the critical juncture – all because you said the word q.u.i.e.t.(shhhhh!)

So what can you do? It is time to role model the desired behaviour. You cannot control what is happening outside of your department, but you can claw back a little control from the chaos within. At the beginning of every shift, I check the key equipment that I might need to make sure it is working, I make sure that nothing is missing, and I make sure roles have been allocated before the inevitable happens. I set the tone!


All of this behaviour, including the examples I give in my talk, could be seen as manipulative, perhaps even a little sly. Teams that have a happier outlook, with members that embrace positive emotional contagion, are safer and more efficient. Whereas when experimental psychologists planted a MOANER as a confederate, they found that teams became much less efficient.

Which sort of team would you rather work in?

Selected References

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154.



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