They shoot messengers, don't they?

"Mr. Corleone is a man who insists on hearing bad news immediately."

-The Godfather

"If you're not hearing bad news, you're at risk."

How good are you at listening to things you don't want to hear? A faculty member recently asked me this over a cup of coffee prior to the start of grand rounds. After reflecting, I responded: "I hope I'm getting better at it, because I seem to be getting plenty of practice."

But the reality, I must admit, is that I much prefer to hear good news and not bad. My perspective is that good things almost always result from hard work and careful planning; the corollary of this is that surprises are almost always bad.

Like most people, I prefer to hear good things at work: an assistant professor gets a grant from the National Institutes of Health; a resident gets his or her first choice in fellowship; or the dean is pleased with some recent development in my department. My preference is that the people who work in my department, and for whom I am responsible, are happy and successful, and that means good news.

Intellectually, I know that it is important that my colleagues and staff can be candid with me, and in particular that they understand that they can share bad news with me. Don Corleone was right; it is better to learn of problems while they are still small and, ideally, can be addressed promptly and satisfactorily. Nonetheless, even though I know better, my observation is that hearing bad news can be disappointing, discouraging, and frustrating.

Still, if you are responsible for running a practice or an ophthalmology department, you'd better know what's going on. "Once your people are afraid to come tell you bad news," a chairman of an ophthalmology department once told me when I was a young faculty member, "your days are numbered."

Apparently I'm not the only one who prefers good news. According to testimony before the international relations committee of the House of Representatives,¹ Saddam Hussein instilled an "atmosphere of fear . . . throughout his civil and military bureaucracies. Iraqis at all levels understood that in this regime the bearer of bad news in almost every case was punished severely. When Saddam developed a new plan for the defense of Iraq that made no military sense, his generals, with few exceptions, applauded the wisdom of their great leader."

Once, as a young faculty member, I had a valued employee who developed problems that dramatically interfered with job performance. In retrospect, people tried to tell me, but I just wouldn't listen. If I had listened, a big problem would likely have been avoided.

What about you? Does your office staff feel comfortable coming to you with a problem? If they do, is your response to thank them for the "heads up" or to vent at them? Have you ever been surprised when a valued staff member or junior partner resigned due to concerns that might have been addressed satisfactorily had they felt comfortable raising the issue with you? Instead, they let things fester until finally they decided to leave.

It would border on foolish to compare an ophthalmology department or a clinical practice to a totalitarian government at war, but the principle is the same. Nobody really enjoys hearing bad news, and many of us probably are reluctant to pass the bad news up the ladder.

How painful do we in leadership roles make it for others to come to us with the "ugly truth"? How good are you at listening to things you don't want to hear?

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu