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I am posting this blog five days after Halloween. But in keeping with the Halloween theme, I decided to write a blog about something I find scary in a practice. Toxicity.  Not the obvious type of toxicity with drugs, but rather a toxic environment.

We are health care providers.  Though most of our efforts are on improving the health of our patients, it doesn’t mean we can ignore the mental health and well-being of our own staff.   And, for that matter, our own health. 

In my more than forty years of practice, I have worked in a large clinical setting and in a partnership private practice.  I have also been doing fill-in work for many different optometrists and opticians.  It has given me a unique perspective on the relationships between staff and doctors.  I am still confused on why anyone chooses to work in a toxic negative environment when they could make small changes and create a positive one.  It has never made any sense to me. And yet, I have seen it happen over and over.


There are many factors that determine the environment and culture of an office.  In my experience, the strongest factor I have seen is the leadership of the practice. The leader sets the mood for the office. Leaders guide by example. They show us how to treat our fellow workers, as well as the patients who visit our offices. As a leader, we need to be aware of the example we set.

There is a hierarchy in most practices and it is necessary to some degree.  Someone has to be in charge and make the big decisions.  But their management style affects everyone who works with them.   Employees may try to counteract the undesirable aspects in an office, but it will fail unless the leadership gets on board.


Every practice is different.  And every solution different.  But, there are some common elements in practices that have positive cultures.  One of the most important factors is how we treat our staff.  I’m not talking about salary, bonuses, vacation, and other benefits.  Those things make a difference, but they are not the most important factors in how an employee feels about their work and why they stay in a position.  Studies have shown that employees will stay in a job, even when the pay is lower, if some strong basic needs are being met.

These basic needs include:  being heard, being appreciated, and knowing that what they do makes a difference. If people feel these needs are being met, they will become a good and loyal team member.

I know meeting basic needs won’t solve every problem, but it is an excellent place to start.  Treating our employees with respect and valuing their contributions and their ideas has no bad side.  It’s a win-win for everyone involved- doctors, staff and patients.  It’s also a win for our families.  If we leave our office less stressed out and tired, we can bring a positive energy home to our family instead of a negative one.


As I pointed out, I have worked in different settings.  When the office environment deteriorated, I did everything I could to make it better.  I put up with toxic environments for years trying to make them improve. But, one person alone can’t change a bad situation.

I stayed too long and felt myself become a different person.  I didn’t recognize myself anymore. I had no joy, no love for what I was doing.  No energy to even care anymore. Even my family noticed the changes and expressed concern for me. 

I love my career choice and taking care of people.  Fact is that I still do.  I am good at what I do. But I experienced first-hand what a lack of respect and trust can do a person- what it did to me.  Not being heard and not being valued stripped everything away from me. Being constantly bombarded with negativity damages a person at a basic level. Toxicity is detrimental to your practice on so many levels and not just in staff turnover.  And there is no reason for it.

There is no doubt in my mind that toxic environments change people in a negative way. The literature also supports these harmful effects.  It is well-documented that it is not only a psychological change, but also has many physical manifestations.  


It is beyond the scope of this blog to identify all possible contributors to a toxic environment. Books are available that cover the topic better than I can.  But, as a start, I would like to share some of my observations on what I have seen.

  • Never correct or criticize an employee in front of their co-workers and absolutely never in front of patients.  It is humiliating and robs a person of their dignity.  You have made it impossible for them to be effective in working with patients or fellow workers.
  • If you are angry, take a moment before dealing with the problem.  Words can hurt and can’t be taken back.  Consider what you want to say and how to express yourself in a constructive manner rather than a destructive way.
  • Don’t play favorites or compare one staff member to another. This is the antithesis of creating a team.  Appreciate every team member for their own unique skills and abilities.  When you start looking for the good traits in everyone, you may be very surprised at what you learn. And when you find those skills, you’ll see that they can complement and inspire those of other staff members.
  • Do you notice all the good things your employees do?  The times they go above and beyond what is expected of them. Do you notice when they correct a behavior you asked them to change? If you only notice the shortcomings, the mistakes and never the things they do right, you will have a problem on your hands.  


Bosses who only use negative feedback don’t realize that it won’t get them what they want. No matter what your staff does, you will always find something wrong.  Soon staff members will just give up.  What’s the point if you only see the negative and always find something else to criticize?  

When you choose to lead with positive feedback and notice all the little good things, you will get more and more of that behavior.  We all will repeat a behavior that gives us positive feedback and a sense of being valued and appreciated. It’s a good feeling.

Constructive criticism is necessary, but there is a right and wrong way to do it.  Remember that even if you try and balance criticism with positive feedback, we only hear and remember the bad things.  Everyone knows this.  Think about all the positive reviews you’ve received and that one nasty one that you just can’t forget.  Our staff experiences the same response.  

Try and make the critique into a conversation.  Share your observations and the problems you’ve noted and then ask them if there is something you can do to help them bring up their performance.  Include them in the solution. Outline the changes that you expect and need.  Establish a time table to re-evaluate performance.

Distrust, micromanaging and not being consistent creates an apathetic and defeated staff. Training your staff, encouraging them to learn, fostering their skills and then empowering them to perform will give you a talented, motivated and happy staff.


There is so much in our daily lives we can’t control, but creating a positive environment is something that is in our control.  It encourages each person to rise to their highest level. And it will be noticed and felt by every patient who enters your office.

Obviously, staff selection and training are also important to a cohesive work force and a positive environment.  But recognizing that part of the problem may be a toxic environment, allows you to begin to find the solutions.  Deciding to make a change is an important start.  Your life will be better for it.

What do you do to foster a positive office setting?  How do you interact with your employees to give them positive, as well as negative feedback?  Share your ideas on what has worked for you in your office.  Your comments and ideas may help someone else find a way to make their office environment more desirable. 

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