Building an Honest Feedback Culture — Part 2
Imagine you’ve built it.
The structure I described in the last post is in place. Your meetings have feedback woven in. Roles distribute responsibility. The norms make honesty expected and safe.
You’re done, right?
Not quite. Even with the best structure, you still have to speak up. What you say is shaped by something structure cannot reach: your instinct for what good feedback should sound like.
Most of us get that instinct wrong. We learn feedback from environments that modeled it badly. We end up with a default that feels caring but isn’t, or a default that feels honest but lands as cruelty.
Kim Scott, author of Radical Candor, offers one of the clearest frameworks I have found for addressing this. She developed it over years of giving and receiving feedback at Google, Apple, and Twitter. It fits physician leadership surprisingly well.
The Two Axes
Scott’s model has two axes.
The first is Care Personally.
Do you truly care about the person you’re giving feedback to?
Do they know that you do?
The second is Challenge Directly.
Are you willing to tell them what you actually think, even when it is uncomfortable?
When you put those two axes together, you get four quadrants.
“It’s not about being a jerk. It’s about caring enough to be honest.”
– Kim Scott, author, Radical Candor
Quadrant 1: Ruinous Empathy
This is where most well-meaning physician leaders end up.
You care about your team. You don’t want to upset anyone. So when someone underperforms, you soften the feedback so much that it doesn’t land. You smile and nod when a colleague’s proposal is flawed. You let the colleague who’s always late keep being late because bringing it up feels awkward.
You may think you are being kind, but you are not.
Scott calls this Ruinous Empathy because it harms both the person and the team. The person never gets the information they need to improve. The team sees you tolerate substandard work and assumes that standards do not matter. Eventually, when the situation becomes intolerable, and you finally take action — such as firing someone, writing them up, or escalating to HR — they are caught off guard. No one ever told them.
“Why didn’t anyone say anything?” they ask.
The honest answer is: because we cared too much to be honest.
Quadrant 2: Obnoxious Aggression
This is the other place physicians live, often without realizing it.
You challenge people directly and tell them exactly what you think, but you forget, or never try, to show that you care.
It’s the attending who says, “That interview was a disaster,” and walks off.
It’s the chief who tells a colleague in front of a committee, “I don’t know why you’d bring something this half-baked to the table.”
It’s the medical director who fires off a scorching email at 11 PM, copying the entire department.
The feedback might be technically correct, and the intent might even be good. But if the relationship has not been established and care has not been shown, the message feels like an attack.
The person on the receiving end doesn’t think, “How can I improve?” They think, “How can I protect myself from this person?”
That’s the end of any feedback culture you were trying to build.
Quadrant 3: Manipulative Insincerity
This is the worst quadrant. And, thankfully, it’s relatively rare. But it shows up in politics.
It’s the leader who neither cares about the person nor challenges them directly. They smile to your face and undermine you behind your back. They tell you what you want to hear and complain about you to leadership.
If you find yourself living here, you have a bigger problem than feedback skills. You have an integrity problem.
For most physician leaders, this isn’t where we struggle. But it’s worth naming, because every large team has at least one person operating here, and recognizing it matters.
Quadrant 4: Radical Candor
This is where good feedback lives.
You care personally. And you challenge directly. Both. Always.
It’s the attending who pulls the resident aside after the interview and says, “I was hard on you in there. I want you to know why. You’ll be running these intakes on your own in a few months. I need you to be ready. Let’s go back and walk through what you missed.”
It’s the chief who tells a colleague, in private, “I want to give you honest feedback about the proposal because I think you have a real contribution to make here, and I don’t want this version to sink it. Here’s where I think it’s not landing.”
It’s the medical director who, in a one-on-one, says, “I’ve noticed something in the last few meetings, and I want to talk about it. I’m raising it because I think you can lead this group, and right now, something is getting in the way.”
Notice what these examples have in common. They express care first and establish the relationship before delivering the challenge. Then they challenge clearly and specifically, without softening the message.
Why This Is Hard for Doctors…And For Everyone Else, Too
Physicians have a particular challenge with Radical Candor, and it comes from our training.
We learned that caring means taking action. If the patient is in pain, fix it. If the team is stressed, absorb it. If a colleague is struggling, cover for them.
Caring, in that framework, looks like protecting people from discomfort.
But Radical Candor changes how we think about caring. Caring personally about someone’s growth does not mean sparing them discomfort. It means giving them what they need to improve, even when it is hard to hear.
The kindest thing you can do for a struggling colleague is to tell them, with clarity and warmth, what’s getting in their way. Not “give them time to figure it out.” Not “let it work itself out.” Tell them.
That’s harder than rescuing. It’s also what they actually need.
A Quick Self-Diagnosis
Not sure which quadrant you’re operating in? Kim Scott would probably say worry less about the quadrants and more about the axes. She would also say that we fall short on this framework almost every day.
But if you want to improve, try this.
Think of one piece of feedback you’ve been meaning to give someone for a while. Now ask yourself why you haven’t given it yet.
If you’ve been avoiding it because you don’t want to hurt their feelings, you’re in Ruinous Empathy.
If you’ve been delivering it sharply because they “should already know better,” you might be in Obnoxious Aggression.
If you’ve been smiling to their face and venting about them to others — that’s Manipulative Insincerity, and it needs to change today.
If you have been waiting to have the conversation because you want to find the right moment, the right words, or the right way to say it, congratulations. You are trying to use Radical Candor and are on the right track.
But you might also feel stuck. Knowing which quadrant you want to be in is not the same as knowing how to have the conversation. Most physician leaders I know can recognize Radical Candor but still hesitate to use it when it is their turn.
What’s Still Missing
The structure tells you where feedback can live.
The framework tells you what good feedback looks like.
What is still missing are the mechanics: the actual words and actions that keep the conversation on track when emotions run high. For that, we will turn to Crucial Conversations by Patterson, Grenny, McMillan, and Switzler next week, a practical complement to Radical Candor.
Also, it’s worth noting that Scott now says that she should have called her book Compassionate Candor rather than Radical Candor. She says that some bosses have interpreted her call for radical candor as permission to be jerks, which she never recommends.
In the meantime, enjoy Kim Scott’s 6-minute video about becoming radically candid:
This is the second of three posts in Building an Honest Feedback Culture, a short series on what it actually takes to build an honest feedback culture in physician-led teams.
Part 1, Why Not Everyone Gets Honest Feedback, published last week, diagnoses the factors underlying the lack of honest feedback.
