I am a people person, plain and simple. I enjoy interacting with my fellow employees, and I view many of them as extended family. However, I never make the mistake of thinking they are family when it comes to the job they're expected to do. My son may or may not make his bed every morning, but I can't fire him either way. However, a receptionist who was like a daughter to me wound up exploiting my sympathies to come in late repeatedly had to go.

I don't to say that this distinction is an easy one for me to make. I know the struggles my employees go through, and the urge to help them is an instinct that comes naturally to me. Nowhere does this come more into conflict than during performance reviews. If it were up to me, every employee who did good work would get a sizeable wage increase.

Of course, it isn't up to me, and through the years I've developed a thick hide in order to be fair to all concerned. As a way to distance myself and maintain a professional demeanor, I follow some basic rules of negotiation:

- Know what your goal for the review is in advance. A good evaluation balances both strengths and weaknesses, so know the gist of what you want to get across to your employee. A direct approach is the most effective.

- Listen actively to what your employee has to say. I know from having been on the receiving end of many performance reviews, what it's like to not be heard. Often, if there's a problem, the solution can found through hearing what someone is saying, and reading between the lines.

- When it comes to salary increases, have a fall-back position. Know that the employee may want more than you initially offer, and so you have to know whether the issue is flexible and the limits you're willing to accept.

- Make concessions together. If an employee asks for a larger increase, perhaps there can be a performance-related expectation tied to it. Don't feel you have to win or they have to lose. The key is to feel like you are both getting something mutual from the review.

As I've said many times, the nature of a medical practice invites a certain welcome intimacy; a sense that we're all in this together. While that can be seen by some as an invitation to exploit the situation, at its best, it makes both management and staff feel like they're on the same team. It's a philosophy that satisfies the twin needs of running a sustainable business and giving patients the best care possible.