Leadership in Medicine: Not an Oxymoron

Leadership instruction should be made a standard part of every doctor's training if we are going to adapt to changing circumstances and lead the reformation of healthcare in the 21st century.

Leadership in Medicine. No, that is not an oxymoron, even though traditionally docs have been trained to be the Lone Ranger and frustrated would-be leaders have resorted to the old “herding cats” metaphor. Recent trends in training have encouraged a team approach, but still lag in recognizing and promulgating the importance of physicians’ leadership responsibilities; and not just with other docs, but in our communities and society as a whole.

Great leaders, like great athletes, are born and spend their lives honing that inborn difference. Inborn? How do people in a stalled elevator or in a jury room know whom to turn to? We always know, although defining the “it” factor remains a challenge. Those of you who have encountered such rare individuals know what I mean. But the problem is that at every level of society we need more leaders than nature produces.

Look at the military, for example. Out of immediate necessity they have long since appreciated the value of leadership training for survival, let alone efficiency. So to get enough leaders, they have found that leadership can be broken down to a group of habits that can be acquired and polished with practice. And I believe leadership instruction should also be made a standard part of every doc’s training if we are going to adapt to changing circumstances and lead the reformation of healthcare in the 21st century.

Just for discussion’s sake, here are excerpts from some leadership manuals:

1. The most successful leaders have a clear sense of purpose. A broad goal, “The vision thing.” All successful organizations work backward from that. The “how” develops from the “what.”

2. Successful leaders are persistent, tenacious in working toward their goal(s). And they have to also know “when to fold ‘em” as well as when to “hold ‘em.” Not easy. This is where experience and education, AKA “seasoning,” comes in.

3. Gathering information before reaching a conclusion is vital, and happily docs are already schooled in this data-oriented approach to problem solving. Being open minded is an important feature of all progress, in science and in managing people.

4. Listening, with focus, more than you speak, is an essential part of the information gathering process. As many patients can attest, time pressures or not, some docs can still do better in this regard.

5. Once all pertinent information is gathered, leaders are decisive. The decision must be prompt, with the key reasons for the decision communicated clearly to all stakeholders to “get buy in” or “get on board,” without needless delay or foggy presentation.

6. The best bosses surround themselves with the smartest people, whether in formal positions, or in an informal “kitchen cabinet.” And if things go awry, which they always do, the best boss will take responsibility for any failure of those under them, without excuses. And then privately set about re-directing that person in a positive direction. If things go well, lavish public praise can often be an important element in employee satisfaction, effectiveness and retention. Which helps the organization further its goals.

7. And while we are at it, a steadfastly positive attitude is absolutely essential for any leader. In the end, no one likes a complainer or negativity, justified or not (EHR and ICD-10 notwithstanding).

8. Lastly on this list, is the Holy Grail of leadership: self-control. Grace under pressure. To spin on Hemingway, a high EQ (Emotional Quotient) trumps a high IQ by itself every day. If you are one of the lucky ones who have a strong EQ, use it. If you don’t have it, you can learn better habits. Either way, medicine needs docs trained as leaders to earn our way to our rightful position at the forefront of healthcare advocacy. We need more and better leadership to get physicians above being pawns and/or window dressing as we now all too often find ourselves.

N.B. - Follow-up on my recent article on “Financial Elder Abuse.” This week alone:

1) At the retirement community where I am the Medical Director, we identified a visiting venipuncturist who had approached multiple residents at a vulnerable time for a “loan.” When several complained that they weren’t being paid back, he was apprehended.

2) In my town, a man was arrested this week for opening multiple accounts using his 82-year-old father’s social security number. Elder financial abuse; the beat goes on….