Physicians Need to Re-assume Leadership

The lack of informed "followership" can make moot the effort of putative leaders. And such a fractured network of rudderless health care leads to avoidable poor outcomes for our patients..

It has been said that, like pornography, leadership is hard to define, but you know it when you see it. In an effort to dispel this impoverished thinking, I am offering a selection of what some thoughtful people have had to say on the subject.

As I said last week, some leaders are born but there are not enough of those in medicine so we will have to train the willing and the able. And we especially have to stop training doctors to resist group action toward a common good. You cannot have good leaders without knowledgeable and agreeable followers.

To the point of reorganizing the health care mess that we are now mired in, Niccolo Machiavelli said, "There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain of its success than to take the lead in a new order of things."

To the point of altering the selection and training of physicians to a more collaborative and organizationally aware model, Malcolm Forbes wrote, "No one is a leader if there are no followers." William Russell refined that to "In a society safe and worthy to be free, teaching which produces a willingness to lead, as well as a willingness to follow, must be given to all." Or an ancient named Tiorio who posited, "You will never be a leader unless you first learn to follow and be led."

Consider Benjamin Disraeli, the 19th century Prime Minister under Queen Victoria, when he said, "I must follow the people. Am I not their leader?" Or his contemporary Lord Byron who famously wrote, "When we think we lead, we are the most led." You get the idea.

The lack of informed "followership" can make moot the effort of putative leaders. That's part of the reason why the American Medical Association, the largest and most powerful medical organization, only has about 20% of physicians as members. Without an effective group that is seen to speak for most, if not all doctors, the lack of clout that comes from no unified voice is very wasteful and costly to us as individuals and as a society.

Worse, we are becoming aware that such a fractured network of rudderless health care leads to avoidable poor outcomes for our patients. In part, that's why the United Nations ranks the U.S. not "the best in the world" as some uninformed patriots maintain, but an appalling 37th. Yes, we may have the best care, but it's only for some, some times and some places. And at a silly, unsustainable price.

Henry Ford said that "Asking who ought to lead is like asking who ought to sing tenor." As I said, some are born, but we need more training and understanding all around. Fisher Ames tempered this thought by musing that "Leadership requires the docility to learn."

Other thoughts and definitions hat provide some illumination include:

Leadership is the "...initiation and direction of endeavor in the pursuit of consequence." - Royal Ascott

Leaders "...require a well grounded imagination of the problems of the future." - Stanley Allyn

"The ability to keep a cool head in an emergency, maintain poise in the midst of excitement, and to refuse to be stampeded are the true marks of leadership." - R. Shannon. Maybe we should look to ER training as a factor....

"A leader must face danger. He must take the risk and the blame and the brunt of the storm." - Herbert Carlson. All of medical training, for that matter.

"A great leader never sets himself above his followers except in carrying responsibilities." - Jules Ormont

Vance Packard put it one way; "Leadership appears to be the art of getting others to want to do something you are convinced should be done." Harry Truman put it another; "Leadership is the ability to get men to do what they don't want to do and like it."

"The crux of leadership is that you must constantly stop to consider how your decisions will affect other people." - Michigan State Police Maxim (!). Sure sounds like medical training to me.

Ben Hogan was quoted as saying, "Never complain..." and William Boetcker added "The final proof of (leadership) is never to complain."

Even Osama Bin Laden threw in "People flock to the strong horse."

I'll leave the last word to Napolean Bonaparte: "A leader is a dealer in hope."