The Best Medicine: Leadership With a Personal Touch

All across the country this month, students are marking that great American rite of passage: graduation. I recently had the honor of delivering the commencement address to medical school graduates at the University of Arizona. The speech gave me an opportunity to reflect on the importance of strong and able leadership, a subject that often gets short shrift in the busy world of medicine. But few subjects are as central to the well-being of our health care system and the patients we serve.

I'm talking about the ability to form solid and honest relationships with a wide range of colleagues and patients -- to influence and to be influenced by their behaviors in positive ways. Indeed, how we treat those around us on a personal level is as significant as all of the medical knowledge we gain and apply in our careers.

Effective leadership is a rare thing, and something we don't teach well in medical school. I can't say enough about its importance. In fact, I wish I could bottle these lessons as a graduation gift.

As we train to become physicians, our teachers focus primarily on the knowledge and skills needed to practice medicine. But it is our capacity to maintain strong human bonds through the obstacles we inevitably face that distinguishes those who succeed from those who do not.

Like any skill, developing the capacity for leading requires careful analysis, practice and the willingness to change based on feedback. Most of us don't have the luxury of executive coaches or leadership gurus to critique our performance. For this reason, it is essential that we develop our own abilities to take stock of our interactions, reflect on what we can do better, and determine how to hardwire the right behaviors into our interactions with fellow physicians, nurses, assistants and others who are so vital to our success.

This capability is often referred to as "emotional intelligence." It includes self-awareness as a primary element -- the ability to view our own behavior through the eyes of others. Unfortunately, we often learn to figure out after the fact how an interaction or discussion went wrong. As we develop greater insight, we can identify the triggers that lead in an unproductive direction and avoid attitudes and actions before they damage relationships.

This level of maturity is our goal. How do we get there?

Lesson number 1: Become better observers.

Study how effective leaders interact with others. They are our best role models. We can also learn a lot from those who struggle with their leadership roles. The important thing is to evaluate our own interactions by whether they elevate the people around us, not by whether they cast us in a more positive light. If we can accomplish the former, the latter will reliably follow.

Lesson number 2: Give the people we work with the credit they deserve -- and do it explicitly, repeatedly and unselfishly.

We lose nothing by being generous. To the contrary, people remember this kind of thoughtfulness. Even more important, they will work harder and smarter to sustain the experience of being appreciated and valued.

I learned this lesson the hard way at the University of Chicago's medical school. For a time, I served as the school's faculty dean for medical education, overseeing the curriculum and interacting with a wide range of faculty and students with differing points of view. At one point, our curriculum was undergoing a complete overhaul, and the university's alumni magazine produced a cover story on the process and the potential for curricular renovation. It featured a long interview with me, including "action" shots of me doing whatever actions a dean does. (Answer -- not much.)

Shortly after the story was published, I received a call from the most esteemed senior physician in the medical center, our chair of medicine. I was delighted to visit with him -- he was leading the search committee for a new chair of surgery and it was a job I wanted. He began our meeting by telling me I had screwed up and in a big way. He pointed out that success in curriculum revision would be determined by the innovation and support of the faculty much more than anything I could do personally. He said that by putting myself forward as the face of change to the exclusion of others, I had undermined the credit due to my colleagues on our team. I left his office knowing that I had bungled the magazine interview and missed a precious opportunity to do something positive for our staff. I felt I had lost two jobs in one day.

But something clicked, perhaps because of his directness and the respect I had for him. I made a conscious decision to change. From that day forward, I made a point to recognize the contributions of others. When the next publicity opportunity arrived, I assumed a lower profile and instead put forward colleagues who had contributed to the project. And a funny thing happened. In their public comments, nearly every faculty interviewee gave me generous credit for enabling their contributions and for creating a supportive environment. The praise was disproportionate to anything I had done. And so things worked out nicely. We finished the curriculum revision and the chair of medicine was the first to acknowledge my maturation. (I ended up getting the job as chair of surgery and serve for 14 years.)

I was reminded of this experience recently when my wife and I visited Venice, Italy, with a group of friends. One afternoon, we wandered off into the maze of islands and canals that make up that amazing city-state. In due time, it was getting dark and we had no clue how to get back to our hotel. I approached a crusty and very authentic looking workman and asked him how to find St. Mark's Square, the central plaza where we were staying. He smiled and said simply: "It's not far, but it's not easy."

I have since adopted this as my mantra. Strong, effective leadership is attainable but not without work and conscious effort. It is often said of surgeons that we are occasionally wrong but never in doubt. I can say with complete certainty that I have no doubt about the workman's wise counsel.