Physician Leadership. Karen J. Nichols
In fact, that is what I do all day, every day!”
You begin to wonder if maybe that mentor is not quite so kind as you thought, when she says…
“You've tried leading three times already, so it would appear that if you could have figured it out, you would have done so by now.”
Double ouch!
Hence, this little book. This doctor is me. Unfortunately, I didn't go to a kind and wise mentor to get this good advice after just three tries at leadership. I've been a leader all my life. My three younger sisters still call me “bossy.” After one “instruction” session in the backyard, one of my sisters said, “You are not the boss of me!”
But I always assumed that I was! The evidence started early. In the Christmas pageant, I was one of the group of 4‐year‐olds who had been taught to sing a song as we marched around the entire 15‐feet oval area down front in the church where the pulpit was positioned. However, as each succeeding child followed the one ahead, they effectively cut off the end of the oval, in order to follow more closely the one ahead. By the time I was the next in line to walk around the oval, it was not an oval anymore, it was more like a 3‐feet circle. This would never do. I knew what we were expected to do and led the rest of the group of 4‐year‐olds all the way around the full oval. That generated no end of comments from the parents. I was just leading!
Clearly, those “guidance opportunities” provided early leadership training. I was president of every organization in which I participated before matriculating at Kansas City College of Osteopathic Medicine (KCCOM)(now KCU‐COM): vice president of my class four times at KCCOM; chief resident at the 500 bed Oklahoma Osteopathic Hospital; president of the Arizona Osteopathic Medical Association, the American College of Osteopathic Internists, and the American Osteopathic Association. It has always been very clear to me that I am a doctor, and all doctors are leaders, right? Remember, I'm an internist, and as the old line goes, “Maybe wrong, but never in doubt!”
I'm the one who wished I had had this little roadmap. It took years of reading, conferences, practice, and trial and error to learn these lessons. And I had a master's degree in Management with a specialty in health care administration before I went to DO school! It is a painfully true statement that I have made every mistake in the book! Sam Levinson said, “You must learn from the mistakes of others, it takes too long to make all those mistakes yourself.” In retrospect, it would appear I have tried to make all the mistakes, believe me – just not on purpose. Another helpful perspective that I tell myself is that there are no mistakes, only lessons, and lessons don't work if you don't put them into practice.
There is also a painful truth about physicians. Physicians are smart. Physicians are educated and trained in one of the most challenging topics known to man: the care and maintenance of human beings. So, when we physicians are launched into patient care in an unsupervised practice capacity, we are ready to go! We are also set up to fall into a huge trap in the rest of life's activities. Completing the arduous process to be educated and trained in medicine naturally results in developing an appropriate degree of confidence in the knowledge, skills, and abilities to be a physician. Unfortunately, that knowledge and those skills don't translate into mastery of other topics; witness investment mistakes, misbegotten land purchase deals, failed joint partnerships, you name it, which brings us back to: leadership. Physician knowledge and skills are not inherently fungible or scalable to other topics, despite the self‐perceived assumptions and confidence to the contrary.
Thus, these are the 11 things you must have nailed down to move to the next level of developing knowledge and skills. This book is a roadmap. Master these points and move to the next level. The problem I have frequently seen is that the physician who wishes to lead leaps into learning finance and wage and salary administration. All worthy and important topics. However, when she doesn't understand principles of communication, persuasion, and conflict management, as examples, she can't effectively implement those next‐level skills.
There are some important differences between being a great physician and being a great physician leader. I cannot emphasize enough that some approaches and skills that we are taught as being emblematic of the best approach a physician can employ do actually work well when transferred to the leadership sphere. The big stumbling block we physicians run into is when the medical care paradigm we employ is not the appropriate leadership approach and may actually be the opposite and contraindicated.
Here is the expected response from our new physician leader, both here and throughout this book, with her comments italicized to identify our conversations. And her first response:
“Seriously? I'm a terrific physician. Well regarded and well respected for my clinical skill, acumen, and approach. How can that be bad?”
Stay tuned. We will cover what works and what doesn't.
A further caution comes from Stanford's Jeffrey Pfeffer (Fox 2006): Good leaders can make a small positive difference; bad leaders can make a huge negative difference. Yikes!
Chapter Overview
So, I have set up this roadmap for physicians like me to get the basic principles behind what makes leadership work. This book covers the essence of leadership in the form of brief summaries of 11 topics. We will cover the following:
Chapter 1 – How to discover and understand your personal approach and style to thinking and interactions, as well as that of others, and how that information can and will move your agenda forward more effectively.
Physician Approach
I don't know many physicians who know there are different personal approaches, let alone what theirs might be and how that impacts their interactions. In my practice of internal medicine, I never had any idea. I'm the doctor. I tell it like it is. What is wrong with that? There may not be anything wrong with that approach as a physician.
Leader Approach
This chapter will guide you in getting to a much more effective understanding of your approach and that of others and why, as a leader, understanding your approach and that of others can make or break your leadership efficacy. Simple as that.
Chapter 2 – How to employ principles of communication to accomplish your objectives.
Physician Approach
Communicate?? I can talk to my patients, I can translate their medical situation into lay language, I can answer their questions. I have learned that over the years and have honed my skills. OK, good, that approach works well for the physician.
Leader Approach
In the leadership realm, just telling someone what is happening and what to do about it is often one of the least effective ways to lead. There is a lot more to communication than just telling people what to do.
Chapter 3 – How to implement practical techniques of communication to good effect.
Physician Approach
These points go into new territory far beyond what we usually must employ with our patients.
Leader Approach
In the same vein as in Chapter 2, there are proven techniques of communication to accomplish the goals of the leader. Follow this roadmap!
Chapter 4 – How perspectives, yours and others, impact and are impacted by the organization's culture and how those perspectives affect your leadership effectiveness.
Physician Approach
Physicians have to consider different perspectives when working with patients who come from other socio‐economic and educational backgrounds,