Physician Leadership. Karen J. Nichols

       Leader Approach

       As a leader, this consideration of perspectives is crucial and very similar to what a physician needs to do.

       Physician Approach

       Physicians are usually good decision makers for and with their patients, if they understand what the patient hears and wants. And one of the reasons we are so good at this is because we have been trained thoroughly to know the options, questions, and implications that are available. Research has shown that the physician leader steps through the entire decision tree about a medical issue (for example, steps A–J to reach conclusion/decision K). And having done that so many times, it may look like the physician made a snap decision, skipping several levels of consideration, but that is not what happened. After a time, even the physician may not have realized they automatically went through all those steps, but they did. This is commonly known as creating and evaluating a differential diagnosis, something doctors do very well.

       Leader Approach

       The challenge for physician leaders is that we haven't been trained in any of these points/steps about leadership considerations. So, in a leadership situation with the same number of critical steps in the decision tree as above, the physician may jump from A directly to K. However, they didn't have the same education/preparation to learn about all the intermediate steps, as they did in a medical setting, in order to accurately reach an appropriate conclusion/decision. Physician leaders often don't even think about creating a differential diagnosis in a leadership situation. Very dangerous road conditions ahead!

       Physician Approach

       This is not a big topic of concern for physicians. Medical decision‐making is part of the medical approach.

       Leader Approach

       However, as a physician leader, understanding the kinds of issues that sabotage what looked like a good decision is crucial. This is a critical chapter for physician leaders to learn from, as it deals with challenges the physician seldom if ever has to even think about. This is another area where this roadmap guides the novice physician leader through as‐yet untraveled territory.

       Physician and Leader Approach

       Here is a point where there is complete alignment between being a physician and a leader. There is only one standard for character. Honorable and ethical, every day in every way.

       Physician Approach

       As a physician, we may be in a “captain of the ship” position. Emotional intelligence can be employed to create a more conducive environment to better understand our patients, but often it may not be necessary. However, in the setting of hospitals and health care systems with the need for building teams and promoting inter‐professional collaboration, relationship‐building is becoming a greater part of the practice of medicine.

       Leader Approach

       As a physician leader, either understanding or ignoring the importance of relationships and how to build and nurture them will literally make or break you. Road map, here we come!

       Physician Approach

       I challenge any physician to embrace the fact that they must negotiate to get what their patient needs. We are physicians – we know what our patients need! The need to negotiate implies that I will be trading things my patients need in order to get approval for things my patients need even more! This cannot be the way medicine should be practiced. Physicians should advocate for what is best for their patients, not negotiate and accept a lesser option.

       Leader Approach

       However, as a leader, such negotiating skills are critical. The well‐intentioned physician leader who demands what is “right” and refuses to negotiate will lose every time; another roadmap thing.

       Physician Approach

       Conflict management for the physician is very different from conflict management as a leader. What is the most common conflict that physicians must manage? Getting approval for the appropriate treatment/drug/surgery. We are well trained and have this information at our fingertips for our patients' medical issues.

       Leader Approach

       Conflict management as a leader is a very different animal. Once again, the physician is trained in all aspects of the medical issues of a particular presentation. However, in a leadership role, the conflicts arise because of different perspectives, experiences, backgrounds, a whole host of issues. And physicians are not accorded deference in a leadership situation just because they are physicians. Boy, is that annoying!!

       Physician Approach

       Physicians sometimes do have to persuade patients to select a course of action that the physician knows will get them to their stated goal. The wise physician will consider the background of the patient, previous experiences of the patient and their family, and misperceptions perpetuated by the internet or friends and family, for example. However, this occurs at a very basic level. And the persuasiveness is enhanced by the authority of the physician (one of the principles of persuasion that works to our benefit).

       Leader Approach

       The physician leader must have a thorough understanding of principles of persuasion and which ones will be most effective in leading to the desired outcome. The science of persuasion has been heavily studied, and the physician leader must understand which principles fit which situation and can be employed to move the group in the most successful direction. Skip this chapter at your peril! Hazardous road conditions ahead!

       Physician Approach

       Understanding change comes naturally to the physician. The newest drug, the newest surgical technique all change all the time, sometimes at breakneck speed. The physician must and does adapt.

       Leader Approach

       As a physician leader, it is less clear how change alters the leadership picture. It certainly does; the challenge is the physician can't easily learn about the changes from the latest medical journal because those changes occur in the legal system, the mergers/acquisitions that fly by, the governmental interventions, the insurance companies, the health systems and on and on. An unforeseen/ignored change in any one of these components of the health care delivery system can severely disrupt your leadership. The physician leader who