Doctor as fixer is too narrow a role.
“Awareness is not a giver of solace….It is a disrupter and an awakener.”
(R.K. Greenleaf )
Greenleaf in his book Servant Leadership asks, do those served by your leadership grow as people? I wonder, do you even serve yourself in your work as a doctor or are you so busy running around the wheel that there is no time or capacity for awareness? Do you serve your patients as well as you could? How about the junior doctors you are responsible for training and assessing? How do you serve your colleagues?
The doctors I work with are seeking to be better leaders, to be better at giving and receiving feedback, to be better supervisors and teachers, to be more effective communicators with their patients, their families and their colleagues, to be better able to look after their patients. They are interested in serving others.
From the beginning of medical school students are taught the hippocratic oath, expressed simply as do no harm for the purpose of this discussion. As a minimum we all accept this, but this is not the same as serving others or leading others. To learn the skills of leadership doctors need to look elsewhere. I was struck at the 2018 Gathering of Kindness in Melbourne how many doctors from our big hospitals had undertaken community leadership programs so that they could learn the skills they need to lead a team of people. All said they did not have the skills they needed for their job and that their workplace would not fund this learning, as the priority was on technical updates for their clinical work, so they sought it elsewhere.
I am not seeking to define leadership here, however I will note that most leadership programs and books start with the premise that we must know how to lead ourselves first, before we can lead others well. Those people who have undertaken the community leadership programs are indeed leading themselves well and the program has unanimously served them well. These doctors are not relying solely on their organisations to teach them leadership. They are expanding their capacity in the interests of serving more effectively. Many eminent leadership teachers have concluded to lead we must first know thyself (Peter Drucker, Stephen Covey, Bill George, Daniel Goleman to name a few). As a result most leadership programs begin with a process that aims to increase self awareness.
Psychologist Daniel Goleman describes self awareness as “knowing one’s internal states, preference, resources and intuitions”. Monitoring our inner world, our thoughts and emotions as they arise, the what and how of ourselves, if you like. It is more than gathering knowledge about ourself, it is seeking to understand how that self knowledge impacts moment to moment on self and on others, how the self interacts with the environment. This knowledge is key to developing emotional and social intelligence. High self awareness scores in the business world are the strongest predictors of success.
So if self awareness develops, will this help a doctor serve others more effectively? How will self awareness develop the doctor’s skills to be of service or to lead? And, how do we know if we have indeed served the ‘other’?
Jim Collins in his book Good to Great concluded that “greatness.. is largely a conscious choice”. Humility, he said, is essential for great leadership. The great leaders, Collins concluded, gave credit to the team whenever there was a success and when there was trouble they looked in the mirror to their own contribution to the problem. Greenleaf thinks that service involves helping others develop. This kind of leadership exists beyond the ego. As Ricardo Semler recognises managing the ego is a delicate exercise, one that requires balance. So how does all of this apply to doctors who want to serve?
Doctors are trained to solve problems and they see themselves in this way, as problem solvers. People arrive for an appointment with the doctor to have a concern resolved and they are happy when indeed the doctor (and/or their team) provides them with an answer and ideally a fix, for the presenting problem. This feels like service for both parties. What happens though, when there is no fix or there are many possible answers, none of which are clear cut? This happens every day in medicine many times over. How can the doctor be of service in this situation? How do they lead themselves and their patient in this ambivalent circumstance?
Awareness can go a long way towards serving the doctor in this situation. It helps the doctor acknowledge and learn about their unconscious biases, to be alert to their assumptions and their ego and to develop skills in regulating their own emotions. This affects their communication and their expectations and these impact on their relationship with the patient, allowing them to communicate and expand beyond the role of ‘fixer’.
When a doctor does not have the answer to the patient’s problem this can raise strong emotions like fear, self doubt, shame and even guilt (the origins of Imposter Syndrome). These feelings make us all feel vulnerable and uncomfortable. Learning mindfulness raises our awareness and teaches us how to regulate our feelings and as a result, to think more clearly, be more effective. It allows the doctor to work with the patient towards some form of resolution like acceptance of the situation. Many cultures and many patients in our own culture, value time talking with the doctor highly and feel better afterwards, even when the presented problem remains.
Often I talk with doctors about mindfulness and sometimes they are keen to learn these skills. Many times doctors tell me they don’t believe in mindfulness. Mostly, if they are open and willing to have the conversation and a few experiences of practicing mindfulness, they change their minds. Too often though a doctor is busy asking the questions, shutting the door on possibilities, (diagnosing trains doctors to rule out options) and getting busy fixing the problems like time management, to even notice. They think they are being of service, I wonder if they slowed down would they speed up! Mindfulness teaches us this skill. Mindfulness can be uncomfortable initially, like any new skill, we are first consciously incompetent before we are competent. Practicing mindfulness grows our awareness and yes, sometimes it gets more uncomfortable before things improve.
Awareness helps us see, hear and feel our own behaviour and our own thoughts, not all of which are obvious and least of all to ourselves. Awareness grows our discomfort sometimes, that’s called learning or growing. We can awaken to our own limitations, disrupt our habits and assumptions, prioritise more effectively, show our compassion more readily and be ready to serve well when we are mindfully aware.
If you are waking up from your own busy-ness and stress and really want to take your service to another level, let’s talk. Greenleaf thinks that service involves helping others develop. When I sit with groups of doctors who are open to learning, the outcomes are profound, largely because doctors are witnessing each others’ growth and that gives them all courage. Personally the doctor opens up their mind and their heart, allowing new thoughts and emotions to awaken. Learning naturally occurs in this environment. The doctor has been disrupted and a new kind of healthcare (service) can develop. To enter this space requires some level of openness in the first place, some willingness to disrupt oneself in the interests of serving others better. Some courage. The same qualities we ask of patients- openness, willingness, courage.
I have been working with doctors for four years as coach and facilitator, sadly only two doctors so far have been over fifty years of age. The junior and mid career doctors I work with are keen to serve and want more from their mentors than technical updates, they are seeking to give and receive leadership that is awake. I wonder what the impact of medical experience is in terms of our willingness to grow and I wonder how our senior doctors are serving themselves and our junior doctors.
How are you serving your patients and trainees? Are you awake? Do they develop in your leadership or are you stunting their growth? Medicine is so much more than technical skill, doctors who are self aware have so much more capacity to serve.