Chapter 36: Physicians as leaders – aim to be the best !
|"I start with the premise that the function of leadership is to produce more leaders, not more followers. "
- Ralph Nader.
Doctors have always been highly regarded, and are considered to be the elite of society. The community looks upto them, and they are expected to be role models which others can emulate. Thus, while one would expect many doctors to be leaders, unfortunately, very few are. Names like Dr Albert Schweitzer; Dr Jivraj Mehta ; and Dr Bernard Lown ( who founded International Physicians for the Prevention of Nuclear War, which was awarded the Nobel Peace Prize in 1985) spring to mind, but most of us would be very hard-pressed to think of even a single contemporary Indian doctor who could legitimately be considered to be a leader.
Why is this so ? Is it because Indian doctors are too busy taking such good care of their patients, that they cannot spend any time or energy in providing leadership to the society they live in ? This is too charitable an explanation. The sad truth is that the entire Indian medical profession today is headless. Our medical societies and associations are renowned for being corrupt – and it is a matter of lasting shame for all Indian doctors that the chief of the Medical Council of India has been locked up on charges of corruption by the Supreme Court. What is even worse is that the Court has chosen to appoint a non-physician to head India’s premier medical council !
Why have things come to such a sad pass ? Unfortunately, most leading doctors are engrossed in petty medical politics and pulling each other down, like the legendary Indian crab who will ensure that none of the others crabs in the basket will ever be able to crawl to their freedom because he will pull them back to captivity.
The entire profession now has a tarnished image. Doctors are seen to be greedy, corrupt and unethical , and few doctors are proud to be doctors anymore – which is reflected in the fact that so few want their children to follow in their footsteps. After all, if leading
doctors take cuts and kickbacks, what is the image of doctors in society going to be ?
We need to get our act together, and we can play a leadership role if we want to. Not only is this our right, it is also our responsibility. After all , we occupy a privileged position in society, which has given us a highly subsidized education, prestige , and a comfortable income and we need to make the most of these privileges to fulfill our role as responsible citizens. After all, if doctors will not become leaders, who will ? We are educated, articulate , affluential , respected , and deal with humans and their problems daily – I am sure the average doctor would become a better leader than the likes of our present leaders, such as Laloo Prasad Yadav. We wield considerable personal influence because of our one on one intimate relationship with our patients – and doctors who have powerful patients can have a powerful impact on society. Unfortunately, many of us use this influence to further our own petty ends , rather than thinking of societal good. We need to leverage this ability, to provide leadership to society . Unfortunately we have abdicated this responsibility , even in our daily professional life. In private hospitals, doctors kow-tow to the trustees, and in government hospitals, they scrape and beg before the babus and politicians, to get the best postings . Far from being leaders, we are so disunited and fragmented , that even illiterate workers have more powerful unions than doctors do.
How does one go about becoming a leader ? How do leaders become leaders ? Is it in the genes? charisma ? education ? wealth ? luck ? training ? experience ? It’s actually a little bit of all of these - leaders have leadership skills , which all of us can learn ! There are basically 4 groups of skills - personal skills; interpersonal skills; team skills and organisational skills.
The Leadership Diamond created by Dr Koestenbaum provides a useful model of how to think like a leader. The Diamond describes four interdependent leadership abilities: Ethics, Vision, Courage and Reality, which are a leader’s inner resources. Their inter-relationship determines the shape and size of the space within the Leadership Diamond, which in turn describes an individual’s leadership capacity, called "Greatness."
In the Leadership Diamond, ETHICS refers to the importance of people and integrity. It means caring about people; being sensitive and of service to them; and behaving in accordance with moral principles. VISION means being creative , applying analytical skills, thinking big; looking at situations in new ways; and being inspirational. COURAGE is defined as taking charge; using power wisely; acting with sustained initiative; managing anxiety; and being free and responsible. REALITY refers to a no-nonsense approach to facing life without illusions; relying on data that is factual rather than emotional; and being tough, task-oriented and results-focused.
All of us are already leaders in some way – either in our clinic, family, hospital, or medical association ( some are good leaders, most are indifferent and some are terrible ! ) We just need to enlarge our perspective and think big, so we can strive towards achieving greatness – accomplishing a big goal which is worth aiming for.
In order to become a leader, you first need to take control of your own life. Start by working backwards . Think about your epitaph – what do you want to be remembered for , after you are dead and gone ? Everyone has areas of special interest, which they are enthusiastic and excited about – something which "turns you on” . Treat this as your niche and then focus on it. The trick is to start small, and then grow. Visualize this as a T-shaped model of your life and spend the first few years in developing depth in a specialized area – the vertical stem of the T. Once you are acknowledged to be a leader in this focused field, you can then expand your horizons and start to broaden your area of influence – start working on the horizontal stem of the T. The depth of knowledge which you have picked up in a specific area will prove to be immensely valuable when you
apply it to other fields, since leadership principles remain the same in all areas.
Just like executives are taught to plan their career , doctors too need to plan their life, if they wish to become leaders. If you do not have a goal you will never be able to achieve it ! The commonest mistake many doctors make is that they focus all their energies on building their practice, so that all they accomplish in their life is treating more and more patients. They become busier and busier doing the same thing they have been doing all their life. While patient care will always be your core competence, after some time this is likely to lead to boredom, and repetitiveness stifles personal growth.
Life has stages, and you need to progress from one stage to the next . While most of us make the transition from being a medical student and then a resident ( education ) to becoming a doctor ( professional work ) with ease, because this is performed automatically and is expected of us, few of us are able to think of moving on the next step, with the result that we often remain stuck as competent doctors all our lives. This is why so many middle aged doctors burn out when they are 40 or 50. They have reached the peak of their plateau and do not know where to go next, so that they never achieve the leadership positions they are so capable of. Traditionally, doctors have continued doctoring till they reached their graves – but this is no longer true, and fortunately, there are many more leadership options available today. While it is true that making the transition involves a certain element of risk, the ability to take risks is a key skill every leader needs. In fact, not taking the risk is sometimes the biggest mistake doctors make – and then regret for the rest of their lives.
The final leadership platform is the arena of politics, where you can play a leadership role on a much larger scale. However, for most doctors, politics remains a dirty word, and a popular joke says politics is derived from poly, meaning many, and from ticks, signifying blood-sucking parasites. While many of us enjoy complaining about the poor quality of our leaders , and talking about how corrupt and inefficient they are is a popular topic of party conversation in India today, we cannot afford to take such an ostrich in the sand attitude anymore.
The government is now passing new rules and laws which curtail medical autonomy and this bodes ill for the future of our profession. We have no choice but to become politically active, if we want to regain control over our professional independence.
An excellent example of the increasingly intrusive government policies in healthcare is the recent amendment to the PNDT ( Prenatal Diagnosis and Treatment) Act . This amendment is a major slap in the face of all medical professionals, because it treats all doctors as potential criminals, who need to be constantly policed. Thus, the Act mandates that all clinics which perform ultrasound scans should prominently display a sign saying, " Fetal sex determination not performed here”. This is highly demeaning and is an insult to all doctors ! Why should doctors have to put up a sign which says they do not perform an illegal act ? Using the same analogy, all police stations should also have a sign
saying , "Bribes not taken here " ! To compound the insult, the Act has created an avalanche of non-productive paperwork, because all ultrasound scans performed during pregnancy need to be reported. Even worse, this Act demands that we compromise our patient’s confidentiality, because the name and address of every pregnant woman undergoing an ultrasound scan ( which today has become a routine procedure) should be reported to the government !
The fact that such a poor piece of legislation was passed in the first place makes for an interesting story, and underlines how powerless doctors have become in the face of vested interests. After the Census 2001 figures were released, an NGO moved a public interest litigation in the Supreme Court, claiming that the decline in the sex ratio was a result of fetal gender determination, because the government was not implementing the PNDT Act properly. In response to the Supreme Court directive, the Health Dept secretaries were hauled up, and they promptly bent over backwards to comply. Unfortunately, bureaucrats only understand paperwork, and the Act was passed uncritically, because it appears to be designed to protect the girl child. In reality, this amendment encroaches on our patient’s reproductive rights, because it prevents them from using technology to plan their family. Unfortunately, no one has spoken out against it, and sadly, future generations will pay the price ! What is to stop the government from further restricting reproductive freedom by implementing an even more coercive population policy which enforces a one-child or two-child norm, as suggested by former
Union Health and Family Welfare secretary, A.R. Nanda ?
Doctors are obliged to protect their patients’ best interests and we need to stand up for our patients. We do not function in a vacuum, and we need to take a leadership role in shaping medical policies which affect public health and private medical care for the sake of our patients – and for our sakes as well ! This is an opportunity we need to seize, and while individually there is little we can do, together we can command respect and clout. An excellent example of our collective power is the fact that a surgeon kidnapped recently in Bihar by goons was released only after the members of the Indian Medical Association of Bihar jointly threatened to strike.
We need to learn from doctors in the U.S. . Predatory insurance contracts, HMO cost pressures, burdensome government regulations, and the threat of unjust malpractice suits have galvanized them into organized political action. They can no longer afford apathy since their survival is now at stake, which is why they are playing an increasingly active role politically. They have realized that if they wish to continue to practice quality medicine , they have to get legislators to pass doctor-friendly and patient-considerate reforms. Doctors have started to lobby for their rights, and many medical societies are active and alert in this area. There are none so blind as those who will not see, and if Indian doctors continue to turn a blind eye, we will soon find ourselves in the dire predicament the medical profession in the U.S. does today. American doctors are so buried in paperwork today in order to meet legal guidelines that many are choosing to retire at the age of 40, because they cannot put up with the irksome burdens any more. The malpractise crisis has taken the joy of medicine away, and if we don’t watch out, the three devils of modern medicine in the U.S. today – stifling insurance contracts; HMO cost squeezing techniques; and an avalanche of governmental regulations and paperwork are all likely to become a reality in India in the next few years in response to market pressures which shape the Indian economy as we become part of the global economy.
Healthcare has become an important issue in India today. The government is finally seeking to play an active role in ensuring our population is healthy, because it realizes that our people are our most important resource, but because of poor health care, they cannot reach their potential. Unfortunately, though this is such a vital area in which
doctors have so much expertise, they have provided precious little input, and this is sad. We need to take a leadership role, and by becoming politically active, we can influence issues beyond medical practice, such as prescription-drug costs and universal medical coverage. We must be involved in the process that governs the way we practice. Isnt it better to be a player than a victim? We need to play an active role in ensuring that we take only the good from the West, and leave out the bad, so we can capitalize on our strengths. Government policies that threaten the quality of health care are often developed by officials who arent knowledgeable about medicine. Doctors who hold public office can defend our profession and protect the patient-doctor relationship.
Doctors are well-educated, and because they are in constant touch with their patients, they are aware of ground reality. They are highly respected members of society, and are likely to become much better leaders than the present tribe of politicians, many of whom are corrupt and semi-literate. But can doctors become good politicians ? Isn’t this role better left to others ? Interestingly, there is a strong tradition of doctors entering politics. Our past history provides many role models of doctors who have become excellent leaders, and a shining example is Dr Jivraj Mehta, the Dean of Seth G S Medical College, who later became the Health Minister of Bombay state.
It’s also worth recollecting that the very first article in the very first issue of the largest selling medical journal in the USA, Medical Economics ( dated October 1923) was titled The Place of the Physician in Politics." The author was Dr Royal S. Copeland of New York, one of two physicians in the US Senate. Copeland argued that doctors, thanks to their experiences in caring for patients in the cities and countrysides of America, had the broad vision required of a public servant. Copeland acknowledged that a doctor would be reluctant to leave his profession for a different calling. However , "when he does venture into this field, his education, his experiences, his human contacts, his broadened sympathies and intimate knowledge of the endless needs of the human family must make him a useful and active agent for the good of the nation. He knows the heart of humanity."
Organizing doctors, the saying goes, is like herding cats, and because of their fiercely independent spirit, Indian doctors have failed to play an active role in healthcare policies, because they are not organized or united. The tragedy is that we often waste our time and energy fighting each other. While many doctors are politically active , they are usually active only in medical politics , where they squabble over promotions, medical society chairmanships, and grants. What a waste !
Many doctors are now sitting for the IAS examination to become IAS officers, because they want to take a more active role in running the country. Doctors often top these examinations, and they do become good bureaucrats, because they are trained to think scientifically, search for the truth; and to fight for their patients and to serve them. As an aside, it’s interesting to note that politicians want to stop doctors and other professionals from applying for IAS jobs, because they are worried that it will be difficult for them to coerce educated public servants into doing their bidding !
The best way is to start small – apply for a corporator’s seat, for example. Unfortunately, many doctors have huge egos , and expect to get elected just because they are doctors. Ground reality can be unflattering and you’ll have to learn humility - don’t expect to become health minister just because you are a doctor. Fortunately, you may not have to indulge in corrupt practices to get elected, because good doctors have lots of good will in the community . If nothing else, trying to get elected will teach you the art of negotiation and compromise ! Don’t expect other doctors to be supportive – and even your family members may feel you are crazy to leave the security and comfort of your medical work. While it is true that becoming politically active may cut down your medical practice , you may find that your patients may be your most loyal supporters.
We all need to evolve with the passage of time , as Shakespeare so eloquently described when talking about the seven stages of man, and joining politics allows a doctor to do so. Your sphere of influence grows, so that your "stage " is then no longer your clinic or your hospital, but the city or the state – and your patients are then no longer just the ones who come to your clinic, but rather the entire population. You start to think on a much larger
scale , so that your potential for doing good also becomes much larger. In India, poverty remains the leading cause of ill-health, and as Rudolf Virchow , the father of pathology
( and a member of the German parliament ) wisely said many years ago, " Medicine is a social science and politics is nothing else but medicine on a large scale. If medicine is to fulfill her great task, then she must enter the political and social life. Since disease so often results from poverty, the physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”
Doctors will make far better leaders than the corrupt politicians we have today. Because they are educated, financially well off and able to think scientifically, they will be able to make decisions which are in the best interests of society, rather than only looking out after their personal selfish interests. Unfortunately, most able doctors are so devoted to their profession , that they hesitate to take on the larger work of helping to heal the ills of our nation. However, we owe this to our colleagues, to future doctors and to our patients !
You need to aim for a goal which inspires you ! Be proactive and learn to "think out of the box " - or get ready to be left behind . Trust yourself – you are well educated, resourceful , creative and capable . However, you might need help to plan your next step, because it is still not the traditionally accepted thing to do in India.
Fortunately, today there are professional coaches available, who will help you plan your life. A number of excellent websites (https://www.physiciancareerventures.com) and books ( Learning to Lead: A Workbook on Becoming a Leader by Joan Goldsmith) are available to guide you as well.
Be willing to go off the beaten track . Follow your own heart – and others will follow you, so you can become a leader, with the ability to influence far more people than you could as a doctor !