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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, cultures, age groups, genders, and ethnicities.

 Leader Approach

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

Chapter 5 – What are effective approaches to decision‐making to get to better solutions with better buy‐in? How can unintended consequences lead any decision‐making process off the rails?

 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!

Chapter 6 – This chapter is about decision‐making that doesn't work, and why not.

 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.

Chapter 7 – How your character guides your personal approach, which affects your interpersonal relationships.

 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.

Chapter 8 – How your relationships, enhanced by employing emotional intelligence, can make or break your leadership. Further, developing good relationships becomes the backbone of building teams.

 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!

Chapter 9 – What are the basic steps to employ effective negotiation skills?

 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.

Chapter 10 – What are the principles of conflict management?

 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!!

Chapter 11 – What are the tenets of persuasion, and how do they have a big influence on what you and others decide to do, most of which you are not even aware of?

 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!

Chapter 12 – How to manage change to promote successful leadership.

 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 doesn't understand how to successfully implement change is severely handicapped as a leader. The medical and political climate speaks to the importance of this emphasis.

Chapter 13 – What are specific meeting dynamics that can aid or sabotage your purpose?

 Physician Approach

 In the care of patients, there are not a lot of meetings that directly impact the care of a specific patient, other than a tumor board, which is carefully scripted and conducted in a very traditional way.

 Leader Approach

 The physician leader who doesn't understand the impact of meeting dynamics on effective leadership is seldom going to be able to achieve their desired goals. And will never figure out why. Thus this roadmap!

Chapter 14 – How the physician leader functions as a whole person.

This is a perspective chapter addressing issues that both women and men physicians and physician leaders must wrestle with. And this focus covers all the issues now seen in diversity, equity, and inclusion.

Chapter 15 – Summarize the big picture.

Yes, the big picture summarized in this chapter is a strictly leadership thing, as the big picture for the physician is the patient. And that is as it should be.

“I thought you said there were 11 topics. How did we get to 15 chapters?”

Good question. Some topics are dealt with in two chapters. You will get the basic concept in one chapter and the practical techniques in the second chapter. And there is a bonus chapter dealing with issues of being a whole person as a physician, especially as a physician who is a woman, one of the minority groups in medicine, and who is coming from a specialty, internal medicine, that has been underrepresented in many organizations in which I have participated. Its not exactly a topic with defined principles and techniques in the same way as the other 11 topics, but it has pertinent and important perspectives for physician leaders from many diverse groups.

This roadmap summarizes the topic and then provides the connections to the tried‐and‐true resource documents when you get stuck or are ready to dive into the details. Each chapter will present the idea in a basic outline and finish with some questions to guide your understanding of the main points. Each section will also finish with that list of top‐notch resources when you are ready to do the deep dive into the topic.

You don't have to read this book in the order presented. You may be fully experienced on some of these topics. You may just need some specific pointers on one topic or another and can go directly there. My caution is that everyone must touch base with Chapters 1 (know yourself) and 2 and 3 (communications) to be sure you have those points nailed down, as everything else builds on them. I do have to add that even if you think you are very familiar with a particular “stretch of this roadmap,” you may find that you know the topic as a physician but don't have a full appreciation for the topic as a physician leader.

A caution: Reading articles and books (even this one) will give you ideas, but they can't teach you how to think. The “Five Steps” and the “Three ‘Ps'” and every other generic framework for problem‐solving are heuristics/rules of thumb. They can describe approaches, but they cannot make you think. Just as in medicine, articles and books are not the gospel; they are just the author pinned down.