Conventional Management Assumptions are Killing Our Doctors: The Need for Positive Leadership

Recently I was very influenced by an article written by Pamela Wibble, and is titled, “What I’ve Learned from My Tally of 757 Doctor Suicides.”  She shares her personal quest to understand why so many doctors commit suicide.  She indicates that physician suicide is a public health crisis and shares many stunning observations.
Here I draw from her analysis and list the headlines that particularly capture my attention. Contributors to suicide include:

  • Bullying, hazing and sleep deprivation.
  • Academic failure at particular points of career progress.
  • Assembly-line medicine (15-minute intervals) and punishment for low productivity.
  • Post-traumatic stress disorder, particularly in emergency rooms.
  • Doctors who never forgive themselves for patient deaths.
  • Malpractice suits and public shame for unintentional mistakes.
  • No time for doctors to deal with their own pain
  • The fear of exposure if help is sought.
  • Some medical professionals prefer to keep the issue quiet.
  • Blaming doctors for emotional distress and deflecting attention from unsafe working conditions creates increased hopelessness and desperation.

Why do I react so strongly?  First, losing anyone to suicide is a horrible loss.  Second, losing highly educated and seemingly self-sufficient doctors to suicide is both a surprising and a horrible loss.  Third, the article appears to be about medicine and doctors.  If you are a literalist, that is all you see.  I believe the article is really about something bigger.  It is about organizations everywhere and the inability of administrators to create positive culture.
I shared Wibble’s article with a few friends who are surgeons.  One has been making presentations on a related topic.  He shared a sophisticated analysis of stress and burnout.  He suggested many approaches to self-care.  Another came back with analysis showing how stressful the work can be.  He described many tradeoffs and suggested there are no easy answers.  Then he closed with this thought: “I suspect these stress levels are related to the ‘negative’ culture in many surgical departments, and the bad behavior that surgeon stereotypes often are associated with.”
I would modify his sentence and expand it beyond surgery and beyond medicine: “I suspect these stress levels are related to the ‘negative’ culture in many organizations, and the conventional behavior of administrators and employees in those organizations.”
Consider this: in medicine, we find bullying, hazing and sleep deprivation.”  We no longer stand for bullying and hazing in first grade.  Why does it occur in sophisticated medical systems?  Why does it occur, in less blatant forms, outside medicine?  What assumptions are being made, and what are those assumptions doing to our organizations and our lives?
In the above headlines, we also find punitive educational designs that lead to failure; economically driven service designs that often do not work for patients or doctors; job designs that lead to post-traumatic stress disorder; failure to psychologically support those who lose patients or experience malpractice suits; failure to recognize that doctors are humans who experience pain; failure to create effective support systems; and the administrative need to cover problems and blame the victim.
If I took a conventional route, my next paragraph would be a condemnation of medial administrators.  That would be misleading and less than useless.  I have worked on culture change projects in a number of health systems.  I find the administrators, like the doctors, to be highly stressed, but wonderful people who want the best for patients, staff, and doctors. It’s not just doctors who experience pain. On a given day in any organization, the workforce is full of human beings in pain.
A couple of years ago, I was invited to speak to young people who were finalists for residencies in a well-known hospital.  The idea was to spend the day on leadership.  During the morning, doctors gave advice that was accepted.  When I went on, I said, “From listening this morning, I conclude that leadership for a young doctor is to get on national committees so as to gain visibility and power.  It seems to have nothing to do with serving and elevating patients, staff, and colleagues.”
This is not just about medicine.  I was once head of a doctoral program.  I recognized the examination process leveraged the fear of failure and was designed to create maximum stress.  I redesigned the process so it still examined capacity but greatly reduced fear and stress.  I assumed my very progressive colleagues would welcome the proposed system.  Instead they resisted it at every turn.  I boiled down their arguments to one less-than-wholesome idea: “We went through it. Why shouldn’t they?”
Conventional management assumptions are killing our doctors and sapping the energy of the entire global workforce.  Positive leadership is the ability to transform conventional organizations into flourishing systems.  Scientifically we know that transformative influence means embracing and modeling the common good; showing individualized consideration; providing inspirational motivation; and challenging conventional thinking.  Management courses do not teach people how to do this because professors make the same assumptions about teaching that administrators make about management.
In a recent talk, I explained the problem and offered a new approach to leadership development.  It is not about knowledge and skills, it is about vision and the acquisition of moral power.  It is time to realize that in every profession we have to make an enormous investment in positive leadership, the ability see possibility and optimize human potential.
The Talk:
An Educational Program for All:

  • How is the suicide of doctors reflected in your organization?
  • What elements of “negative culture” exist in your organization?
  • What assumptions justify negative culture?
  • How could we use this passage to create a more positive organization?


2 comments on “Conventional Management Assumptions are Killing Our Doctors: The Need for Positive Leadership

  1. As always, your insights resonate with me. I’d like to add one of my own to the conversation.
    It has been my experience at the University–first as a student, and later on staff–that the environment is designed to encourage competition. This is not only true in the student population where so many are graded not on what they’ve learned or how they’ve engaged that knowledge, but how they can prove they know “more” than someone else.
    This is even more pronounced in the faculty structure. Tenure, position and prestige are the things which seem to define success; I have only rarely encountered what I would perceive as a passion for teaching for the sake of helping others learn, and encouraging students to grow as whole persons.
    In the realm of the health system, I believe this reaches its epitome. In addition to the hazing and shaming that seems to be a required part of the medical environment (and how counter-intuitively that phrase reads!), research ideas and studies are jealously guarded; concerns for intellectual property seems to trump the goal for which the research is being conducted.
    As I was processing these ideas, it occurred to me that the culture presumes–and therefore, perpetuates–a pyramidal structure, which is designed not just to reward those who compete well enough to reach the pinnacle, but to do so at the expense (personally, professionally and emotionally) of those who may be just as talented and educated but not as competitive by nature.
    My question, then, is this: assuming this picture is accurate, can we find a way to “flatten” the structure so that more members of the culture have opportunities to succeed on the merit of their own efforts, without doing so at the expense of someone else?
    It’s probably clear I lean toward a “yes” answer to that question; I’m not sure how to achieve that outcome, however.
    Either way, thanks for making me think about these things, and looking for ways to apply them not just in the abstract, but in the world around me where I have influence and can make a change.

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