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Cover Focus | Sept/Oct '19

Lessons in Leadership

In medical school and residency, I was unaware how important the topic of leadership would eventually become to me. Then, when I started out in practice and began to build and interact with a team of employees, I discovered I needed to learn the tenets of leadership. As a result, for the past 10 years I have been conducting an ongoing independent study on the makeup of a successful leader and the best methods to effectively lead others. This article outlines some of the key lessons I have learned in the process.


In his book Extreme Ownership, Navy Seal Jocko Willink describes a situation in which an exchange of friendly fire resulted in the death and injury of some of his troops. In his postmortem report detailing the incident, Willink was asked to identify all the individuals who were responsible. Despite his subordinates’ mistakes, Willink decided that, as a leader, any action they took was ultimately his responsibility because he must not have properly instructed them or impressed upon them the importance of their jobs. This action of taking responsibility showed Willink’s troops he was a man of intense character—someone who had earned their respect and for whom they would risk their lives.

Several months ago in our clinic, a VIP patient had a special request for cataract surgery that should have been easy to deliver. (Given the nature of the case, I can’t disclose the details.) As part of our process, the nurses in our preoperative area briefed the scrub techs and circulating nurses on the surgical plan, including any special instructions. Despite the various layers of checks involved, the special request was missed. Because I was not made aware of the special request, and because I had not made myself aware of it through a thorough review of the plan, I also missed it. As soon as the nurse recognized her error, she approached me and explained what had happened. It was too late; the error had already been committed. Rather than blame her for her part in the chain of events, I reassured her that every patient I operate on is my responsibility.


By making the people around him or her feel safe and protected, a leader creates a circle of trust; those inside are then inspired to help the leader execute his or her vision. Harry Overstreet said, “The very essence of all power to influence lies in getting the other person to participate.” A leader must think about how he or she is going to motivate others to engage. Will you offer higher salaries or higher wages, and then work your employees to the bone? Or, will you try to inspire your team members, share values and beliefs, and build trust and security? Those inside a circle of trust share mutual respect, understanding, and support. The wider you can extend that circle, the more people on your team will feel protected and will buy in to your vision. Some leaders create a small circle of trust, say of just the executive staff or the doctors, but those outside that circle may not feel protected. But what if you extended that circle of trust to include everyone from the custodian, to the front-desk person, to the person who checks in and checks out patients? We need our entire team to be within that circle of trust so that every member feels motivated.

The way I see it, you can either lead like Darth Vader and force people to advance your goals, or you can lead like Yoda and inspire people to adopt those goals as their own. And it is important to note that leadership is a choice, not a rank. Although leaders look after the people in their charge, those without people in their charge can still lead from wherever they are, by taking care of the people on their right and on their left.


You cannot build trust with others if they cannot count on you to tell the absolute truth. If you are willing to create false narratives about a surgical complication when explaining it to a patient or to his or her family members, your team is watching and looking to you to see what is acceptable. When a complication occurs, a leader owns it and is transparent about it. It is most important to tell the truth when it hurts (and when it is also the easiest time to lie). Leaders must hold themselves to a higher standard of honesty and integrity.


Having good character means doing the right thing when no one is looking. A leader’s legacy is based on his or her character and how he or she treats the people he or she isn’t necessarily required to treat well. If you treat people as expendable, that will affect your legacy. As a leader, you must to be consistent—what you say and do at work and outside of work must align, and you should take extreme ownership of every aspect of your life. Of course, we all have room for improvement. But it’s important to have people in your life who are willing to help you identify any weak spots. An individual at the top level of leadership inspires others and maintains a paradoxical blend of personal humility and professional will.


A standard is not your ideal but what you tolerate. If, in your surgery center, you walk by a piece of trash on the floor and don’t pick it up, then your standard is to have trash on the floor. Although it is important to understand and adhere to these standards, you might need to hold different employees to different standards based on where they are in their learning process. A new employee does not necessarily need to be held to the same standards as a more seasoned colleague out of the gate.


Leaders must clearly define expectations. Frustration is a division between expectations and reality. If you do not define expectations for your employees, they will experience frustration. You must emphasize that you expect above-the-line behavior of everyone and explain what that entails: having an organized workspace, maintaining friendly interactions with coworkers and patients, being willing to help whenever and wherever, taking initiative, showing up early or staying late, etc. Suggest that, when a problem occurs, employees take immediate ownership and correct their actions. You can also communicate what constitutes a subpar performance, such as showing up late, shifting blame, or refusing to take ownership and move forward.


Although it sounds like a paradox, a leader should be both focused and detached. Leaders are made to tackle complex problems, and, if you don’t act, those complex problems only become harder to deal with. You must be the calm in the storm, and you must be able to remove yourself from the emotion of a situation in order to view it from 50,000 feet. An effective leader is detached enough to make rational decisions but not so detached that he or she stops caring.


A leader does not need to know all of the answers, but he or she should know who to call for them. It is important to know how to ask for advice and when to listen. A leader must also own his or her reactions. We cannot always control the events around us, but we can control our response. How we react to a situation will affect the outcome, and our attitude will affect others. The emotional state of a leader is transferred to his or her employees like a virus. If you show up to your office in a bad mood, everyone around you will catch that bad mood. If you show up with a smile on your face—even if it takes a private pep talk—that positivity will transfer to those around you for the benefit of you, your staff, and your practice.

Gary Wörtz, MD
  • Private practice, Commonwealth Eye Surgery, Lexington, Kentucky
  • Founder and Chief Medical Officer, Omega Ophthalmics
  • Chief Medical Editor, MillennialEYE
  • garywortzmd@gmail.com
  • Financial disclosure: None

Sept/Oct '19