Leadership carries a high risk for bossiness.
Some medical Chiefs gain humility from caring for sick complex patients. It shapes their approach to leadership. Unfortunately, many forget their failures. Others never learned in the first place.
Many Chiefs of Staff have never seen sick patients at all. But as chief, they see all the medical disasters and deal with the most difficult doctors. They risk thinking all doctors are difficult and basically failures waiting to happen.
Like leadership, some specialties are also more likely to foster bossiness. Niches with low medical risk and high paternalism present the most significant risk. These doctors never see sick patients but spend all day giving definitive advice.
However, chiefs and niches do not explain enough. Not all doctors become bossy from being chief or a member of a medical niche.
Blaming bossiness on a chief-niche explanation assumes an external locus of control: bossy doctors were victims of a bossiness-inducing environment.
We could also assume an internal locus of control. What goes on inside a doctor to make them so bossy?
A. Good intentions
Children torture kittens with cute outfits, “Because Kitty likes it.”
Parents torture children with cute outfits, “Because it makes you look smart, dear.”
Politicians torture citizens with things they would never choose themselves – so-called merit goods.
Doctors do the same.
Many doctors give orders for a living.
A group of us asked a young cardiac surgeon about life with his new baby. Had he changed any diapers yet?
“Oh, sure. I call my wife. She comes. I hold out my hand like this.”
He held out his hand, palm up.
“Then I say, ‘Wet wipes!’ And she gives it.
‘Lotion!’ And she gives it.
Just like surgery.”
Most doctors are practical. Especially in procedural specialties, we use the shortest path between intervention and outcome.
Barking orders wastes less time than decision by committee.
Doctors do not study leadership to become doctors. Aside from loads of math and science, most doctors do not study much of anything else: medicine demands total commitment without room for non-clinical things.
Many doctors assume they are so much smarter than everyone else that they should be the boss.
Arrogance goes beyond hubris. Some doctors cannot tolerate anyone else in control. They hold others in disdain.
A few doctors hate their colleagues. They want to cause pain. A position of power, such as Chief of Staff, lets them exercise their wish.
Hubris, arrogance, and maleficence are less common, but we must admit they exist.
However, many situations demand a level of control that looks bossy. In this sense, bossiness may not be bad in itself, only when misapplied.
It is a bit like debridement. Dead tissue needs to be cut off to save the healthy bits underneath. Cutting too little is bad; removing vital parts is worse.
Fortunately, only rare wounds need major debridement. Most need a light cleaning or nothing at all. Too often, people use bossiness when it is not necessary – like debriding healthy tissue.
Pandemic chaos and fear created a petri dish for bossiness. It turned some otherwise rational doctors into dictators.
COVID gave literal or social media microphones to some very bossy doctors. Politicians deferred to a handful of experts. No one dared speak against them. The few who did faced punishment.
As pandemic fear subsides and normal chaos returns, we should ask:
- Who were the bossiest doctors?
- Who needs counselling after losing their COVID pulpit?
- Can we protect ourselves from bossy doctors in the future?
Some doctors are just born bossy. They use power to work out their own issues. But we don’t need to let them ruin our lives in the process.
Shawn Whatley is a physician, past president of the Ontario Medical Association, and a Munk senior fellow at Macdonald-Laurier Institute. He is the author of When Politics Comes Before Patients – Why and How Canadian Medicare is Failing.
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