Leadership – to serve or to be served?


Category : Medical Rants

Most readers know that I have leadership responsibilities, both in my job and in my society work.  Leadership comes with great responsibility.

Too many leaders lose their moral grounding.  They view leadership as their accomplishment and their opportunity.  They forget the most basic principle that leaders should serve those who they lead!

Two recent accusations of conflicts of interest should remind us of the dangers of leadership.  Patient Safety’s First Scandal: The Sad Case of Chuck Denham, CareFusion, and the NQF


Payments to CEO Raise New Conflicts at Top Health Quality Group

In both cases prominent leaders in medical quality and safety appear to be receiving financial benefit that could cloud their judgments.  In neither situation can we say that the apparent conflicts of interest actually changed their decisions, but we need to require that standard to find this situations uncomfortable and disappointing.

I submit that these leaders have not followed the precepts of servant leadership.  These situations do not occur when one truly puts those whom is leading as defining processes and expectations.  We in leadership must always ask how we can help our followers, not how we can help ourselves.

Each day I try to help our students and residents grow.  It is not about me, it is about them.  I fail sometimes.  Sometimes my actions feed my ego.  Most humans have difficulties with leadership.  Too many leaders in the public eye abuse that privilege.

Of course, the easy way to avoid this trap is to ask, if those who I lead knew about this activity, what would they say.  If the “followers” would critique me, I should not do that.

We should take the ethical high ground.  It is our job to serve, not to be served.

Comments (6)

I must say this is a depressing time for the profession. The last issue of the journal Science dealt with some problems in a key study on preoperative beta blockers, leading to recommendations in Europe (thankfully the guidelines here were more conservative) that may have led to untold patient deaths. A few weeks ago the BMJ highlighted some problems with EBM, and it seems that weekly I come across an article on guidelines being written by those with conflicts of interest, or the poor quality of much medical research, and now this, which in my opinion stinks to high heaven. Our leadership really needs to get its house in order.

I often find parallels between medicine and the clergy. My 150 plus year old church has suffered a massive loss of membership due to a minister who lacks any type of skill and the solution is to take money given in the past for the continued maintenance of the building to support his salary.

The denominations position is that I am the problem and need to work harder at making the church a success, and of course donate more money.

This parallels medicine in that leadership often feels they are entitled to the financial benefits of their profession and readily engage in conflicts. Patients and doctors at the bottom are berated for not understand the greatness of those above, and admonished that they have no standing in the medical system.

When the moral and ethical backbone of these two systems is eroded we face what we have now which is a system based on subterfuge and personal gain. This system is doomed to failure.

The old line denominations are failing and medicine is finding it is being regulated more and more by government forces creating an unworkable system for patients and doctors. The social contract is broken, and the outcome is still in doubt.

Steve Lucas

I agree, Mr Lucas. The infuriating thing is that Dr Cassel has made a career (and a large fortune) basically by putting herself in a position of monitoring the behavior of other doctors, both in her work with the ABIM (in which her compensation was outrageous IMHO) and in regards to medical quality. Just as with a minister, people in such positions should practice and be held to the highest standards of behavior.

While I’m on a rant, I’m going off subject. ,I’m really irritated about CME in this country. I can get any number of excellent, sometimes free or very inexpensive courses on almost any subject via companies like the Teaching Company or MOOC/Coursera. For medical cme I have to pay large amounts to the CME industry, frequently travel to distant cities where academic lecturers are flown to give one or two lectures apiece (how inefficient is that when their lectures could be taped locally and distributed widely), sit through 8-10 hours of lectures for several days straight (fatigue and information overload in my mind make this less than an optimal way of learning) and if you do the MOC you end up wasting a lot of time studying things which you may never see in your particular practice. CME should be convenient, ideally done almost daily or several times a week, and something we can tailor to our particular niches. As it s set up now it seems it’s designed for the CME industry more than for the doctors who need it.

Mt. Doc,

Continuing education is a problem in a number of fields. My attorney wife spent her entire career in public service and received continuing education credit for the classes she taught others in public service.

Today she sees the same problems you do of long travel to hear speakers in fields she has no interest and will not relate to her continuing work in her former field, all at a very high price.

The killer is when she is told that if she worked in a field with a lucrative salary she would be able to afford her CLE and maybe she should leave law and let someone who knows how to make money have her slot.

My wife has worked to improve the lives of millions of children around the world and some bozo feels she should move aside so someone can make money on the work she has done.

Steve Lucas

Saw your all’s posts. All I can say is that I’ve reached out on a couple of occasions to docs and some admin to help, and didn’t get any support. I actually got fired for it. I’ve seen doctors several years behind the research. That means your CME credits are worth squat, so it backs up what you all are saying. That instead of taking responsibility for mistakes and doing something to fix them, or giving just a hand slap, its led to decreased trust in the profession, a backlash among patients, no one is happy. I’m sure you are going to see it get worse. Sad to say but true.

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