To be influential as a physician leader, we must also focus on the bigger picture rather than care for a specific patient. Deborah McPherson, MD, FAAFP (Family physician, Associate Director, Family Residency Program, University of Kansas School of Medicine) suggests that this transition to the bigger picture is challenging. McKenna and Pugno (2006, p. 32) quote Dr. McPherson:
“Physicians focus on serving the immediate interests of the individual patient often in the context of a specific encounter. Leaders focus on serving the long-term interests of the collective. That duality can be disorienting. The unlearning it requires is often difficult, even painful. And yet, the duality has its advantages as well. When frustrated by the challenges associated with either of those roles, physician leaders can find re-invigoration and renewal by focusing on the other.”
While the capacity to shift roles can be beneficial, it also can be disorienting, as Dr. McPherson notes. Resilience is required—which is one of the two competency clusters identified by McKenna and Pugno. This being the case, we have to ask how physician leaders gain this capacity to be resilient. Dr. Sandstrom enters at this point. She focuses on relationships, noting that we must “constantly acknowledge and recognize the attributes and contributions of others.”
I propose that we are resilient in the midst of and because of relationships. We are resilient in large part because of the support we receive from other people with whom we are relating. Social networks provide us with options when we feel stuck. They provide us with a variety of helpful resources and members of the network assist us in a variety of ways—ranging from being a constant source of reassurance and appreciation to being a constructive critic (Bergquist and Mura, 2011). At an even deeper level, we can point to relationships as a primary source of our sense of self (Sullivan, 1953) and even as a primary source for our perception of reality (Brothers, 2001).
We can also point to our appreciative ability to sense another person’s distinctive perspectives and practices as the primary source of influence. Psychologists describe this as acquiring a “theory of mind” (Premack and Woodruff, 1978) regarding how other people are different from us. As quoted by McKenna and Pugno (2006, p. 176), Penny Tenzer, MD (Vice-Chair, Department of Family Medicine Residency Program, University of Miami School of Medicine) points to the critical role played by a “theory of mind” in the engagement of physician in productive relationships with their workplace colleagues:
“A leader will share what they have learned. For it is in sharing knowledge that we can gain from the points of view and insights of others and thereby see the world through different eyes per se, as well as exponentially expand our knowledge bases. A leader realizes that it is through others that true leadership thrives and survives.”
A set of unique resilience-enhancing points of view are available to us when we have gained this appreciation of differences. This means we can be resilient by shifting our sense of self and our perspectives on reality through our interactions with other people. We can be resilient because we understand where other people “are coming from”—and thus we know how they can be of greater support to us as we deal with shifting VUCA-Plus conditions. Given the multiple selves that we carry with us (Gergen, 2000)—especially as physician leaders in a swirling healthcare system—it is essential that we find relational support to match this multi-self challenge.
I wish to take this analysis one step further. A “rational/empirical” perspective regarding influence relies on the power of numbers. We influence policies and behavior by providing tangible evidence regarding the effectiveness of a specific intervention. However, we know that numbers do not always change people’s minds. Evidence does not always “win the day.” Persuasive narratives will often have a greater impact (Bergquist and Weitz, 2024). A compelling story based on a specific case study will frequently tip the scales toward some policy.
