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Dr. Campbell: The power of 'I don't know'

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Recently I read an interesting article on leadership published at Inc.com.  Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in Medicine.

In this article author Curt Hanke writes about the inspiration and leadership positives found in the three simple words:  "I Don't Know."   On first blush, we may think that a leader speaking these words may no longer inspire confidence and may lose the support of his or her troops. However, as Hanke goes on to detail, the words "I Don't Know" may provide inspiration and motivate teams to perform even better.

As physicians, we are leaders – we lead teams, we lead students and other trainees, and most importantly we lead patients.  There are times when we lead and guide patients and families on very challenging journeys through brutal, sometimes devastating diseases.  Often, being a good leader is the most important part of our job.  With leadership comes many responsibilities– and those whom we lead look to us to show confidence as we provide guidance in uncertain times.

As physicians are leadership roles are two-fold:

1. We lead teams of caregivers with a common goal – the best outcome for our patients.  Our teams look to us for confident judgments during crisis (such as during a code blue) and guidance when making day-to-day clinical decisions.  Our teams are bright and capable.  Our team members are diverse both in training, ability and in education – nurses, physical therapists, pharmacists and other physicians–all working in concert to achieve clinical success.

2. We lead patients and families.  We are the experts in a complex field that is foreign to many – we are relied on as guides, as advisors as well as generals on the field of battle.  We must inspire confidence and show kindness at all times.  Our patients are often frightened and uncertain.  We must help them learn, grow and adapt to changing medical and clinical scenarios.

To lead in this way can be very challenging but is not terribly dissimilar from leading in the business world.  We must be prepared – with knowledge of disease and the best available therapies.  We must be aware of the strengths and weaknesses of each individual on our medical team (including our own) and we must be able to motivate those in very different roles to band together for common good.  We must lead patients and families with compassion – we must understand things from their perspective and apply their needs into the equations we use to make clinical decisions.  We must lead both groups with honesty.  We must be willing to say "I Don't Know" when appropriate.

Then we must harness the power of "I Don't Know" in four distinct ways (according to Mr. Henke):

1. Creates Possibilities: As a leader, saying "I Don't Know" in medicine may create an opportunity to bond with patients, families and team members.  Having the courage to articulate your shortcomings as the leader may actually garner more respect and tighten bonds through your honesty.

2. Inspires Engagement: As a leader, saying "I Don't Know" in medicine may provide opportunities for others to take center stage and bring forward ideas that they may have otherwise kept to themselves.  It allows others to think more creatively and inspires team members to find "ownership" in working to solve a particular clinical mystery or treatment problem.

3. Avoids Complacency: As a leader, saying "I Don't Know" in medicine provides me with the motivation to learn more and to be better.  Not knowing the answer right away drives me to reflect on my particular skill set and take stock in what I can do better both as a leader and as a team member.  When the leader works to improve, it often inspires growth among team members as well.

4.  Inspires "Fun" During Difficult Times: As a leader, saying "I Don't Know" produces engaged team members and these engaged team members are more productive. Ultimately a more productive medical team results in more positive patient outcomes.

Effective leadership is vital to success in both business and in medicine.  The most effective leaders know their own limitations and are not afraid to share that with the team that is inspired to follow them.  Courage to say "I Don't Know" may be the difference in discovering the most accurate diagnosis and prescribing the most effective treatment plan for a patient and their family.  Be willing to admit when you fall short – as Socrates stated "The only true wisdom is in knowing [what] you don't know.    "

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