1. Bolwell, Brian J. MD, FACP

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A few weeks ago, I flew out to Los Angeles to visit my daughter. She is studying to be a clinical psychologist and had just finished taking a bunch of tests-it was a good time to visit. Over the past few years, we have discussed my leadership journey and she has been interested in the topic. In addition to going to museums, eating at very good restaurants, and watching movies, we sometimes discuss emotional intelligence and leadership. And, of course, we spend a bit of time discussing things from her past.

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On this occasion, for some reason we had a conversation about Disney movies that we watched when she was growing up. She was born in the middle of the "Disney Renaissance" from 1989 to 1999, when there was a return to musical animated films, including "The Lion King" and "Beauty and the Beast." My two favorites of that era are "Aladdin" and "The Hunchback of Notre Dame." She knows this, and we talked about why I like Hunchback so much.


It's probably because I really like the character of Esmeralda, and especially like a song that she sings entitled "God Help the Outcasts." She sings of the outcasts-her people: "Show them the mercy they don't find on Earth; I ask for nothing, I can get by, But I know so many, less lucky than I." It's an unusual Disney movie that raises the subject of societal inequities, and it features a character who has a fair amount of self-awareness. And I am a big believer of trying to help the outcast. In a way, that is what cancer medicine is often about. It's one of the reasons I feel pretty good about the field of oncology; we try to help people of all walks of life with major challenges, no matter who they are of where they are from (see "We Do What We Do," Oncology Times 2017;39(14):14).


Esmeralda and this movie have very little to do with leadership...except...on the flight home I was reading Stephen Covey's recent book, Primary Greatness. It consists of a series of essays written by Covey before he passed away. As such, it is more about how to lead a good life than a book centered on leadership principles. I am a big fan of Covey. Known for his book The 7 Habits of Highly Effective People, I think his best leadership book is The Speed of Trust, which I have referenced previously in this column.


So here I am, on a plane over the Rocky Mountains, and I read a part in Primary Greatness that discusses loyalty, and how important loyalty is for those who aspire to live great lives. His main point is to be loyal to people when they are not present-too many people criticize those who are not in the room. You can be constructively critical to an individual if necessary, but in such a way that you would not be ashamed if they overheard the conversation.


He then suggests that one additional way to demonstrate loyalty is "to defend the defenseless-the outcast, the low person on the totem pole, the minority, the scapegoat." He actually used the word "outcast." He must have remembered the "Hunchback of Notre Dame" Disney movie, too. Energized, I put the book down for a minute, and then started it again from page 1.


Things to Remember

My takeaways from this book are seven basic principles. The first is the importance of loyalty, mentioned above. I think they are applicable to us all and are certainly applicable to the practice of cancer medicine. The remaining six include the following.


1. We have three separate lives-our outer facing public life, our private life that we share with our family and those closest to us, and our secret life-where our heart is, where our motivations are. He writes that "most people never visit their secret life-they never exercise the unique endowment of self-awareness." He argues that until you choose your own motives, you cannot really choose your own life.


This makes sense. I previously have discussed how important self-awareness is if you want to get better (see "Change," Oncology Times 2018;40(11):16-17), and that getting better is a constant goal of leadership-they are connected. Looking at our inner motives about a complicated issue is usually a good way to achieve clarity.


2. "Integrity is essential for primary greatness. Integrity consists of courage and character.... Courage is the father of all virtues. Eventually, every value is tested. Integrity means that your life is integrated around principles and your security comes from within, not from without."


Many have written about the fact that character development and leadership development are one and the same. But not that many discuss courage in such a direct way as Covey. But he is right. Leading a cancer center is filled with conflict and challenges about finances, mission, commitments, people, resources, etc. One has to constantly look inside at one's core principles and have the courage to act on them.


As I have written in the article "What Leadership Books Do Not Tell You" (Oncology Times 2017;39(1):14-15), you can't fight every political battle, but you need to fight the ones that need to be fought and stay true to your core beliefs. That takes courage. Additionally, you need to be comfortable with who you are. If you want to be a good leader, you need to have inner security, and not depend on validation from others to prove your worth. Insecurity can lead to a lot of bad behavior. Leaders-indeed, everyone-can do better if they make decisions based on core principles and worry less about what might be convenient or popular.


3. Before you find fault in others, first, work on yourself. Put another way, take responsibility-do not be a victim.


This one sounds easy, but it's not. Sometimes the noise can get so loud that it's hard not to play the role of the victim. I still do it sometimes. But I know it is a flawed strategy and never generates positive results. Instead, I need to start with me. If I am in a tough situation, I need to examine how I got there, what I could have done differently, and more importantly, what I personally can do to make things better. It starts with me.


4. Traditional teaching of leadership tends to focus on the wrong thing. "Skills don't trump character, yet the training and education of most people is designed to build competence, not character."


This one has merit but is complicated. Medicine is a field that requires a huge amount of learning and work to become competent at the practice of medicine. And medical leadership requires teaching to understand finances, marketing, and other non-medical leadership topics. Having said that, I believe there is little question that high-level leadership should focus on character development. It is an unmet need with opportunity.


5. Emotional maturity comes from a combination of character and consideration. One needs the ability to express their feelings and convictions with courage, balanced with consideration for the feelings and convictions of others.


This theme resonates with me. This has been one of my most important learnings. I have long known that, at the end of the day, character wins. But I have had to learn how to voice my opinions better, with more consideration for others, to walk in their shoes while I am speaking. To move away from a win-lose mentality to a win-win view. This point is a big deal. Even if you are in the right, if you express yourself in an abrasive and hurtful manner, you will achieve nothing. And if you wind up being less than tactful, and others are wounded by your words, you have only one thing to do-have a face-to-face conversation, apologize, and mean it.


Academic medicine has so many doctors who are brilliant, yet at their core are insecure and express themselves in a confrontational way. Their lack of consideration for others becomes at best, highly limiting, and at worst, bullying. Getting both right-courage and consideration-is hard to do but is the right thing to do. This is also true when dealing with patients. How to deliver bad news is an art, but clearly you need the courage to tell the truth coupled with the empathy to use consideration and kindness while delivering it.


6. The ongoing importance of learning. The book quotes Henry Ford: "Anyone who stops learning is old, whether 20 or 80. Anyone who keeps learning is young." The book continues, "I recommend a balance between personal and organizational development."


We all need to continue to learn the practice of medicine, especially oncology, because things are changing so rapidly. Those of us who have been in this field for a while know that it was not always the case, but the past decade in oncology has dramatically changed the way we treat most cancers. But I agree with the part about personal development. I guess that is obvious because I read so much about the topic, and about leadership. This book actually recommends listening/watching TED talks regularly. (Which I do. I even follow TED talks on Twitter). I think that such learning is fascinating and can be transformative if you let it. Use such learnings to learn more about your secret self and become more self-aware.


The main theme here is to try to live your life based on your core principles. Become more self-aware. Become comfortable in your own skin. Have the courage of your convictions. Help the outcasts. Keep learning. And try to find a message from every song that you hear that you can apply to leadership.


Well, maybe not the last part. Generally, when I am listening to Britney, I just let it flow.


Straight Talk: Today's Cancer Centers


BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.

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