"Five Things"

Last night, I had the honor and privilege of attending a special ceremony in Columbus, Ohio - my mentor, colleague, and friend, Richard J. Brilli, MD, MCCM received the John F. Wolfe Endowed Chair in Medical Leadership and Pediatric Quality & Safety.   Rich has taught me so much and has done so much for my career over the years, that I would not have missed this ceremony for the world.


Those of you who have worked with Rich in the Pediatric Intensive Care Unit (PICU) will remember that he always taught about "five things."  For example, there are "5 causes of arterial hypoxemia," "5 reasons that children get admitted to the PICU following spinal fusion surgery" (at least in the old days), and at least "5 bugs that can kill you."  I used to joke with Rich about this when I was a PICU fellow - however, the joke was always on me.  I had to laugh (inwardly, of course) on my first day of clinical service as an attending when all of the residents were waiting for me to say something half-way intelligent.  I quickly reverted to the "five things" method of bedside teaching! 


As I was thinking last night, there are at least "five things" that Rich has taught me about leadership.  Specifically, there are "5 leadership values" that Rich taught me - these remain personal values for me to this day.


1.  Honor:  Rich said it best last night during his acceptance speech.  "It is a blessing.  It is a gift.  It is a privilege to do what we do every day.  Honor it."  Above all else, honor the patient in front of you.


2.  Courage:  Rich always taught me to have the courage to stick to your core principles and your core values.  Everything else flows from your core values.  Stand up for what you believe in.  Stand up for those who can't. 


3.  Commitment:  Making clinical decisions about someone else's critically ill child is frightening.  But you owe it to the patient to make that decision, and once you do make the decision, be strong and stay committed to it.  I think the same is true in health care administration.  If you honor the patients your organization is taking care of (#1) and stick to your core principles (#2), the decision you make is more than likely the correct one.  Stay committed to that decision and course of action, until the information tells you it is time to make a new one.


4.  Humility:  Working in the PICU is difficult - on any given patient, there are probably at least 100 different ways that you can make a mistake or error and cause harm to the patient.  Be humble.  We work in a difficult field in healthcare - there is no place for haughtiness and ego here.


5.  Patience:  Rich joked last night that he had some "idiosyncracies" - he does!  But he was always patient, especially with the residents and fellows.  Have patience with those who work for you.  Give them breathing room.  Give them enough autonomy to develop (some of the best ways to learn is by making a mistake) without placing the patient in harm's way.  Again, there is something here for those of us in health care administration as well.  Leadership is a learned skill - it takes time and practice.  Be patient with new and emerging leaders.


Again, thank you Rich for everything you have done - for your patients and their families, for all of the medical students, residents, fellows, and junior attendings that have worked with you, and for me personally.  We owe you a lot more than you will ever know.  Congratulations!  Here's to the almighty Fick equation and "five things"!