A tale of two leaders

I just read a fascinating book by the Naval historian and author, Joan Druett called "The Island of the Lost: Shipwrecked at the Edge of the World" (if you read my most recent post, "Taming the Chaos", you shouldn't be surprised at my reading choice).  The story takes place in a group of islands in the South Pacific (nearly 300 miles south of New Zealand), known as the Auckland Islands around the time of the U.S. Civil War.  The book is fascinating, at least to me, because it tells two completely different stories that happened, rather coincidentally, at roughly the same time - the shipwreck of the schooner Grafton and its crew of five men on January 3, 1864 and the shipwreck of the much larger (1100 tons) sailing ship, Invercauld and its crew of 25 men on May 11, 1864.  The two ships wrecked at opposite ends of the island, the two crews never interacted (and really had no idea that they were both on the same island), and while *SPOILER ALERT* both crews were eventually rescued, how well they fared were very different.  In fact, the way that the two captains and their crews handled this series of rather unfortunate events couldn't have been more different.  As Florence Williams writes in her New York Times book review, "Their divergent experiences provide a riveting study of the extremes of human nature and the effects of good (and bad) leadership."

The Grafton castaways were led by their captain, Thomas Musgrave, whose example of leadership in the face of crisis parallels that of the famous Antarctica explorer Ernest Shackleton.  While Musgrave's leadership undoubtedly influenced the eventual outcome (all five members of the Grafton crew survived and returned home), the resilience of the individual crew members (a French gold miner and the first mate, Francois Raynal, a Portugese cook, a Norwegian, and a young Englishman) were just as critical.  They salvaged virtually every useful part of their ship, and at one point actually flipped the 56 ton ship over on its side to see if they could repair it and sail home themselves!  They built a rather sturdy cabin (which still stood several years after their rescue) for shelter using materials from the ship, as well as the limited natural resources on the island itself. The five men survived largely by eating seal meat (they were able to use some of the ship's provisions, but they had only planned to be at sea for at most two months, so the provisions were limited), but made several attempts to actually grow their own food (using pumpkin seeds and potatoes left over from the ship's stores).  They carved a number of items out of the local wood, including a set of playing cards, a chess set, and dominoes.  If you've ever watched the 1960's American sitcom, Gilligan's Island, you have a pretty good idea about how resilient and resourceful these five men really were during their 18 month stay on the island.  Raynal was particularly resourceful - with the aid of the others, he constructed a forge and started manufacturing nails and other tools that they needed to convert their small dinghy into a seaworthy vessel that they could use to sail home.

One particular episode particularly stood out to me.  At one point, relatively early in their stay, the five men started to argue about who was in charge.  The three sailors felt like they should have a greater say in what happened to them and somewhat resented how they were being treated by Captain Musgrave, in particular.  There are a variety of leadership styles, and one could certainly argue that a more authoritarian, "command and control" type of leadership is preferred in a time of crisis.  However, Musgrave acknowledged both the others' concerns, as well as their need to have input into some of the decisions that were being made.  They held an election for who would be in charge, and rather unsurprisingly, Captain Musgrave was unanimously elected as the leader of the group.  Recognizing that harmony among the five men was critical to their survival, Musgrave initiated a nightly series of "classes."  They taught each other their individual languages (Portugese, French, and Norwegian), and both Musgrave and Raynal taught the other three men to read and write.

As I mentioned above, the experience of the Invercauld castaways was vastly different.  If the Grafton shipwreck was more like Gilligan's Island or Robinson Crusoe, the Invercauld shipwreck was more like Lord of the Flies.  The ship struck a reef during a storm and sank immediately.  Nineteen of the 25 crew members made it safely (barely - most had to kick off their shoes to keep from drowning) to shore, and the others drowned.  The survivors spent the night on the shore and at daybreak tried to salvage what they could from the ship's wreckage.  They found some provisions, lit a fire with the only dry matches that they could find, and stripped the clothes and boots from the six men who had drowned when their bodies washed ashore.  They exhausted what little food they had salvaged and spent four days with virtually no further attempts to seek shelter or find food.  Unfortunately, their refuge was at the base of a 2,000 foot cliff.  After four days, three men climbed the cliffs to find food, and soon thereafter everyone except one dying sailor and his caretaker climbed the cliffs to seek better shelter.  The weather was very cold, and many of the sailors suffered from frostbite.  They were able to find some food (they killed a wild pig), but more or less went the next three weeks without any additional food.  One by one, their numbers dwindled as some of the men died from starvation and exposure.  They eventually found an abandoned village the ruins of a long abandoned whaling settlement, but the lack of food and adequate shelter caused several more deaths.  The three remaining crew, including the captain and first mate, survived on shellfish and roots.  After nearly a year, they were eventually rescued by a ship that had stopped at the island for repairs.

The differences between the two castaway groups is stark.  Where the men of the Grafton did everything possible to survive for the long haul, eventually saving themselves by converting a dinghy into a seaworthy sailboat (Musgrave and two others sailed to another island and found a ship to bring the remaining two castaways home), the men of the Invercauld seemed to accept their fate without trying to save themselves.  The differences in leadership between Musgrave and the Invercauld's captain, George Dalgarno, is even more stark.  Whereas Musgrave took full responsibility for the health and welfare of his crew (even returning with the ship to rescue the last two castaways), Dalgarno was nonexistent as a leader.  As Joan Druett writes, "Instead of demonstrating leadership, Captain Dalgarno seemed too paralyzed to order a search for shelter and food."  He did little to care for his men, nor did he take charge of the situation.  In other words, he failed to lead.  As a result, the men of the Invercauld fell into madness, anarchy, and despair - some of the castaways even resorted to cannibalism.

As the explorer, Sir Raymond Priestly, once said, "For scientific discovery give me Scott; for speed and efficiency of travel give me Amundsen; but when disaster strikes and all hope is gone, get down on your knees and pray for Shackleton."  I would add, "Or pray for Musgrave." 

Taming the Chaos

Why do I thrive on chaos?  I even like to read about chaos - case in point, I just finished reading a dystopian novel by the science fiction writer, Kim Stanley Robinson that is set in New York City about a hundred years from now, called simply, New York 2140.  Basically, everything that climate change scientists are now predicting has come true.  The oceans have risen and New York City has become like the city of Venice, Italy.  The book was just over 600 pages, and probably just a little too long, but I found it fascinating nonetheless (check out some of the reviews of all Robinson’s work here and here and here).  In fact, I found myself enjoying the story so much that I began to think about all of the other dystopian novels that I have read and liked.  Here are just a few recent examples, The Postman by David Brin (a post-apocalyptic story which was made into a movie starring Kevin Costner), Pavane by Keith Roberts (a story in which the Roman Catholic church reigns supreme and basically runs the world, basically because the Protestant Reformation never happens), and The Road by Cormac McCarthy (another post-apocalyptic story that received the 2007 Pulitzer Prize for Fiction). 

So the question I have to ask myself again is this - do I thrive on chaos?  One could certainly argue that my choice of medical specialty, pediatric intensive care medicine, could suggest that assertion.  Moreover, as I think about all the times that I felt like I have really excelled (which happened to be the times that I also most enjoyed, believe it or not) as an administrator, it's been when the proverbial shit has hit the fan!  The important point to realize, however, is that chaos doesn't have to equal anarchy.

What do I mean?  There are a couple of definitions of the word chaos in the online Merriam-Webster Dictionary:

1. A state of utter confusion

2. A state of things in which chance is supreme; the inherent unpredictability in the behavior of a complex natural system

I like the second definition much better than the first, as I think it more accurately describes what I believe to be the true nature of chaos versus anarchy (which I think is best defined by the first definition above).  The difference is very subtle, but very important.  Consider, for a moment, that the term chaos itself comes from ancient Greek mythology.  Chaos was the void that existed before the beginning of creation.  As the ancient philosopher-poet, Ovid (who was actually Roman), defined it, Chaos was the original state of things, a disordered and shapeless mass from which the maker created and shaped the Cosmos.  In other words, out of disorder came order. 

Perhaps those of us who seem to thrive on chaos do so because we like to create order out of disorder.  There is a method to the madness, discipline in the confusion, organization in all the mess - the trick is to find it.  I came across a great blog post from Matt Bodnar that offers a few tips on how to effectively manage chaos, or creating order out of disorder.  He bases his recommendations on the life of one of America's most legendary Air Force fighter pilots and military strategists, John Boyd (you probably have heard of his OODA loop).  And speaking of movies, if you've ever watched the 1986 movie Top Gun, the U.S. Navy's Fighter Weapons School, which is the setting of the film, was based upon the Air Force school that John Boyd started).  Bodnar boils down his recommendations to three elements:

1. "Fight the enemy, not the terrain" - in other words, confront your cognitive biases, ego, and your own limited perception of reality to focus on the goal ahead.  Don't be distracted by all that other stuff - don't be afraid of past failures, because they will paralyze you from completing the task at hand.  Learn from past mistakes - for sure, but don't dwell on them.

2. "Agile does not mean speed, but rather speed of decision-making" - in particular, be very wary of trying to make perfect decisions.  No decision is perfect - and if you wait for all of the information necessary to make a perfect decision, you've probably waited far too long.

3. "Schwerpunkt" - I've talked about this before in a related context (see, for example, "HRO: Deference to Expertise" or "...plans are useless, but planning is indispensable"), but "schwerpunkt" roughly translates from German to "center of gravity" or "focus" and refers to the high-reliability concept of "deference to expertise" or the similar concept of "commander's intent" (see also, "Sua Sponte").  In other words, leave the critical decisions to the leaders on the front-line, who will have the most accurate and up-to-date information (decentralized decision-making). 

Bodnar provides less of a recipe to follow to manage chaos, but his main points are well-taken and will probably help anyone successfully manage a chaotic situation.  And if that doesn't work, try reading some of the dystopian novels I mentioned above to see how the characters in the novels created order out of disorder!

Clash of the Titans

Nope - I am not going to talk about the 1981 movie from my youth, Clash of the Titans, which was "loosely based" (I will argue this point to anyone) on the Greek myth of Perseus and Andromeda.  Notably, the film starred Sir Laurence Olivier as the Greek god Zeus and Dame Maggie Smith - you may know her better as the Hogwarts teacher, Professor McGonagall - as a minor character, the Greek goddess Thetis.  Nor will I talk about the 2010 remake, which followed the original's plot but had the significant advantage of 21st century special effects.  No, what I want to talk about is when top executives don't get along with other members of the executive team.  We have ample examples today - just turn on CNN and watch any story about our current President and some unfortunate member of his team (the list is long, but recently the stories have been about the President's social media habits interfering with the work of his current Attorney General).  I am sure you have observed examples in your own professional life. 

We can all appreciate how well executive teams function when the top leaders work well together and get along (see some of history's great dynamic duos here or just think of leadership pairs like President Obama and Vice President Biden, Mark Zuckerberg and Sheryl Sandberg, or even Captain Kirk and Mr. Spock (sorry, I had to throw them in there).  Here's the question though - how important is it for the top leaders to get along and work well together?  As it turns out, there's objective evidence to suggest that it is incredibly important.

A group of economists explored this exact question in a study that was published a few years ago in the journal, Management Science.  These investigators used a large data-set from Major League Baseball to examine the whether the relationship between the general manager (sort of like the Chief Executive Officer) and manager (think, Chief Operating Officer) of major league baseball teams had any effect on the overall performance of professional baseball teams.  The investigators used data from every single game played during each and every major league baseball season from 1988 to 2012 - during this period of time, there were 136 manager (again, in baseball, managers are like the head coach in football) and 94 general manager leadership dyads in 42,302 games.  Basically, the degree of "match quality" (in other words, how well did the general manager and manager get along) was compared to outcome measures such as game result (wins versus losses) and run differential (how many runs did a team win by).  The statistics used were incredibly complex, but suffice it to say that they factored in a number of important variables to come up with as accurate of an assessment as possible.

So, what did these investigators find?  There were two major conclusions that I think are relevant to our discussion today:

1. Match quality definitely impacts how well the team does, both in terms of win-loss record and whether the team generates an economic profit.

2. Match quality doesn't necessarily improve over time - in other words, either the general manager/manager leadership dyad works from the beginning or it doesn't.  If the two leaders don't get along, they likely didn't get along as time went by.

What are the implications here?  I fully admit that running a large company or hospital isn't exactly like running a major league baseball team.  However, if the key, influential leaders on a professional sports team aren't working well together, the team is probably not going to win any championships.  Similarly, if the executive leaders in a company or a hospital aren't getting along or working collaboratively, you can almost be certain that the company or hospital aren't going to do well either.  Bottom line - the executive leadership team MUST work well together.  Sooner or later, owners (in the case of professional sports teams) or Boards (for companies or hospitals) will recognize that the executive leaders just aren't working out and will need to be replaced. 

Leadership matters.  Collaborative leadership matters even more.  At the end of the day, there is just no room for a clash of the titans in the C-suite.

Juke Box Heroes

There was a summer a long time ago when by some strange stroke of luck I was able to purchase front-row tickets to a Night Ranger concert (the stroke of luck was the fact that I paid only about $5 more per ticket than their actual cost).  The opening act was a band called The Outfield.  I thought "The Outfield" was a decent band, but at the time I really liked Night Ranger (and had probably seen them live two or three times before that concert).  You would think that I had a really great time - seeing one of my favorite bands from the front row.  It was definitely one of those "once in a lifetime" opportunities, but surprisingly I was really disappointed!

Both bands played a great set, and the weather was perfect.  But I was still disappointed.  There was just something about being so close to these "Juke Box Heroes" that didn't sit right with me at the time.  It was almost, as if, the proximity to these musicians changed my entire perspective.  The fact that they were so close to me reminded me of all the times I watched some of my high school friends play in their rock band.  The fact that they were so close took some of the magic away.  They were no longer "rock-n-roll superstars" - they were just a few guys playing in a rock band.

Our society tends to glorify celebrities.  It doesn't matter whether they are musicians, athletes, or movie stars.  We revere them and place them on a pedestal.  The truth is that these individuals have a unique skill - maybe even a special skill.  But we shouldn't worship them or think that they are something that they are not. 

We sometimes do the same thing with leaders too.  There's even a theory that explains how some leaders just seem to have a unique and special gift, whether superior intellect, extraordinary courage, or divine inspiration that at the right time and place create history.  It's called the "Great man theory", and it was developed in the 19th century by the Scottish philosopher, Thomas Carlyle (there were - and are - great women too, but this was how Carlyle chose to name his theory).  Carlyle wrote in his book, On Heroes, Hero-Worship, and The Heroic in History: "The history of the world is but the biography of great men."

Carlyle's "Great man theory" makes two key assumptions.  First, every individual destined for greatness is already born with the innate characteristics, traits, and attributes necessary for his or her greatness.  Second, there has to be a need for these individuals to "do their thing" - a crisis or otherwise moment in history that requires these individuals to step forward and lead. 

Carlyle wasn't alone in his view of the world.  Similar ideas have been proposed and/or defended by notable figures throughout history, including the ancient Greek writer, Plutarch (see his work, Parallel Lives), the psychologist, William James, the philosopher Friedrich Nietzsche (see, for example, his concept of Ubermensch), and the philosopher and essayist, Ralph Waldo Emerson (see his lectures on "Representative Men").  All of these works share the same theme that history is created by a few great men with special, unique skills and characteristics that make them great.  In other words, great leaders are born not made (nature triumphs over nurture again).

So, why then should we read about the great leaders of the past?  If nature is more important than nurture, and we don't inherit those "leadership genes" from our parents, why should we go to the trouble of reading Plutarch's Lives or Emerson's lectures on "Representative Men" (as individuals throughout history have done)?   

I don't think I fully subscribe to the "Great man theory" - in truth, the theory has largely fallen out of favor.  And the most compelling evidence that we have is that leadership - even great leadership - can be taught.  Even great leaders like retired U.S. Army General Colin Powell believe that leadership can be taught!  So, enough with the whole nature vs. nurture leadership argument.  As it turns out, a study of twins suggested if your biological parents held positions of leadership, then you have a 24% likelihood of being a leader too (not necessarily a ringing endorsement for the nature side). 

But I'm not here to debate whether leaders are born with the ability to lead or not.  Well, not really.  Bringing it all back to my personal "Juke Box Hero" story - I think that by putting our leaders up on the proverbial pedestal - we help foster the perception, indeed a false one, that you have to be a so-called "great man" or "great woman" in order to be a "great leader."  It's simply not true.  We can all be leaders - these days we need all of the leaders that we can get.  Even us mere mortals can learn to be leaders - or improve upon the leadership skills that we already have.  This is where I think we can spend time reading about leaders throughout history - whether "great men and women" or not, other leaders have something to teach us. 

I will end this post with a quote, as I frequently do.  The American futurist Jacque Fresco said, "I don't believe in the great man theory of science or history.  There are no great men, just men standing on the shoulders of other men and what they have done."  So, I invite all of you to stand on the shoulders of the great leaders of the past - read about them.  And learn.

Tap Code

About halfway through my first year of medical school, I applied for and received a commission in the United States Navy as part of the Uniformed Services Health Professions Scholarship program.  That summer, I attended what is known as Officer Indoctrination School (OIS) at the U.S. Naval Training Center in Newport, Rhode Island.  OIS basically teaches physicians, nurses, lawyers, chaplains, and similar non-staff corps officers the basics of being an officer in the Navy - it's affectionately known as "Knife and Fork" school.  In addition to learning how to march and wear a uniform, I also learned how to sail a boat and became certified in scuba diving (the small boat sailing and scuba diving was on my own time, which perhaps gives you some idea of why OIS is called "Knife and Fork" school.

One of the highlights of my time at OIS was a special guest speaker that came to give us a lecture - he had been lecturing at the Naval War College, which is also in Newport.  It's been over 25 years ago, but I remember the lecture in vivid detail.  The speaker was Vice Admiral James Stockdale, a U.S. Navy fighter pilot, former Prisoner of War in Vietnam, and a winner of the Congressional Medal of Honor.  Admiral Stockdale finished his military career as President of the Naval War College.  He was an amazing man.

Admiral Stockdale told us about his time as a Prisoner of War at the infamous Hanoi Hilton.  He talked about being tortured repeatedly.  He talked about something that management guru Jim Collins subsequently has called the "Stockdale Paradox" in his book, Good to Great.  He told Collins:

I never lost faith in the end of the story, I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.

The "Stockdale Paradox" boils down to this:

You must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.

Stockdale also talked to my OIS class about how he and his fellow POW's communicated with the use of something called the Tap Code.  The "Tap Code" is a way to encode a message on a letter-by-letter basis, which is transmitted by tapping the walls or metal bars inside a cell:

Each letter is shown on a 5x5 square - the first number of taps indicates the row and the second number of taps indicates the column.  So, two taps followed by three taps would be the letter H.  The letter K is left out of the 5x5 square - two C's were used in place of the letter K.

At times, the prisoners were unable to communicate by tapping.  They used coughs and sniffs in these situations.  As Steven Southwick and Dennis Charney write in "Resilience: The Science of Mastering Life's Greatest Challenges", 1 was a sniff, 2 was a cough, 3 was a clearing of the throat, 4 was a hack, and 5 was a spit.  With this method, the letter H was a cough followed by a clearing of the throat.

For these prisoners, the "Tap Code" was all about maintaining a connection with another human being.  It's what kept them going through it all.  Through this human connection, the POW's were able to keep a chain of command and maintain their morale.  Human connection meant survival.

Admiral Stockdale, writing in A Vietnam Experience said:

When you are alone and afraid and feel that your culture is slipping away, even though you are hanging onto your memories...hanging on with your fingernails as best you can, and in spite of your efforts, still see the bottom of the barrel coming up to meet you, and realize how thin and fragmented our veneer of culture is, you suddenly know the truth that we all can become animals when cast adrift and tormented for a mere matter of months.  It is then that you start having some very warm thoughts about the only life-preserver within reach - that human mind, that human heart next door...[when people ask] ""What kept you going?  What was your highest value?"  My answer is: "The man next door."

Human connection.  It's incredibly important, of course.  Several clinical studies have consistently shown that a small social network or lack of emotional support is associated with a three-fold increase in subsequent cardiac events in patients who have suffered their first heart attack, a two- to three-fold increase in future coronary artery disease among otherwise healthy patients.  Social support - having friends and families to rely upon - may, in fact, have just as strong of an impact (in this case, a positive benefit) on overall life expectancy as obesity, cigarette smoking, hypertension, or lack of exercise (in these cases, a negative effect).  Emotional support can help improve outcomes for patients with post-traumatic stress disorder, depression, or even cancer.

One of the things that new leaders are never quite prepared for is being alone.  Every leader experiences it.  And we are not always prepared for it.  As William Shakespeare said in his play. Henry IV, "Uneasy lies the head that wears a crown."  It's been talked about many times - if you don't believe it, just Google "Loneliness" and "Leadership."  The important thing for all leaders is to do whatever they need to do to maintain that human connection.  Find colleagues outside of your current work setting that you can share stories or bounce ideas off of each other.  Find a mentor - and use that mentor.  Better yet, be a mentor to someone else.  It's so very important.  Maintain a human connection.  Figure out your version of the "Tap Code."

"The brave man is not he who does not feel afraid, but he who conquers that fear"

Every medical student (actually, nowadays it's probably more like every middle school student) learns about the so-called "fight or flight" response, first described by the Harvard physiologist, Walter Bradford Cannon in the early 1900's.  Even if you can't remember the name of it, trust me that you've all experienced it.  Whether it is a physical emergency (such as running away from a bear in the woods) or a psychological one (speaking before a large audience for the first time), the body's response is the same. 

Stress, anxiety, fear, or danger all activate the body's sympathetic nervous system, which increases our heart rate, shunts blood flow to our muscles, releases glucose to the bloodstream (glucose is the fuel that drives our muscles to work), and causes our pupils to dilate (leading to so-called "tunnel vision" so that we focus on the danger ahead and nothing else).  Basically everything we need to "take care of business" (e.g., run away from the bear, which is the "flight" response or to at least put up a good "fight" against the bear).  All of these effects are mediated by the chemicals norepinephrine and epinephrine.

As it turns out, our body's "fight or flight" response does a great job of preparing us to "fight" or "flight."  The effect of stress on performance is so well-known, there is a name for it - it's called the Yerkes-Dodson Law - also sometimes referred to as the "Inverted U Hypothesis."  Think of it this way.  If you graph performance on the y-axis and arousal (a measure of the body's "fight or flight" response, if you will), you get something that looks like an upside down letter "U". 

Basically, if our "fight or flight" response has not been activated (see the far left-side of the graph), we don't do a very good job at fighting or running away (or the modern-day equivalent, speaking in front of a large audience).  Our peak performance actually depends upon having a fairly high degree of arousal.  Too much activation of our "fight or flight" response, however, leads to worse performance, as shown by the far right-side of the graph.

What's perhaps less well known is the fact that this same "fight or flight" response has important effects on our brains too.  For example, why is it that we always seem to be able to remember a time in our lives when we were extremely nervous, scared, or in danger?  As it turns out, the same chemicals that activate the physiological "fight or flight" response, norepinephrine and epinephrine, acts on our brain's cognitive networks to not only better focus our attention on the danger in front of us, but also to place the event in our memory banks for better recall at a later date. In other words, we remember these events - some times in exquisite detail - so that we can react accordingly when faced with a similar event in the future. 

Researchers at the University of California conducted a series of experiments to show that norepinephrine helps shape our memories of past traumatic or otherwise anxiety- or fear-provoking events in our past.  In the first set of experiments, college undergraduate students were shown a series of photographic slides involving a traumatic event (for example, a young child being hit by a car) or an emotionally neutral event (say, just a car).  One week later, the students were asked to recall the details of the slides that they were shown.  The students shown the traumatic slides remembered details much better than those shown the emotionally neutral slides.  In order to prove that it was the "fight or flight" response that increased the student's recall the details of the slides, these researchers treated them with a drug called propranolol, which inhibits norepinephrine's effects (again, recall that norepinephrine mediates the "fight or flight" response).  Students that were treated with propranolol remembered a lot less of the information in the slides and in fact did not differ from those shown the emotionally neutral slide.

A follow-up study drives the point home.  Rather than blocking norepinephrine this time, researchers treated the college students with a drug that increased the body's norepinephrine levels right before showing the photographic slides.  This time both the students shown the emotionally neutral slides remembered the details one week later just like the college students shown the traumatic slides in the first experiment!  As one researcher suggested, if you want to "make mild moments memorable, add a little arousal".

If you have ever read my blog in the past, you know what's coming next - what's the take home message for leaders?  Here I would say this.  Don't be afraid of fear or anxiety.  Your body is actually helping you out with the "fight or flight" response.  The South African dissident, Nelson Mandela, spent over 27 years in prison for "conspiring to overthrow" a corrupt, racist government.  During all of his years, he learned the simple fact that "courage was not the absence of fear, but the triumph over it...The brave man is not he who does not feel afraid, but he who conquers that fear."  We will never (hopefully) experience the level of fear or oppression that Mandela felt.  But his words ring true nonetheless. 

 

Today is National Women Physicians Day

Today, February 3rd, is National Women Physicians Day.  It is the fourth time we have honored women physicians across the United States in this way.  The day was picked to honor Dr. Elisabeth Blackwell, the first woman to receive a medical degree in the United States, who was born on this day in 1821. 

We honor all of the women physicians today, who are entering the medical profession in greater numbers today, yet continue to make approximately 8% less than their male counterparts (some studies suggest this pay gap is even larger), even though they have been shown to have better outcomes in certain studies (see, for example, one recently published study here that showed that elderly hospitalized patients treated by female internists had significantly lower mortality and readmission rates than those cared for by male internists).  Studies continue to show that women physicians are subject to gender bias, discrimination, and outright harassment and abuse (see a very recently published study in the New England Journal of Medicine here). 

Dr. Blackwell said, "If society will not admit of a woman's free development, then society must be remodeled."  Her words are still true today.  Until society has changed - and women physicians are freely and openly accepted, fairly compensated, and appropriately treated - we need to continue recognize the work ahead of us by celebrating and acknowledging days like today, National Women Physicians Day.

Dr. Hala Sabry, an emergency physician and passionate advocate for equality in medicine (and one of the leading proponents to recognize Dr. Blackwell as the first woman to receive a medical degree in the United States), stated in an article in Forbes magazine in 2017, "Especially with all the negativity in the air and in the media right now with regard to women and equality, it's important to reflect and spread the word on what we've accomplished, and how far we've come."

She added, "Medicine is not immune from inequality.  But we're ready to celebrate."

Let us celebrate National Women Physician's Day.  But let us all recognize the work that we have to do ahead.