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PHYSICIANS TAKING GREATER LEADERSHIP ROLE

Should physicians be taking a greater leadership role in our society? You are listening to ReachMD, the Channel for Medical Professionals. Welcome to the Clinician’s Roundtable. I am your host, Dr. Maurice Pickard and with me today is Dr. Donald Palmisano. Dr. Palmisano is not only a physician but he also has a degree in jurisprudence. He is also the former president of the American Medical Association and he is the Clinical Professor of Surgery and the Clinical Professor of Medical Jurisprudence at Tulane University School of Medicine and most significantly he has just written a book called On Leadership: Essential Principles for Success.

DR. MAURICE PICKARD:

Thanks very much for joining us today.

DR. DONALD PALMISANO:

Well, thank you Maurice and thanks to ReachMD for having me.

DR. MAURICE PICKARD:

To begin with, could you just tell us why did you write this book at this particular time?

DR. DONALD PALMISANO:

I wrote the book for 2 reasons. I dedicated it to my 6 grandchildren and my hope is that this book will serve as a North Star for leadership in their generation and the other very important reason that I wrote this book, the 21st century has shown that terrorism can make our own corner of the world a dangerous place and now we see it affecting other areas of the world and I believe that democracy and liberty thrive when we identify true leaders and nurture potential ones. So the goal is to show people how to identify true leaders because in a time of crisis you don’t want a sham leader, you want a true leader, and it will also encourage other people who may have some hesitation about stepping up into a leadership role, perhaps because they have a fear of talking before audiences and I think this book gives you the salient points on how to become a leader.

DR. MAURICE PICKARD:

Well our audience is about 90% physicians. How can they use this book?

DR. DONALD PALMISANO:

Well, physicians play a very important role in our society. They earn the trust of patients and they work for the benefit of patients and so when leaders come to the forefront people identify those people they place trust in and so physicians already have the trust and it’s important for physicians to be involved. One example is what’s happening to the healthcare system in America. The system is broken and we need to have physicians, the people who are actually treating the patients come forth with ideas and not just let economist who have yet to treat a patient come forth with some plan that may have failed in another part of the world. Physicians have to be actively involved.

DR. MAURICE PICKARD:

Well, do you think that they have kind of shunned this responsibility?

DR. DONALD PALMISANO:

Well, I think more and more physicians are saying, I am too busy, I am trying to keep my practice open. We have more regulations. We have unfunded mandate. We have a broken medical liability system. We have all of these other burdens that are put upon me as a physician. We have price fixing by the government in Medicare and Medicaid. We have the onerous actions of many manage care entities where they have monopsony power. They can control what they pay you and so as your overhead in a physicians’ practice increases your revenue stream decreases and therefore you find it more difficult to stay in practice. So you are running faster and faster and earning less money treating patients without giving them the time that you want to devote to the patient and consequently the physician says I don’t have time to be involved in medical politics or go to Congress or go to my state legislature, but that’s a mistake because in times of crisis the people who know what needs to be done those individuals have to step forward and that’s what always happen in America, that’s how this country was founded because people have the courage to step forward. It would have been easier to say but we will stay in submission to the tyranny of the king. We will do that because we don’t want any problems. We don’t have time. Well, we have to make time otherwise we are going to lose the wonderful profession of medicine as we know it.

DR. MAURICE PICKARD:

Is there an audience among young doctors that could use this book?

DR. DONALD PALMISANO:

Absolutely. In one of reviews to my book in New Orleans magazine it was recommended that every medical school use this book as a basis of a course and I am privileged to start teaching a course this year at Tulane University School of Medicine on leadership in medicine.

DR. MAURICE PICKARD:

Well, you know, students though basically learn from role models and we can think back about those role models that were so important during our early education. So students have to look some place for a role model as far as leadership qualities. Where do they look?

DR. DONALD PALMISANO:

Well, I think they look, as you pointed out to their teachers and I think the medical school has now realized that we have to put forth a medical student who becomes a physician who has the ability to deal with all of the challenges. It does no good to have the knowledge and the skill to treat a patient if you are not permitted to be able to treat the patient in the patient’s best interest.

DR. MAURICE PICKARD:

If you are just joining us, you are listening to The Clinician’s Roundtable on ReachMD, The Channel for Medical Professionals. I am your host, Dr. Maurice Pickard. I am speaking with Dr. Donald Palmisano. Dr. Palmisano is a Clinical Professor of Surgery at the Tulane University School of Medicine and the former president of the American Medical Association. He has just written a book and is called On Leadership: Essential Principles for Success.

I know you were born and raised and practiced in New Orleans. The first chapter of your book deals with Katrina. Did this what happened in Katrina, you know, the leadership that was shown or the lack of leadership that was shown prompt you to write this book?

DR. DONALD PALMISANO:

Well, I had the goal of writing this book for many years and I traveled a lot during my tour of duty with AMA and I had a little electronic device I could make notes on and I wrote the outline of the chapters, but when Katrina hit it gave me the chapter that I call the antithesis of leadership because what was so shocking about Hurricane Katrina was that we learned those lessons in 1965 when Hurricane Betsy hit New Orleans. I was a resident at Charity Hospital on the Tulane Service and I participated in helping during that crisis and I responded to a radio message any doctor come to City Hall and I went there and the mayor assigned me to a shelter where 2000 people were waiting for me and when I got there they had no medicines, they had no phone, and it was of no value for me to be there because I didn’t have the medicines that I needed to give to the diabetics who had been without their insulin and so we had no communication and now 40 years later here comes Katrina and in fact 1 year before Katrina, the federal government, the state government, the local government did a mock hurricane called Pam and they said this was very instructive. We have learned a lot of lessons and now we are ready and so what happens when Katrina comes. Katrina arrives and all of these lessons were not used and did not have communications, did not have places where people could go for shelter, and to have the supplies there, it was just a disaster, and that was an example of not having effective leadership. You have to be able to be prepared. You have to be able to make decisions in a crisis even when you don’t have all of the information and you can’t be bound by some rule book that says you must contact somebody else before this patient’s life is saved. No, you need to act now and so that gave me the first chapter, but the point that I make in this book, I listed 20 elements of leadership that I have learned from observing leaders and also from reading history. I won’t go through the 20 points, but I can say in a sentence the leader is defined as a fully informed and decisive person with integrity who advances courageously toward a goal and is determined to overcome obstacles and setbacks along the way and the bottom line of that you can’t be a leader without courage and the ability to make a decision and act on it in a crisis when time does not allow waiting for all of the facts.

DR. MAURICE PICKARD:

Many of our readers have not had a chance to read your book and it’s filled with many examples of leaders. However, the one that struck me the most was the leader that you described who is a police officer in New Orleans and I wonder if you could tell our listeners a little bit about him.

DR. DONALD PALMISANO:

Yes sir. Many years ago a man took hostages in a middle-income neighborhood in New Orleans. The police arrived at the scene and the man had one of the hostages at the window with a gun to the hostage’s head. The police discussed the situation for a moment and then the ranking officer stepped out of his car, walked slowly toward the house, the gunman watched him with great interest, the policeman took his coat off, laid it on the ground, and then reached for his 38 Smith and Wesson 4 inch standard issue revolver, held it up, and then placed it on the ground. He then walked toward the house, opened the door and walked in. At that point the gunman, he was a few feet away from the gunman. The gunman put the gun in the policeman’s face and said now I am going to kill you and the policeman slowly raised his right hand, not to push the gun out of the way or to a strike a blow, but he put his hand on the gunman’s forehead, and said you have a fever. Let me take you to Charity Hospital and the gunman looked in amazement at the policeman and said I have a fever? and he says you have a fever. I know the doctors well. Let me take you to Charity Hospital and the gunman continued to look at him as the policeman slowly put his hand on the gun and took it from the gunman. At that point the other policeman rushed in and handcuffed the man and were about to take him to lockup when the policeman, the major said no. I promised I would take the man to Charity Hospital. Let me take him to Charity and he took him in his own police car and that man was my dad, Dominic Palmisano, Major Palmisano of the New Orleans Police Force, and he was an example of a leader who not only talked the talk but he walked the walk and his men admired him, they revered him, and they would follow him anywhere because he would never ask his men to do something that he wouldn’t do himself.

DR. MAURICE PICKARD:

I think that story says a great deal about how your book evolves and I know you, like many of us in our first year of medical school wonder why are we here? What are we doing this for and you turned to your father, Dominic, and you asked him for advice and what was the advice that he gave you? What did he tell you to do in order to persevere?

DR. DONALD PALMISANO:

Well, he told me when I was thinking about quitting medical school in my first year. He said, son you are smart enough to be a doctor, but you have to remember 3 things. Do your homework, have courage, and don’t give up. Do those 3 things and very little in life is impossible and at first I wondered what does he know about medical school but he had a great power of observation and he was fearless throughout his life. When I was with him I saw him repeatedly demonstrate courage and he was just fearless, but what I learned as I grew older was my dad’s 3 points. Those were the elements for success and by his actions he also taught me the rest of the elements for leadership because you can successful and not be a leader. Many books that are written about leadership are really books about success. I did this, you do this, and therefore you will be successful. You will be a leader. Well, I don’t agree with that. I do believe that leadership can be taught. I don’t believe you are born a leader. I believe that some people are born into circumstances that give them greater advantages but there are repeated stories in history that people born in adverse circumstances rose to the challenge and became great leaders.

DR. MAURICE PICKARD:

I am sure our audience after hearing this very provocative and interesting discussion about your book on leadership would like to get more information. Is there some way they can do that?

DR. DONALD PALMISANO:

Yes, they can go to www.onleadership.us and read more about the book there. It is also available at major bookstores nationwide and you can get it at Amazon. You can download it to a Kindle. There are many ways to get the book, but go to www.onleadership.us and you will read more reviews about the book and more information. Thank you.

DR. MAURICE PICKARD:

I’d like to thank you very much for being our guest. We have been discussing this very interesting subject on leadership. It may help us recognize leadership qualities in our selves individually that we don’t realize we have and certainly allow us to judge the leaders around us.

I am your host, Dr. Maurice Pickard and you have been listening to The Clinician’s Roundtable on ReachMD, the Channel for Medical Professionals. Please visit our website at www.reachmd.com which features our entire library through on demand pod cast or call us toll free with your comments and suggestions at 888-639-6157. Thank you for listening.