• Dr. Robert

An Oxymoron – Motivation from An English Person.

(Dr. Robert's disclaimer - I wrote this article last year as a first draft for a well-known chiropractic magazine. Unfortunately I should have read the article submission guidelines first, as I went well beyond the maximum word count they would accept for an article. Their loss. I refuse to trim down the article. While the article is directed specifically at chiropractors, I think that it may be of use to others.)

Major Richard Winters

Before I begin this rambling little jaunt, I have some explaining to do. I am English by birth and upbringing. I have the typical English person’s knack for sarcasm, irony and poorly-timed wit. This means that I clash with any form of motivation. I don’t need anyone to tell me how wonderful I am, I already know – I’m British!! I often joke that motivational speakers flying into Heathrow airport should be arrested at baggage claim (if only that were true…). That said, I have been in the US long enough to have had some of your culture rub off on me, except for cowboy hats and cowboy boots. No, just no. Now that you have some understanding of my mindset, you will comprehend that when I start talking about motivational matters I do not do it lightly. If you are still with me, brave person, then onward and upward…

The basis for this article is a gentleman by the name of Major Richard Winters. For those of you who saw the series “Band of Brothers”, he will be familiar. For those of you who have not, it is worth watching, if only to understand a little of what our veterans go through. Major Winters, who is no longer with us, is a personal hero of mine. He was a humble man who lived through extraordinary times, and who learned how to lead in the mud of Camp Toccoa, in the heat of D-Day and in the ice of Bastogne. Major Winters formulated the 10 principles of leadership discussed below, and some of you may recognize them from modern military leadership manuals. I firmly believe that utilizing the following principles can and will aid every person, including us chiropractors, to improve our chosen careers and our daily lives. Still with me? Good!

1. Strive to be a leader of character, competence, and courage.

For chiropractors, we should be leaders in our profession, in healthcare in general, and in our practices. Character refers to ethical and moral behavior – doing the right thing every time and all the time. There are no shortcuts in ethics. Morals should not be negotiable or situational. I have come across unethical behavior from chiropractors, medical doctors, dentists, osteopaths, etc., on many occasions (10 years of doing utilization review will give you an opportunity to witness some quite unscrupulous behavior from doctors, therapists, patients and insurance companies), and we can and should be above the kind of unprincipled and ofttimes illegal behavior that can flourish when standards are allowed to slip. “Do to others as you would have them do to you” should be stamped on our foreheads (in reverse, preferably, so we can read it in the mirror).

Competence is not only having the skills and the knowledge of when and how to use to use them, it is also continually and vigilantly honing those skills and expanding our knowledge base. I often tell my patients that if a doctor says that he or she knows everything, then it is time to run, limp or crawl out the door and look for a new doctor. I also say that the day I stop learning is the day they lower me into a 6-foot deep hole. Every day should be a learning experience. I am learning as I write this article, and I hope that it is an opportunity for the reader to learn something new and/or different. We are surrounded by learning opportunities. We have access to websites such as PubMed. We have evidence-based guidelines coming out of every orifice (and about every orifice). We have opportunities to learn from other chiropractors and to get involved in research. We have residency programs through the Veterans Administration. Every single time I treat a patient I learn something new or find an opportunity to search for answers. Even the continuing education courses we healthcare providers take to maintain our state licenses should be an opportunity to improve our competency (maintaining competency should not be an option – a blade that is not repeatedly sharpened dulls with every cut). Picking a continuing education course because it is cheap and convenient isn’t the best way to go. I have fallen into the trap of picking courses just to satisfy my licensing board and not learning enough from them. Not anymore. When I heard that Dr. John Donofrio had passed away last year I was reminded of his favorite phrase “the difference between the winners and the losers? One More Step!”. I try and keep Dr. Donofrio’s wise words at the forefront of my mind.

Courage. For those of us who remember our anatomy classes, the Latin word “cor” refers to the heart, but it is also used to mean inner strength or temper. Courage takes many forms. The courage to do the right thing when doing the wrong thing would be so much easier – and often more fun. The courage to admit you have no idea what is going on with the patient. Sometimes it is the courage even just to roll out of bed and get the day started (if you do not have those kinds of days then I envy you). Courage is bred out of character and is buttressed by competence. Character is maintained by courage and is stabilized by competence. Competence is the foundation for character and is the lattice through which courage is weaved. Maybe a bit too poetical, but I like it.

2. Lead from the front. Say, “Follow me!” and then lead the way.

Leadership is a double-edged sword, consisting of authority and responsibility. Sometimes leadership can feel like an explosion in a razor blade factory. Character (taking the right steps in the right direction), competence (knowing the potential potholes, chasms and landmines that may be in your path) and courage (taking the hard first step despite the risk of falling flat on your face, then taking another, and another…) are the building blocks of leadership. That said, you can have all the character, competence and courage in the World, but if you do not use them, then you are treating precious gifts as baubles. Often, taking those first steps forwards as a leader can be daunting and uncomfortable, but the rewards are great. Some people falter on their first steps as a leader, while others are using a metaphorical pogo stick and bounding ahead. It does not matter, as you are all going in the same direction. You will benefit, as will your patients and your fellow chiropractors.

3. Stay in top physical shape - physical stamina is the root of mental toughness.

I will admit that my 51-year-old body could be in better shape. 15 years of training in martial arts did result in some broken bones and torn tendons and ligaments. I am in just as much need of regular chiropractic care and a good rehab program as my patients. I am married to a chiropractor, have access to exercise equipment and have no physical reason to avoid exercise. I remember being told while at chiropractic college that the number one reason chiropractors leave the profession is due to injuries. While I am not sure of the validity of that statement, I can well believe it. We beat our own bodies up while practicing the science and art of chiropractic. I have recently started performing the same basic rehab exercises that I start my patients on, and I hope to get back close to the condition I was in in my 20’s and 30’s. I want to keep treating patients until I am well into my 70’s, but I have to lay the physical and mental groundwork now. To lead from the front, you must be ahead of others while you guide them, and that means being physically and mentally tough. Physician, heal thyself (ok, I took that totally out of context, but everybody else does, too).

4. Develop your team. If you know your people, are fair in setting realistic goals and expectations, and lead by example, you will develop teamwork.

I work with my wife in a small cash-based practice. We have no employees. That said, we work as a team. We know each other’s strength and weaknesses, we support each other running the practice, we set obtainable goals, we each lead and support in different areas of the practice and she has yet to hit me with the X-ray view box (good thing too, as it is fixed to the wall…). Being a leader and a good role model to your staff is vital, not only for the smooth running of your practice, but also for the wellbeing of your patients. I have encountered several practices where personality conflicts, poor communication skills and lack of direction made for a miserable working environment for all those involved and, more importantly, negatively affected patient care. Patients have many legitimate complaints when it comes to going to healthcare providers in general, such as long waiting lists, waiting for inordinate amounts of time in the waiting room, and dealing with crabby front office staff. In your practice, the buck stops with you. Don’t blame your staff for patients waiting too long for care. Don’t blame your staff when they are being crabby and unprofessional. You are the boss, you hired them and gave them their duties, it is up to you to sort them out. Great leaders look for effective solutions to problems and know how to pick winners, poor managers just look to spread the blame around as much as possible.

5. Delegate responsibility to your subordinates and let them do their job. You can’t do a good job if you don’t have a chance to use your imagination and creativity.

It is not just about picking the right team members and knowing their strengths and weaknesses. You also must let go a little and let them get their jobs done. Micromanaging can turn a happy and productive employee into a former employee very quickly. A completely “hands-off” form of management (which isn’t really management) is no use, as there is no structure or discipline.

6. Anticipate problems and prepare to overcome obstacles. Don’t wait until you get to the top of the ridge and then make up your mind.

This is where competence rears its head again. We cannot predict the future, but we can have a rough idea of some of the muck that life throws at us, and we can prepare. Tax Day should never be a surprise to any of us in the US, although the taxes owed can sometimes make us grimace, and we can and should make plans to limit the amount of grimacing. Make plans for common eventualities, but also be flexible. Planning skills are more important than the plans themselves. “No plan survives contact with the enemy” but planning for obstacles beforehand and flexible planning while dealing with unexpected complications is what will see you through.

7. Remain humble. Don’t worry about who receives the credit. Never let power or authority go to your head.

Ok, this is difficult. Humility is not a natural human state. Someone taking credit for another’s efforts and accomplishments happens all the time. It is the same with blame. Most of us have been the victim of such shenanigans. It hurts. We do not like it happening to us, so we should not like doing it to others. Praise where praise is due, motivate instead of denigrate, and don’t give pride a chance to become arrogance. Own up to errors and be the solution. Owning up to failure does not mean admitting defeat, but it can help you learn how to be victorious.

8. Take a moment of self-reflection. Look at yourself in the mirror every night and ask yourself if you did your best.

Do not allow self-reflection to be a time for recriminations, either directed at yourself or others. Take note of what you have achieved, where you did well, and where you could have improved. Think about your goals, reevaluate and change yours plans accordingly, and learn from what went well and what went badly. I used to emotionally beat myself up quite badly when I made mistakes or fell short of what I could do. It only made me feel miserable. It is not productive. I still beat myself up a little, but it now only results in slight emotional bruising, and my focus is more on tomorrow’s opportunities than yesterday’s disasters. If I can learn that valuable lesson, then there is hope for us all.

9. True satisfaction comes from getting the job done. The key to a successful leader is to earn respect--not because of rank or position, but because you are a leader of character.

I worked in utilization review for 10 years. There were times when I loved the job, and there were times when I loathed it. Even when I hated the job, I had satisfaction from knowing that I put 100% into every case I worked on. The patients deserved no less from me. I am now putting all my energy and focus into helping patients face-to-face. I put 100% into every patient interaction. I am happy. More importantly, my patients are happy with me, and they are healing. That is why I do this job.

10. Hang Tough! --Never, ever, give up.

I can’t add much to this last, but not least, principle. I will add that if you do give up, then you are not just giving up on yourself. You are giving up on those around you, and that includes your patients. For those Galaxy Quest fans out there – “Never give up, never surrender!”.

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