The leadership skill no one taught you in med school

Physician leaders are used to operating under pressure. What they are less practiced at, according to Leon Moores, M.D., is slowing down long enough to notice when the people around them are struggling.

Moores, a pediatric neurological surgeon at Inova Health System and author of “All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes,” has spent nearly four decades moving between clinical and executive roles — from infantry officer and combat-zone physician in the U.S. Army to chief of neurosurgery at Walter Reed to CEO of one of northern Virginia's largest medical groups.

That range of experience has shaped a clear-eyed view of where physician leaders fall short, particularly when teams are absorbing stress from every direction: economic pressure, political uncertainty, operational strain and the personal weight people carry in but rarely mention.

Medical Economics spoke with Moores about what medical teams actually need from their leaders during uncertain times, why projecting false confidence backfires and why he believes listening — not strategy or communication frameworks — is the highest-leverage leadership skill most physicians are leaving on the table.

The following transcript has been edited for style and clarity.

How does uncertainty affect medical teams?

It’s a great question. When we talk about uncertainty, none of us can avoid thinking back to COVID. To a degree, when I think about uncertainty today and compare it to what we were dealing with then — life and death of patients, life and death of providers, maybe even taking a deadly disease home to your family and still coming to work in very uncertain times — many people now almost react with, “Come on, it’s not as bad as it was during COVID.”

That said, everybody processes current times, past times and future times differently, and different things become important in their daily lives. For many people now, it may be costs, fuel prices or long commutes. Where I live and work, there are many active-duty military personnel and retirees. The military is often a generational family business, and many of my colleagues have children in the military, as my wife and I do. Thinking about what is happening in the Middle East adds another layer of uncertainty.

I’m a big believer that you do not leave your personal self at the door. You may put on a professional face when you come in, but those things in your life are still there. If we are paying attention and listening and showing empathy toward our colleagues, we should be able to pick up on when they are having a particularly tough day and try to help them through it.

When things are uncertain, what do people actually need from their leader?

One of the biggest things leaders need to do is very similar to what we need to do as clinicians, and that is being honest and forthright about what we do not know.

We are very used to that in clinical medicine. If a patient comes in sick, we do not have all the data yet. We still have to make some decisions up front, but as we get more information, those decisions and that treatment plan may change. One of the things that may have hurt us a little during the pandemic, in health care and in science more broadly, was an inappropriate level of certainty in what we were putting out. Rather than saying, “We’re scientists. This is what we know right now, but it may not be the final answer,” we sometimes projected more confidence than we should have.

In any environment, that honesty is key. You need to be able to say, “This is the best information we have right now. This is why I made that decision. As we learn more, things may change.”

The other side of that is what leaders themselves need. Sometimes when people get into a position where they are in charge of a team, they forget that they are affected too. Self-awareness is required before you can self-manage. If there is a lot going on in your head, a lot of anxiety or uncertainty, it is going to affect your performance, and you need to know that and plan for it. Maybe that means extra sleep. Maybe it means talking to someone. Maybe it means staying home for a shift so you can bring your best game in when your patients and teammates need it.

You touched on the parallel between being a clinician and being a leader. Could you talk more about that, especially for younger physicians who may not see themselves as leaders yet?

That is a great question and one I love to talk about. One of the things I’ve written about is that if you ask 100 doctors to name a physician leader, they will almost inevitably name a medical director, a chief of service, a chair, a dean or a chief medical officer. Those are the people we tend to refer to as physician leaders.

But if you look at a basic definition of leadership — influencing behavior to achieve a desired result — then every doctor is doing that every day. You do it with patients. You are trying to get them to stop smoking, lose weight, take their medicine. You are leading teams in the intensive care unit, the emergency department and the operating room. So you are constantly having influence as a doctor. Therefore, you are leading other people.

The fact that we are not more explicit about that with medical students, residents and young faculty means we are missing opportunities to teach and coach that skill. People are not necessarily reflecting on their ability to use leadership to accomplish the goal of better patient outcomes.

When you look at what we do in medicine, it is very effective. We gather information, analyze data, formulate a plan, evaluate how that plan is working, gather more data and adjust. That loop is very similar to what leaders in all businesses do. So it is not like physicians need three more advanced degrees to learn how to lead better. A lot of it is recognizing that we are doing it all the time already and using that as the template.

There can be an instinct for leaders, especially in uncertain times, to say everything is fine, even when it is not. Is that the right move, or is it better to be honest with the team?

I think there is a balance there.

I love the movie “Apollo 13.” The ship is starting to fall apart, almost certain death for the crew, the mission is failing, and the commander picks up the microphone and says, “Houston, we have a problem.” That is acknowledging the problem, getting in touch with people who may be able to help, and still not breaking down, screaming and becoming useless.

To a degree, maintaining professionalism and calm while being able to rationally talk about what is going on, even if it is a crisis and not just uncertainty, is super important. If you take that too far and seem robotic, like you have no feelings about it, that is not necessarily going to build the kind of trust you want. But you also should not come in panicking every time the stocks drop or Congress does something in health care or CMS cuts reimbursement.

Those things happen all the time. So it is not about cheerleading and telling everybody everything is fine when it is not. It is about acting as a stabilizing force, a credible stabilizing force, so people can optimize their performance, remain calm and believe they can get through it.

What advice do you have for delivering difficult or uncertain news to a team in a way that still preserves trust?

It starts with what we just talked about: acknowledging that yes, you are affected by this too, without breaking down and becoming useless. If something is super challenging to your team, they probably want to know that you are dealing with it as well.

Then it is about being honest with what we know and what we do not know. The kind of leader who comes in and says, “Everything’s fine,” when everyone knows it is not fine is not going to help. A good example from my past was when we were rolling out an electronic health record system. The biggest bosses kept talking about how great it was, but they were not the ones using it and had no idea what the people actually working in it were dealing with. That kind of “pay no attention to the man behind the curtain” leadership does not help.

Being honest, being upfront and showing a little humanity yourself builds trust. And I think the humanity part also makes it easier for people to approach you if they have a difficult question or if they think your decision is wrong. You really want people to feel they can raise their hand and say, “I don’t think that’s right. I have information here that could help us make a better decision.”

People process stress in very different ways, and it is not always obvious when someone is struggling. How do you make sure you are actually seeing that and not just assuming your team is fine because no one is saying otherwise?

If you want to know what people are thinking and feeling, ask them.

There are environments and ways to do that effectively that are not offensive or intrusive. Some people do not want to share their feelings with their boss, and that is perfectly appropriate. But through repeated actions, letting people know that it is okay to do so — asking how they are doing, what they need, whether there is anything you can do to make the day better — all of those things help people feel that maybe the boss really does want to help.

That is a much better position than having everyone around you feel like they are just a cog in a wheel with no feelings and no one has any feelings for them. You definitely do not want to fall into that trap.

How do you maintain team trust when a situation is still unfolding and you do not have all the answers?

I think when people join a health care organization, whether as a physician, nurse, technician or administrator, they probably come in with a certain bucket of trust just because you were hired into the organization. You can add to that trust through your actions, and you can decrease it through your actions as well.

You do not want to be in a true crisis, in the operating room in the middle of the night with a trauma patient, and have people not trust you. So if you have built that trusting relationship over time, then when there is a crisis people are more likely to respond, to speak up and to trust that there is a reason for what you are doing.

One of the ways to build that trust is to constantly ask questions, and when people make suggestions or raise concerns, to celebrate that. If someone says, “Wait, can we pause and look at this X-ray again?” you want to say, “That’s great. Let’s pause and look.” Everybody hears that.

If there is a high-stakes situation, people are even less likely to challenge what is happening unless they feel very safe doing it. You want to build a team where people can throw that challenge flag freely and not get punished if they are wrong. Unfortunately, in all environments, if leaders get flustered, they may snap or just act indifferent. Comments like “stay in your lane” are not useful. They do the exact opposite of what you need.

Not too long ago, I was in the operating room with a team and we added up the operative experience in the room. There were 123 years of experience on that team. That is a lot of knowledge. If every one of those people does not feel comfortable asking a question, then you are missing out on something that could help your patient.

What mistakes do you see physician leaders making most often when their teams are under stress?

Physicians are under a lot of pressure, and most people in health care are. There are health consequences, if not life-and-death consequences, in what we do. We are often under a time crunch, always trying to move to the next thing.

Quite frequently, what I see is that because people are trying so hard to keep moving, if someone says, “Can I ask you a quick question?” or “I have a suggestion,” there is a tendency to stay focused on the next task and brush it off. Maybe it is not as bad as saying, “Shut up and stay in your lane,” but it is still dismissive.

That kind of dismissiveness does not build trust. Even if you only stop for a short time, turning to the person, making eye contact, listening intently and responding appropriately makes a difference. And the response can be, “That is a great point, and I really do want to follow up on it. I have to get to the operating room right now, but can we talk at 5 this afternoon?” That is much better than, “Catch me later,” while you keep walking down the hall.

I do not think most leaders do this out of ego or because they are sociopathic. It is usually because of the constant pressure to move on. But not taking that minute or two to say, “Yes, what are you thinking?” is a mistake.

If you had to give one piece of advice that physician leaders could put into practice this week to help steady their team, what would it be?

Honestly, I do not think any of us listen enough or as intently as we could, and that is a switch you can flip pretty quickly just by being mindful of it.

Any time somebody says something to you, look up from the computer, make eye contact, put your phone away, turn your body toward them and sit down if you can. There are studies showing that if you sit, people feel like you spent more time with them than if you stay standing.

What you are really trying to do is improve psychological safety. Physicians carry a certain psychological size mismatch in health care organizations. That does not make us special, but it does mean doctors have to make extra effort to get other people to feel comfortable challenging them. And you want them to feel comfortable challenging you. Your patients need that.

It is not going to happen passively. You have to actively make it happen. The one thing you can do this week is listen more, or listen better, and do it repeatedly in front of everybody. Over time, people will say, “He really listened to me,” or “She really listened to me,” and that goes a long way.

Is there anything else you think physicians should keep in mind?

I would emphasize listening, again. And I would emphasize knowing that in a crisis, everybody is going to respond differently, so paying attention to body language matters too.

If you have created psychological safety, people may step into your office and say, “I’m having a tough day. Can we talk about it?” That is incredibly meaningful when people are willing to do that. It is also important not to be dismissive of what people are experiencing.

And very importantly, because it is going to take us years to gain back societal trust, I think we need to acknowledge the gaps where we do not know things and that our recommendations and diagnoses may change as we get more data and more information. Be clear about that from the start, and people will trust you more.

And you want to be trusted as a doctor, as a leader and as a human being.