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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 a lawyer.  He is a former president of the American Medical Association.  He is the Clinical Professor of Surgery and the Clinical Professor of Medical Jurisprudence at Tulane University School of Medicine.  He has written a recent book called On Leadership:  Essential Principles for success.

DR. MAURICE PICKARD:

Thank you doctor for joining us today.

DR. DONALD PALMISANO:

Thank you, it's a privilege to be with you.

DR. MAURICE PICKARD:

Why did you write this book at this particular time?

DR. DONALD PALMISANO:

I wrote this book for 2 reasons.  One to leave a north star to my grandchildren, some are very young, the youngest is 3 years of age and one is on the way, so I wanted them to understand about leadership and I also wrote it because I believe the world has become a dangerous place, terrorism has reached America, and we see terrorism in other parts of the world and so much important for us to identify true leaders because in the time of crisis such as an attack of terrorism we need people who can get the job done and not people who lack courage.  We don't want people who can't make a decision in a crisis.

DR. MAURICE PICKARD:

Our audience is 90% physicians.  They are used to people coming to them for answers.  Those are usually medical answers.  Are there other arenas that doctors should be exploring and showing their leadership?

DR. DONALD PALMISANO:

Yes, the physician is a person who is trusted by the patient and physicians needs to understand that in order to give quality care to their patients, they need to be active in the community, in legislation by giving their expertise when pending bills are there and also when people run for office, because if they don't, they won't be able to live a quality care.  People who have never treated a patient will make rules and regulations such that the physician will feel that care can't be rendered to the patient, and so they need to learn how to communicate.  They need to learn to overcome any fear about making a presentation and they need to learn certain things that will allow them to speak clearly and concisely in a logical fashion.

DR. MAURICE PICKARD:

But you know before we get to that, we are all on this treadmill where you don't have to go into the various reasons, but they are pretty obvious to every one and when you turn to a doctor and ask him to be on a school board or a hospital board or even your local state medical society, the response is often I am just too busy.  What is your answer to them?

DR. DONALD PALMISANO:

Well, they will have less time if they don't get involved and so that's the history of great events.  The history of the development of America.  People saying we can't afford to stay in practice because of the onerous tax that the king has levied on us and so what they did was they said no we are going to stand up and give our message.  We are going to plea with the king, we are going to give the facts to the king, and finally, at some point, they said no we cannot tolerate this anymore.  If they had continued in the fashion that they were subjected to, we wouldn't have America and so we won't have the profession of medicine if physicians don't make the time.  You can always find time to get something worthwhile done if you rearrange your priorities.

DR. MAURICE PICKARD:

So, the doctor picks up your book, how is he to use it?

DR. DONALD PALMISANO:

Well, one of the things he has to learn how to identify true leaders and the book gives you the 20 essential ingredients.  I gave 3 of them for success, you have to have courage, do your homework, and don't give up, and you have to add to that, you have to be fully informed the decisive person with integrity and you advance towards the goal, you overcome obstacles along the way.  So, you have to learn that for yourself and you have to also identify others who have great potential to be a leader and help them overcome their fear because most people don't step forward into the arena because they are afraid that they will make a mistake and somebody will criticize them.  They are afraid of being blamed and you have to overcome that fear.  Work in good faith, and if you do your homework and you work in good faith, you won't have to worry about shame and blame.

DR. MAURICE PICKARD:

You have mentioned the word success, is success equals leadership?  Most doctors are in our culture seen as successful.  Does that equal being a good leader?

DR. DONALD PALMISANO:

Well, success and leadership are not the same thing.  You can be successful and not be a leader.  You can also be a leader and not have success because you did follow the principles and you fought with integrity to accomplish the goal and so you have to understand the difference between the two and I go into that in detail in the book, but physicians are successful depending on your definition of success.  They are successful when they carry out their Hippocratic Oath and they hold confidential the information that the patient gave them and they treat the patient for the patient's best interest, in other words, they don't do it for the benefit of the insurance company, they don't do it for the benefit of the hospital, they give the care that's best for the patient.  They are individuals of integrity who are doing the very best for the patient.  "Is this in the patient's best interest?" that's the sine qua non of quality medical care.

DR. MAURICE PICKARD:

If you are just joining us, you are listening to the Clinician's Roundtable from ReachMD, The Channel for Medical Professionals. I am Dr. Maurice Pickard and I am speaking with Dr. Donald Palmisano who is the former President of the American Medical Association and has just written a book - On Leadership:  Essential Principles for Success.

You know the chapter you wrote on communications as a leader, I would like you to talk on that because some of the things you described are the very things that we try to get medical students to do as far as doctor-patient relationships.  So, that same quality that we hope doctors bring to the doctor-patient relationship, we would like to see in our leaders.  What did you describe in that chapter in particular?

DR. DONALD PALMISANO:

Well, there are several things that I described, one is the element of compassionate communication.  You have to learn to be an active listener.  You have to listen to the patient.  You have to listen to your colleagues when they are upset about something and then validate the feelings of the other person.  You don't necessarily have to agree with it, but at least validate and say I understand why you are upset even though they may have the wrong facts.  You can understand their view of the facts why they are upset and three you can ask how you can help.  You must always be civil, but don't compromise your principles and you must never lose the common touch by letting status change you.  The other points that I bring forward I talk about the written word.  If you are going to write something for the press, for newspaper, if you are going to write for medical journal, you need to learn how to write.  The best book in my opinion ever written on that subject is a very small book called The Elements of Style.  It was co-authored by William Strunk and E. B. White.  Many of you who remember that E. B. White wrote for The New Yorker for many years, but he also wrote Charlotte's Web and Stuart Little, that is the best book on this subject.  You also have to learn how to speak clearly and the book makes that point, for instance, if you take something from the Bible, Ecclesiastes have written "under the sun that the race is not to the swift nor the battle to the strong and so on."  George Orwell, he is quoted in that book I just mentioned he rewrites that to show you what happens with much of the modern writing.  Objective consideration of contemporary phenomenon compels the conclusion that success or failure and it goes on, by the second sentence, you are asleep and so you have to write clearly.  Don't use big words, but use words that allow people to understand your message.  You also have to learn some rhetorical devices, you have to learn the language of leadership.  For instance, you could learn The Rule of Three, you group 3 related phrases or sentences in a logical sequence.  This approach turns your prose to something akin to poetry.  For instance, friends, Romans, countrymen lend me your ears that's an example of The Rule of Three.  I came, I saw, I conquered.  Life, liberty, and the pursuit of happiness.  Or you could learn about anaphor.  You should learn about all of these.  The repetition of a word or phrase at the beginning of a series.  One of my favorite examples of that when President Ronald Reagan went to Pointe du Hoc at an anniversary celebration and he said "These are the boys of Pointe du Hoc," "These are the men who took the cliffs.  These are the champions who helped free a continent.  These are the heroes who helped end a war."  Very poetic.  In fact, I had the privilege to meet the ranger who was first up who had the assignment and I wrote about him in the book to knock out the German guns, the 155 mm cannons.  You will have to read about that in the book, but true heroes and President Reagan had the ability to put it into poetry so that people used that example of a great way to describe the heroic accomplishment at Normandy on D-day.

DR. MAURICE PICKARD:

This book is filled with heroes, but the hero that I was most impressed by, I would like you to tell us a little bit about him, you seem to know him quite well in the book, it was a major in the New Orleans police force.

DR. DONALD PALMISANO:

Many years ago in New Orleans in a middle-income neighborhood, a man took hostages and he had one of the hostages at a window and the police came and discussed the situation and he knew something had to be done, so the ranking officer got out of the car and walked slowly towards the home, he took his coat off midway to the house and laid it on the ground, he then slowly pulled out his 38 special 4-inch standard issue Smith and Wesson gun that they used at that time, the pistol and he laid it on the ground and then walked very deliberately towards the house.  The gunman watched him with great interest.  He opened the door, he went in, and he was a few feet away from the gunman.  The gunman put the weapon in the policeman's face and he said now I am going to kill you and the policeman remained calm, raised his right hand to feel the gunman's forehead, and the gunman was amazed at this and the policeman said, "you have a fever, let me take you to Charity Hospital, I know the doctors there, they will help you."  There was a dramatic pause and the gunman then said, "You think I have a fever," and he said, "Yes, you do have a fever," and with that the policeman slowly reached down and took the gun from the gunman's hand.  The other police rushed in and wanted to take the man to central lockup, but the policeman said no, I promised to take him to the Charity Hospital and I will and he took him in his own police car.  That man was Major Dominic Palmisano, my father, and he taught me the elements of leadership by his actions and his words.  He once told me when I was thinking about quitting medical school, he said, "Do your homework, have courage, and don't give up.  Do these 3 things and very little is impossible," and I realized that those were the elements for success, and by his actions, I learned the other elements that gives leadership.  So, he not only talked the talk, but he walked the walk and his men revered him because they knew that he would never ask them to do anything that he wouldn't do himself.

DR. MAURICE PICKARD:

By now, our audience knows that your roots are very deep in New Orleans, you were born there, raised there, practiced in New Orleans, and your begins with Katrina.  Did Katrina have a great deal to do with how you view leadership or the lack of leadership?

DR. DONALD PALMISANO:

Hurricane Katrina showed me that people who claimed to be leaders demonstrate that they are not leaders in a crisis when they can't make decisions and when they show that they haven't done their homework.  Hurricane Betsy in 1965 gave us all the lesions we needed to handle the crisis in hurricane Katrina.  The only difference was the extent of the collapse of the levees, but the problems were the same, flooding, lack of communication, inability to communicate, inadequate supplies, inability to get the people out in time, and those lessons were learned in Betsy and they were also learned in Mark Hurricane 1 year before.  Hurricane Katrina occurred in 2005 and Mark Hurricane was done by the Federal government, the state government, and the local government and they said, "now, we know what to do."  Well, when Katrina occurred, they didn't do those things and the congressional committee that investigated that pointed out that all of this information was available at the time of Hurricane Pam, the mythical hurricane and unfortunately it wasn't carried out by the people at the state and local government and it reaches all the way all branches of government.  So, that was a very important demonstration that if you don't have leaders who can get the job done, they won't get the job done in a crisis.

DR. MAURICE PICKARD:

I want to thank Dr. Donald Palmisano who has been talking with us today about his new book - On Leadership:  Essential Principles for Success.  I would imagine that our audience after hearing our discussion would want more information about it.  Is there some way they can access more about your book?

DR. DONALD PALMISANO:

Yes, they can go to the website www.onleadership.us and learn more about the book and read reviews about the book.  It's also available at Amazon and at major bookstores nationwide.

DR. MAURICE PICKARD:

Again, I want to thank you.  This book is very provocative.  It's filled with information that all doctors can use not only in their profession life, but in their private life as well.

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