The Seven Traits of Leadership on the High Seas of Cancer

Craig R. Hildreth, MD

“The white-haired Texan…led with a distinctively warm and personal touch.”

“Nimitz was content to listen at length and was tolerant of dissent.”

“Even when discussions grew heated, Nimitz remained imperturbable. He did not sign off on a decision until all objections had been aired and registered.”

[of Admiral Chester Nimitz]: “He was one of the few people I knew who never knew what it meant to be afraid of anything.”

-Ian W. Toll, The Conquering Tide: War in the Pacific Islands, 1942-1944

To My New Oncologist,

I am hoping that you can help me. I just found out that I have cancer and it has spread. I know you’ve heard this before, but the past 2 weeks have been unreal, as if I was in someone else’s body. I am told that the cancer is treatable but it is hard to be hopeful after hearing that horrible word thrown at you like a javelin.

My internist gave me your name and I have an appointment with you tomorrow. I think you should know that I am quite familiar with oncologists-my father died of lung cancer, and frankly I was not impressed with the doctor who treated him. As a result, my opinion of oncologists is not very high right now, yet if I want to live to see next year I had better find someone I can trust with my life. My past experience has left me skeptical, so with this in mind:

Can we not waste each other’s time?

Everyone wants their doctor to be compassionate, but what I need most of all is leadership. Of course no one discounts traits like niceness, but I am looking for a doctor who is a great commander, say on the level of Admiral Nimitz, who you may recall was in charge of the Pacific Fleet in World War II. True, it is considered trite to describe a “war” on cancer, but that’s the cliché I like, and so I ask, “Are you as resolute and diligent as the famous admiral?” These are the leadership qualities I seek:

1. Please know your stuff. As a leader, you should have a thorough knowledge of my cancer and of the latest developments in research, and be ready to formulate a plan of attack.

2. Please do your homework. I expect you to have reviewed my medical records prior to my appointment. You’ve looked at my x-rays; you have my pathology report; you know how many children I have. In the world of cancer care, every scrap of data must be scrutinized for its significance.

3. Please respect my point of view. Leaders listen to all sides thoughtfully before reaching a conclusion. With patience and finesse, I’m sure you can help me to feel confident about the plan you have shaped for me.

4. Please be curious. Don’t close your mind to new hypotheses and don’t ignore clues that might lead you toward the best results. Please rid yourself of the temptation to make your day easier by delivering perfunctory care. For example, my next-door neighbor saw a doctor for an unexplained high iron level and he asked her, “Have you ever had cataract surgery?” When she said, “Yes, and so has my son when he was 4 years old,” the doctor diagnosed hereditary hyperferritinemia-cataract syndrome.

5. When it’s decision time, please decide! If you think treating my cancer is not worth it; if you think I am at the point where I should stop chemotherapy; if I have veered off the path you have cleared for me-then speak up! Care for me with a dogged determination to get me healthy and don’t keep any secrets that might lead to regret. I want an oncologist who knows what’s best for me and doesn’t chicken out in difficult times.

6. Please be responsible. Follow up on promises and follow through on tasks. I can tell you with absolute certainty that there is no greater disappointment than realizing that you cannot rely on your doctor.

7. Please talk to me. I need your advice, comfort, and expertise; I am scared and discouraged-are you willing to take a seat, look me in the face, and answer my questions? Leaders welcome scrutiny of their communication skills. No one cares if a flunky is curt.

Thank you for giving me the opportunity to share my concerns. If you think my “Seven Traits of Leadership” match your practice style, then I look forward to meeting you. If not, do not fret-I shall simply sail on to the next harbor.