Professionalism is judged by appearances ... like it or not. (Career Rx).

It's a cold, hard fact that perception Is reality. Struggle with It if you like, but you won't change the simple truth. In this fast-paced world, you get few chances to make any impression, much less a good one. When Andy Warhol said everyone would be famous for 15 minutes, he was speaking pre-email, pre-cell phone, pre-managed care, pre-1990s, pre-everything. Celebrity now is probably measured in mere moments. What your own world sees and hears (or doesn't see or hear) when it looks at you for the brief time you are able to capture its attention is, thus, extremely important.

Your professionalism--not only how you look but what you have to say, how you say It, and the effect you have on others--can directly impact on how well you perform as a physician executive.

How's your sound bite?

As a physician executive, it's your primary job to influence other physicians' attitudes, philosophies, and behaviors, Unlike your peers on the senior management team who have direct line authority and direct reports, you are working with affiliations--some tighter, some looser. Your task is to deal with people who don't have to do what you say. You might have hundreds of physicians with whom you must relate effectively, and yet you only see most of them for three or four minutes at a time, a few times a year. The rumor mill has more direct contact with them than you do.

In this competitive environment, with limited time to manage your relationships, you must take control of all aspects affecting your credibility and your communications. I am not suggesting that you become the stereotyped, airbrushed news anchor, all style and little substance. I am suggesting that you create a total package, one in which the "inside" and the "outside" of your presentation are complementary. Focus your attention on how well you have developed these factors as a physician executive:

* Appearance

* Demeanor 

* Professionalism 

* Integrity

Creating a total package

Here are a few ideas that I have found to be useful in stimulating thinking on this rather delicate subject:

* Write "commercials" for yourself and your organization

This is tough. The exercise of thinking through your mission and learning to put it in bullet points (try to limit these to three per "commercial") may frustrate you for a while. But persist until you are able to deliver these spot announcements for yourself and the company you represent with ease and confidence. You'll elevate the tone of any discussion and add professionalism to any debate if you can introduce yourself and your employer to all your publics in this way. Needless to say, this is not a canned presentation, memorized and delivered by rote. It's a structured approach that frees you to communicate with anyone about who you are and what you do. It will put you on the map.

Here's my own "commercial" message: I am a physician who has chosen to specialize in physician executive search assignments within the field of health care executive search. My goal is to promote physician executives as peers of other senior management team members by reasserting themselves as leaders in health care.

* Use every interaction as a selling opportunity

In my company, we call It "carrying the flag," and we mean by that an awareness that we are always viewed by people we meet as being part of this organization. We are representatives and we have a story to tell that others want to hear. So, tell about the organizational successes and competitiveness, over and over, Internally and externally.

* Make every context a platform

What you and I and everyone who takes their career seriously are selling is not necessarily a product, but ideas. As a physician executive, your primary role is to change belief systems. Old beliefs die hard. It's your job to attack and demolish the old notion that "there's plenty of money and more where that came from." Today's health care organizations are predicated on the concept that resources are limited, not inexhaustible as might once have been believed. And it's up to you, though you only may have a few moments with Individuals or groups of your physicians, to reinforce that message and influence change. This is selling of the highest caliber and complexity. And right now, physicians are more ready to listen than they have ever been.

* Don't hide from criticism; seek it out!

The only way to improve your presentation is to ask for constructive criticism, and then act on the well-meant advice you receive. Let people whose opinion you respect listen to your "commercial" and give you comments. And if they have personal suggestions for you, be ready to act on those as well. It was impressive to see, in a long-ago documentary on acting, the veteran actor Sir Laurence Olivier quietly taking "notes" from a young director after a dress rehearsal. We all can do better, and we have to open ourselves up to insights.

* Use every opportunity that comes your way to listen

As the volume of life has generally increased, everyone feels no one Is listening--and no one seems to feel more abandoned than physicians. When you let the physicians in your organization know that you want to hear what they have to say, you will be paying them a high compliment while also doing your job. Too often, physician executives think their responsibility is to bring others the truth. In fact, it is actually your job to let others tell you the truth as they see it, and to understand them and their issues. Only when you do that can you expect to influence their thinking and actions.

Deep--or all surface?

Before you complain that all this seems superficial and irrelevant to the serious business of health care, or before you sniff that the world should just accept the plain, unvarnished you, warts and all, consider this: No one has time to get to know the real you. The world is spinning much too quickly for anyone to expect courtship-level contact as a part of daily living. I'll risk repeating the phrase that has become the mantra of our times: Perception is reality. It's not merely a veneer that is perceived, the veneer is all that is perceived in most interactions--and it should be as strong, effective, and consistent as possible, at all times.

Mary Frances Lyons, MD, is an Executive Search Consultant with Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis. She can be reached at 8000 Maryland Avenue, Suite 1080, St. Louis, Missouri, 63105 or by calling 314/862-1370. Please fax career development questions that you would like addressed in this column to Dr. Lyons at 314/727-5662.