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The dead moose and other reflections on compassionate physician leadership. (Essay).


Learn how a little compassion goes a long way when it comes to effective leadership.


Two pharmaceutical companies were in the process of merging. During merger discussions, a physician executive remarked, "There's a dead moose on the table." The comment was repeated frequently over the course of the merger.

The moose came to symbolize emotionally charged issues typical of mergers yet avoided by most companies. The physician executive, however, insisted on discussing those issues. He moved the merger forward and contributed to its success. The physician was appointed senior vice president of the newly combined organization, a tremendous feat considering he had worked for the smaller of the two companies.


A managed care organization lost over 50 percent of its stock valuation. The CEO and CMO were dismissed. The new CMO eliminated the medical department and replaced several corporate medical directors with less qualified, less expensive individuals.

Materialistic concerns continued to dominate the company's agenda. Remaining employees commented that the CMO lacked compassion and sacrificed human need for human greed. The company's stock price never fully recovered and the physician never commanded the respect and loyalty his predecessor enjoyed.

These two scenarios demonstrate obvious divergent leadership styles. The pharmaceutical industry physician is thoughtful and considerate. He is aware of the human toll exacted by mergers and acquisitions and the need to address that dimension of the business transaction.

The managed care physician, on the other hand, is focused on the bottom line and his interactions with colleagues are dehumanizing. It is not surprising that these two organizations experienced different outcomes based largely on the degree of compassion exhibited by their physician executives.

Some say physicians forfeited their claim to compassion when they gave up their white coat for a business suit. Others--notably physician executives themselves--argue just the opposite, that it is the failure of lay leaders in health care that actually attracts physicians to management, subsequently making it their raison d'etre.

When transitioning from medicine to management, physician executives vow never to lose touch with people or their ability to care. By becoming a physician executive, it is possible to impact entire populations.

In detailing his principles of leadership, Rudolph Giuliani remarks, "Much of your ability to get people to do what they have to do is going to depend on what they perceive when they look at you and listen to you. They need to see someone who is stronger than they are, but human, too." (1)

Giuliani's leadership became most evident during crises, as is true for many physician executives. His effectiveness resulted, in part, from his compassion for people from all walks of life. Like all great leaders before him, Giuliani left his emotional mark on the world by showing compassion.

Regrettably, compassion may not be viewed as a core quality of leadership. We usually think of leaders in terms of those with strong and consistent character who can deliver stirring speeches and "lead by example." In fact, emotional display is often considered a sign of weakness unless it conveys aggression.

Consider, for example, the bankruptcy of the Pittsburgh-based Allegheny Health Education and Research Foundation (AHERF) and the plight of its former CEO and president, Sherif Abdeihak, who pleaded guilty to misappropriating funds.

According to a close associate, Abdelhak "had a huge. ego and could be brutal in business dealings. No one wanted to take bad news or an opposing opinion to him. Abdelhak...was not unlike many executives in health care--articulate, daring and in control of and respected by his board" (2)

Lasting respect, however, is achieved through compassion, not tyranny. Abdehak led by fear and intimidation, not by empathy and understanding. Unchecked, his aggression resulted in the "Fall of the House of AHEPF," the nation's largest nonprofit health care failure. (3)

Thomas Stewart wrote, "There are CEOs who slash and CEOs who fix and CEOs who safeguard and CEOs who build. The great ones do all these things, too, but first of all they love. Passion, commitment, ferocity--the traits of lovers are in these leaders." (4)


A physician executive worked for a large manufacturing company as the in-house doctor. An employee believed that her illness was work-related, yet the company resisted this interpretation. The physician executive was indifferent to the employee's plight and remained aloof during the physical examination. He is not normally cold to patients, but he suppressed his emotions hoping to avoid the conflict between the patient and the company. The patient complained that the doctor was unfeeling. Senior management saw him as abdicating his role of caregiver.

Emotional constriction is a common defense mechanism used by physician executives. (5) In the short run, denying your emotions eases the tension between the physician's obligations as a doctor and his or her role as part of management. Virtually every physician executive who has done insurance reviews will attest to this.

Over time, however, an emotionally constricted physician comes across as rigid and senior management may misperceive the physician's lack of affection as lack of enthusiasm. In reality, recognizing and confronting the conflicts inherent in the physician executive's job would likely have created a stronger role for him within the company.

Leadership and compassion are related, but they are not the same. A leader has a vision of success and inspires others to embrace the vision and develop a plan to get there. Showing compassion helps achieve that vision.

Compassion and leadership work together. Compassion lends heart to leadership, and leadership lends focus to compassion. Compassionate leadership embodies a value embraced by many health care organizations, namely, respect for people.

Being compassionate assumes that physician executives still recognize the needy and suffering and want to help them. Scores of books remind us that compassion is an accessible state of awareness determining the quality of our well-being.

Leadership in the service of compassion can be very potent. It has been written that compassion is one of the four "powers" of leadership, along with presence, intention, and wisdom. (6) Compassion integrates the other three powers, achieving a new level and quality of leadership.


Three physicians were let go from their full-time hospital staff positions in a downsizing initiative. The medical director charged with their dismissal discussed the situation with each of them, expressed sincere regret and offered to help find them other jobs and write letters of recommendation. One of the physicians, although clearly distressed by the news, was actually apologetic that the medical director had such a difficult job to do. Senior hospital executives thanked the medical director, as the hospital was able to avoid bankruptcy. The medical director's "stock" in the organization rose considerably.

Any physician executive will tell you that terminating another physician's employment is difficult no matter what the circumstances. If not done properly, with compassion, a wrongful termination lawsuit may result.

The approach demonstrated by the medical director stands in marked contrast to many business executives who become "Rambo in Pinstripes" during organizational restructuring. Bent on destruction, those executives are often financially rewarded for reducing headcount and their manner is anything but sensitive and caring.

Many physician executives fail because they lose their capacity to be warm and understanding in everyday interactions. They are unable to bridge the gap between personal power (inherent leadership) and positional power (the authority vested in them as organizational leaders).

Demonstrating compassion helps bridge that gap and creates effective leadership. Showing compassion may even revive a dead moose!


(1.) Giuliani, RW. Leadership. New York, N.Y., Hyperion, 2002.

(2.) Galinski, T. "Abdelhak Reconsidered." Modern Healthcare. 2002, 32(20):30.

(3.) Burns, LR, cacciamani, J, clement, J, Aquino, W. "The Fall Of The House Of AHERF: The Allegheny Bankruptcy." Health Affairs. 2000, 19(1):7-41.

(4.) Stewart, T. "Why Leadership Matters. Fortune. March 2,1998, p. 80.

(5.) Chapman, DW. Corporate Physicians: Between Medicine and Management. New Haven, conn., Yale University Press, 1987.

(6.) Kyle, DT. The Four Powers of Leadership: Presence, Intention, Wisdom, and Leadership. Deerfield Beach, Fla., Health communications, 1998.

Arthur Lazarus, MD, MBA, CPE, FACPE, is a neuroscience director and regional medical research specialist for Pfizer, Inc, based in Prospect, Ky. He is a frequent contributor to The Physician Executive and editor of MD/MBA: Physicians on the New Frontier of Medical Management (American College of Physician Executives, 1998). He can he reached by phone at (502) 228-2480 or by e-mail at His opinions are not necessarily those of Pfizer, its management or employees.
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Author:Lazarus, Arthur
Publication:Physician Executive
Geographic Code:1USA
Date:May 1, 2003
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