I’m Not Always A Nice Guy

I’m Not Always A Nice Guy


Leonard Zwelling

It is interesting that as the participants in our national politics seem to communicate in coarser and coarser language, exemplifying ever more childish behavior, the leadership at some bastions of academic medical excellence concerns itself with being nice. These leaders seem to care less about making progress against human disease and more about “professionalism” which seems to be in the eye of the beholder most of the time.

Recently I have had the occasion to participate in zoom calls with some of these “professionals” and other nice people and I have been struck with the fact that they don’t seem to get anything done. They make excuses, say they will look into things, and do anything in their power not to make decisions, especially about controversial issues involving patient care and doctor competence. They go out of their way not to step on anyone’s toes and not to offend. These “leaders” also take no responsibility for anything. Not exactly Spiderman adherents.

I don’t get it.

I know I am going to sound like an old man, but when I trained and even when I was a vice president, niceness was not a primary criterion for success. Success was.

When I first began overseeing the infrastructure for clinical research at MD Anderson, I had to deal with faculty members getting warning letters from the Food and Drug Administration because patients died on their trials and the deaths went unreported to the Institutional Review Board, the group responsible for the ethical conduct of clinical research. Was I supposed to be nice when the FDA called me? I was afraid I would lose the job I just got. I was not nice to the offending faculty member either. Nice was not in my job description.

I am fully aware of my reputation for toughness and unwavering devotion to ethics, especially in the areas of human subjects research, conflict of interest, and clinical care. I try not to compromise my ethics. I am sure that I fall short all the time, but I try. My debt to those who taught me in medical school and trained me in my house staff years and as a fellow is paid by honoring them with being the best me I can be—even if that is not the nicest me I can be. My teachers were not always nice. They hurt me often. Tough darts. I was going to be responsible for the care of other human beings, many of whom would be very ill. Nice doesn’t count. Competence does.

Now, in the era of perpetual patient satisfaction surveys that relegate the awards reaped by doctors to subjective feelings about how they present themselves to patients, perhaps we should think about how much the patients actually know about the competence of the doctor. I have been startled by some of the treatment recommendations I have heard from physicians. Many make no sense beyond maximizing billing and RVUs. But, that may be what is driving the behavior of modern doctors.

So, here’s my questions. How did our national politics go so off the rails and become so filled with rancor? When did our doctor leaders lose focus of the primacy of patient well-being over hurt feelings?

I may have some redeeming qualities, but niceness is not one of them. When I am in a business setting the business must take precedence and if someone who has done a poor job has his or her feelings hurt—well—too bad. Someone’s life might be at stake and whether you are nice counts a lot less than whether or not you know what you are doing.

It’s fine to be nice. I urge all you nice people out there to be nice. I’m bad at it.

Nice is nice at a party. It is not what drives success in medicine although looking at the current crop of physician leaders, I am beginning to wonder.

I had a medical school classmate who divided doctors into two categories—those he would and those he would not let cut his toe nails. There are far too many in the latter category. But, most of them are nice.

2 thoughts on “I’m Not Always A Nice Guy”

  1. Discipline, integrity and accountability are paramount in any organization as you emphasize.
    Leading and managing colleagues, some who are friends, requires a certain firmness, but it must always be done with respect for everyone and for their viewpoints. I don’t like the word “nice,” but also I don’t like the word “asshole.” Neither approach is effective in the long run.
    One approach that I have used effectively is said respectfully but firmly, leading to a correctional plan:
    “Edward (a misbehaving surgeon), you know that I like you….but I do NOT like the way you have been yelling at your staff in the OR. Let’s talk about how you are going to change that. Otherwise, I may ask you to resign.”
    I often referred colleagues who were not performing satisfactorily to a coach (a psychologist or psychiatrist trained in mentoring) to enhance the self awareness and self control of the colleague. If they refused counseling, I asked them to resign before I fired them. Two thirds of the time, counseling helped; one third of the time, the colleague was moved on.
    I agree that poor performance must be addressed with due process and with the intent to always protect patient care and safety.

    1. Leonard Zwelling

      Yes. I too have used your approach. I also like the use of coaches. It tends to turn down the temperature. Great comments. LZ

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