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Bolwell, Brian J. MD, FACP

doi: 10.1097/01.COT.0000547468.23471.49
leadership; oncology

leadership; oncology

I am by no means an avid social media user but I appreciate and understand its usefulness, especially Twitter. It's a quick way to learn about what is going on in the world today if you follow basic news organizations like The New York Times. In addition to news, I follow TED Talks (@TEDTalks). Recently, I came across a fabulous TED talk by Brene Brown on “The Power of Vulnerability.” She describes her research on what she terms “wholehearted people,” and how having the courage to be vulnerable is the key to becoming connected to others and to experience joy.

It's a great talk that is also filled with humor. So, naturally, I bought her book, Daring Greatly, and read it immediately. It turns out that the title of the book is based on the quote from Teddy Roosevelt who I wrote about a few months ago in Oncology Times (2018;40(7):16). “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Brown begins her book with this quote and then writes “The first time I read this quote I thought—this is vulnerability.”

Most of the book is about living a life “defined by courage, compassion, and connection.” Brown believes that the ability to be vulnerable is the catalyst to achieving this endeavor. She extensively discusses the power of shame—the fear of ridicule; she later defines shame as the fear of disconnection, and says that shame is the killer of innovation. She believes that vulnerability is the place where courage and fear meet. She discusses strategies to confront shame, including the concept of giving yourself a break if you have messed up.

What does this have to do with leadership of a cancer center? Well, many things apply to our work environment, given that work is mostly about relationships, and this a book about relationships. But two parts specifically apply to cancer centers. The first was about the challenge of employee disengagement.

Brown says, “when shame becomes a management style, engagement dies. When failure is not an option we can forget about learning, creativity, and innovation.”

This makes a lot of sense, and it echoes much of what has been written about Google and other companies that thrive on innovation. In an innovative culture, people need to feel empowered to speak up and to try new things, knowing that much of the time the new idea will fail. Failure is ok, and actually useful. The flip side is how destructive leading by fear can become. Not only does such a management style stifle innovation, it erodes relationships. When any relationship reaches the point of letting the connection go, of not caring, the relationship is lost.

Brown writes, “if I had to choose the form of betrayal that emerged most frequently from my research and that was the most dangerous in terms of corroding the trust connection, I would say disengagement.” She is talking about level 1 leadership (Oncology Times 2018;40(3):20-21). Ordering people to do something because you are the boss, and ridiculing them if they fail, are recipes for disengagement.

What is of interest is the potential power of vulnerability for leaders, as well as for relationships. Some of the best talks I have ever heard by leaders occur when they are open about their mistakes, when they admit that they do not have all the answers—when they are vulnerable (Oncology Times 2018;40(1):19-20). Being vulnerable as a leader can stimulate engagement and connection.

The other part of this book that relates to the field of oncology was a chapter about what we do to protect us from vulnerability, and the antidotes to these actions. Key to this is the emotion of joy. Does one fully embrace the euphoria of joy—relationships, health, whatever, or does one keep emotions flat?

At one point, Brown discusses a concept termed “foreboding joy.” Essentially, this is a shield we use to keep joy at bay—what we do to keep things, if they are going well, from being joyous. “Work is going well. Family is good. I feel great health-wise. No major crisis. Oh no! This is really bad. Disaster must be around the corner.” We have all done this to some degree. We do not want to get too high (to feel joy) because something bad might happen tomorrow. We oncologists experience this acutely, we always temper the optimism that a clean scan generates for a patient with words of caution. Brown notes that during her research, she found that people felt the most vulnerable when things were good. The issue is whether or not to embrace the good things, or to blunt them. We may be afraid that the feeling of joy won't last, or that the transition to disappointment will be too difficult.

And here is the key. Brown learned the most about this topic when she interviewed “those who had experienced profound losses, or survived the greatest traumas, including parents who lost children, and family members with terminally ill loved ones.” Sounds like the field of oncology to me. She makes three profound observations from interviewing such people:

  1. “Joy comes to us in moments—ordinary moments. We risk missing out on joy when we get too busy chasing down the extraordinary.... if I could hear my son giggling in the back yard again...if I could get one of my mom's silly tests on my phone...” These are the simple moments that people remember. The simple moments that generate joy.
  2. Be grateful for what you have. Celebrate it. Don't apologize for it.
  3. Don't squander joy. Brown writes, “We can't prepare for tragedy and loss. When we turn every opportunity to feel joy into a test drive for despair, we diminish our resilience. Every time we allow ourselves to lean into joy...the joy becomes part of what we are, and when bad things happen—we are stronger.”

For me, this encapsulates the field of oncology. We see tragedy all the time. People in our field are taught to temper joy, to remain even-keeled. Brown would argue that while what we do is really difficult, it should not be an excuse to disregard the good things in life. We all have our own moments with the people who matter the most to us. Celebrate those moments. You do not have to go on a fancy vacation to experience them because they happen all the time. Recognize them, and hold on to them.

Leadership is about a lot of things, including supporting those who you work with, operating with integrity, setting a vision, being authentic, and many more. Courage is an essential leadership trait as well. Vulnerability is one part of courage that for me, was not at all intuitive. But it makes sense. Going back to the title of the book—Daring Greatly—and the quote from Roosevelt, so much of leadership is being the person in the arena: struggling, failing, getting back up, getting beat up, but always striving to achieve something better—daring greatly. That person in the arena is a pretty good role model for all of us, especially those of us in leadership.

And, if you are the person in your own arena, and you achieve some success—celebrate it, give in to it, and enjoy your own special moment.

BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.

Brian J. Bolwell, MD, FACP

Brian J. Bolwell, MD, FACP

Straight Talk: Today's Cancer Centers

Wolters Kluwer Health, Inc. All rights reserved.
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