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Bolwell, Brian J. MD, FACP

doi: 10.1097/01.COT.0000612744.50837.d1


I recently read a wonderful and profound article about values by Mark Manson. He has a highly irreverent writing style, and his bestselling book features a word beginning with the letter “F” that no one should use in a formal setting.

Manson says there are innumerable books about self-help and how to grow as a person and how to achieve success. The limitation of these texts is that they focus on the end goal, like growing, without focusing on values. There are many examples of tyrannical dictators throughout history who may have accomplished success on some level, but their actions led to horrific and catastrophic consequences. Success cannot just be about a superficial definition of personal achievement. Life is not just about growing as a person to become better; it must be about defining what a better person is. It's about defining your values, and possibly realigning them in a more positive direction.

Importantly, our behavior defines our true values. We might say we are a leader that embraces psychological safety, but if we bristle whenever we are questioned, then clearly we are not living our stated value. Actions don't lie. Many of us state values we wish we had instead of values we actually possess. We lie to ourselves. I can't stress it enough—how we behave (and not what we say) reflects our real values.

A corollary to this is self-love. Self-love is important on many levels, including developing resilience. But if our primary value is self-love, all you will do (because actions define our values) is chase one high after another. We therefore need to value something above ourselves. It can be a cause, or a moral code, or being an empathetic cancer physician. The point is to choose something positive and good because positive values add meaning and purpose to life.

Defining good versus bad values is not a linear exercise, but in general, good values are evidence-based and controllable. Bad values are emotion-based and uncontrollable. Manson says that most people, most of the time, make decisions via feelings and not based on knowledge. Given that our feelings are generally self-centered, this leads to decisions based on short-term goals, and decisions that can be warped. People that lead their lives based on goals fueled by emotion are on a never-ending quest for more. The way out is to stop living via one's emotions and find a purpose that is bigger than ourselves. It must be a real purpose that is rational and, ideally, inspiring. Honesty, vulnerability, and humility are good values. Wanting to feel good all the time is not.

Manson closes his article by discussing steps necessary to change and evolve one's values. Step one requires that the old value fails followed by self-awareness about this failure. From failure and awareness, you form new values and hopefully live them.

I have re-read this essay many times. Basically, this is an introduction to servant leadership. Most of the literature about servant leadership is about values. Honesty, courage, transparency. It's all good. Why then do relatively few leaders live good values consistently? Why are there so few servant leaders? Why are so many people, especially in academic medicine, consumed with values that are emotion-based? As I've previously written, I think it is because they are rewarded for individual-focused, emotion-based values. From podium presentations to grants or notoriety and fame, the individual academic medicine goal is about an individual. The reward system for academic superstars fuels values that are emotion-based. And, as stated above, the superstars chase one high after another. It explains, at least in part, why so many stars have such a hard time focusing on the team instead of themselves.

If you want to get better, if you want to change, you must change what you do (see Change, Oncology Times 40(11):16-17). Well, Manson's essay says the same thing about values. We all live our values. What we do is what we really are. It's not what we say we are. Therefore, if you want to adopt more positive values, you must change what you do. Your actions must change. The problem is that it is very hard for people to change their actions, so, as a result, even with insight, relatively few people take the step to change. But it can be done.

If you feel like you are on a Sisyphean climb chasing after your own personal goals, consider a pause for self-reflection. Think about values that really matter. Contemplate if you are really living those vales. If not, try to have the courage and vulnerability to change your behavior. If you can truly change and live positive values, it not only feels good, it can be liberating. Living more positive values may not lead to more personal success. It may not be noticed by many. But at the end of the day, it will feel good. And I think that one positive step that represents change towards more positive values will only lead to more steps. You will not need the validation of others for your identity or sense of purpose. The liberation is that how you act is totally up to you, and if you are willing, you can act in wonderful ways that go far beyond you.

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

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