When asked to serve as an advisor or consultant for a company or enterprise, I’m likely to be interested if it's something I specialize in or am passionate about. I need to have a vested interest to be effective. Moreover, I take on such advisory roles with the intention of acting as if this were my business, my product or my disease. Unless directed otherwise, they are contracting me to be their Chief Executive Officer for a day. I’m not there to be politically correct, please the company executives or my peers, or take an easy passive role in this challenge. I’m there to make a difference.
The CEO role came up recently when I was talking to a patient about how she manages her condition.
She is a 50 year old woman who has had rheumatoid arthritis (RA) for nearly a year. This first year has been difficult for her. She explained that learning to cope with a new, hard to understand condition was hard enough. But then she had to deal with multiple doctors, often giving conflicting advice or instructions. She was struggling to understand why the hazards and side effects of these drugs weren’t more worrisome than her five swollen joints. She was being bombarded with information, often without explanation or insight: labs (not always in the normal range), doctor’s handouts, web info, patient testimonials, scary internet dialogue, and the earnest counsel of neighbors, friends, and family.
I listened and watched the frustration and consternation on her face. She was asking me to help her understand and manage this “mess”.
I told her she should consider new disease as a whole new business, and that like it or not, she is the CEO. She confessed she has never been a “business” person, only a school nurse and then a homemaker for the last 25 years. I explained she doesn’t need to run Apple or GM motors; she just needs to be in charge of this new business, rheumatoid arthritis.
Patients should act as if they are the CEO. Their business is the affliction that they must manage, deal with and have a plan for. The CEO needs to set goals to improve health and to achieve optimal long term outcomes (profits). The analogies of managing a business and a disease are numerous and instructive for patients and physicians alike.
A good CEO cannot run a business and achieve company goals all alone. A great CEO must be surrounded by others who help determine your success:
- Executives: this should be your rheumatologist and primary care physician. Not all physicians are suited to be your top management team and you only need a few executives to run this business.
- Investors and Consultants: these are people who you hire for specific periods and specific purposes. This includes physical therapists, a knee orthopedist, a nutritionist/dietician or trainer. They have very specific roles that you (and your executives) define for them.
- Personal assistant: Every CEO needs a close and trusted advisor and assistant who can intimately help you manage the day-to-day of your business. This can be a spouse, best friend or trusted neighbor, but must be someone who will advocate for you, stand by you, remind you, encourage you and even organize you to be a better CEO.
- Support personnel: your employees – full time or part-time. These can be family, friends, church congregation, etc. Recognize they are there to support you, not run your business or play the role of an investor, consultant or executive – you already have those skilled positions filled. Do not let the well-wishes, advice and offers of support personnel undermine the well thought-out, scientific, proven plans and operations established by your executives and key advisors.
Some of my patients wish for me to make all their decisions and some wish to be involved with the choices that need to be made. I often say to my patients (and myself) that they are in charge and they have hired me to give then the best advice that money can buy. When, and if, they feel I am not serving them well enough, I encourage them to either fire me or have a frank discussion regarding their expectations and my performance.
My advice to the new CEO patient:
- You are not the disease. The disease (your business) is something you manage. The novelist Anna Quindlen once said, “You cannot be really first-rate at your work if your work is all you are.” Hence you cannot excel at your disease if that is all you do.
- Being a better person makes you a better CEO. Be physically and mentally at your best.
- Do not view your new business (disease) as an affliction, but rather a challenge.
- You will not always be successful; hence, you need a strong plan that you can have faith in when there is a turn for the worse.
Many physicians view themselves as medical consultants (providing evidence-based recommendations) but also as a personal strategist, think tank source, rabbi or consigliere. Physicians ultimately learn how to negotiate the roles they play in the care of their patients. If more patients took on the CEO role, physicians would likely take a greater role in advising, educating, prognosticating and preventing for the good of the patient.
Patients need to be the CEO. If they truly cannot take on this role, they need a trusted friend to do this role along with them. Patients may make the mistake of not questioning something when they have uncertainties. A CEO would never do that. The CEO shouldn’t be afraid to wave her arms like Olympia Dukakis (in Moonstruck) and yell about my “life is going down the toilet” or whatever is most problematic. The physician can remind the patient the differences between a good CEO and a bad CEO.
- A good CEO uses strategy, technology, and available resources.
- A good CEO needs to ask the hard questions.
- A good CEO is optimistic, operates from hope and finds ways to “get it done”.
- A good CEO manages time and schedule.
- A good CEO has a plan how to run the business during successes and setbacks.
- A good CEO has a confident understanding of company finances (cost of care, access to drug).
- A bad CEO misses opportunities, doesn’t get or ask for help appropriately (from doctors, key advisors).
- A bad CEO is lacking necessary knowledge to do the job.
- A bad CEO comes to work unprepared, expects others to do the CEO’s job.
- A bad CEO doesn’t know who to hire and when to fire key personnel or investors.
I told my RA patient that being the CEO will empower you with a plan, the right advisors and team, allow you and others to advocate for you, and will enable you to be the expert of you.
Lastly, when presenting the CEO challenge of running this new business (RA), you have to acknowledge this role and this disease is not always going to be easy or convenient. Chronic diseases like RA are progressive, even though they may wax and wane. The short-term goals and the long-term vision and planning of a CEO are necessary to manage and succeed.
Jimmy Dugan (played by Tom Hanks in the movie League of Their Own) said, “…it’s supposed to be hard; if it wasn’t hard everyone would do it – the hard is what makes it great”.
The Instructive Analogies
- Disease = Business
- CEO = Her/She who manages the business (disease)
- Wellness = “Being in the black”
- Outcomes = Profits or Losses; Remission or Flares
- Control = Power or mastery over your business (disease)