Pearls of Wisdom from ED Leaders

Emergency medicine has its own unique challenges involving leadership, people skills, time management, and setting boundaries in a job which has none. Each month, ED Management asks an ED leader to share some words of wisdom with our readers. This issue features Francis L. Counselman, MD, FACEP, Chairman and Program Director of the Department of Emergency Medicine at Eastern Virginia Medical School in Norfolk.

1. Always keep your two primary missions—outstanding patient care and excellent undergraduate and graduate medical education, foremost in your mind. When negotiating or making any major decision, the goal should always be to make an improvement or enhancement of your mission. Similarly, any decision detrimental to your primary mission is not in the best interest of you or your department.

2. Be accessible. Be available. Sir William Osler recognized this when he stated accessibility was the most important quality for any physician—even more than ability. The same holds true for the chairman. When in town, have an open door policy. When out of town, be sure your staff, residents, and faculty know they can reach you anytime, anywhere, to discuss their concerns.

3. Be lavish in your praise and sparing in your criticism. Give praise in public; constructive criticism should only be given in private.

4. Work shifts in the ED. Remember first and foremost, you are a physician. You cannot provide effective leadership if you do not practice your profession. You will never have credibility with your students, residents, or faculty if you don’t work in "the pit." Time spent working in the ED is time well-spent.

5. Set annual goals for both the department and yourself. You should try to make them challenging, yet realistic. Review these goals every few months; allow them to serve as a blueprint for where to focus your time and energy. At the end of the year, critically evaluate your successes and failures. Examine the failures closely, learn from them, and move on.

6. Don’t be afraid to pick up the phone and call another chairman for advice. Chances are, you will quickly find someone who has experienced the same or a similar problem. You do not need to reinvent the wheel for every problem; there are plenty of proven solutions out there.

7. Always be respectful and professional in your personal interactions. Whether it be with the janitor, a medical student, or the president of the university. Treat everyone with equal respect.

8. Be flexible in your thinking. The profession of medicine in general, and the specialty of emergency medicine in particular, demands it. The dogma of today may be dog meat tomorrow—remember the fate of calcium.